Health care meets Kafka

State regulators are suggesting that eastern and northern Maine should not be allowed to invest in technological advancements in medicine. Welcome to the certificate of need.

For most of us in our profit and nonprofit business worlds, we make a decision about an investment based on whether there is a demand for the service and whether consumers will pay. This is true for Husson College, General Electric, a counseling service or a gas station. Now, enter the Kafkaesque health world of something called certificate of need, a process by which someone else, somewhere else, somehow knows what we really need and are willing to pay for even though it is not what we think we want.

Which raises up the cautionary tale of a positron emission tomography scanner, to us lay people better known as a PET scanner. It is to the MRI what arthroscopic surgery is to old-fashioned knee surgery. It allows physicians to diagnose such health problems as breast cancer and brain disorders without using physically intrusive procedures. St. Joseph Hospital and Eastern Maine Medical Center support PET scanners and state health people refer to them as a “phenomenal technology.”

There is only one thing; even though one of our hospitals is willing to buy it and take the risk that people will volunteer to use it and pay for it, someone, somewhere else is suggesting that the people east of the Kennebec River should only be served by mobile PET units out of Portland and Portsmouth. This is not the “invisible hand” Adam Smith was talking about when he wrote “The Wealth of Nations.” This is the invisible hand of excessive state bureaucracy run-a-muck.

The certificate-of-need process is a policy that allows regulatory boards to decide which hospitals are allowed to invest and what they are allowed to buy, be it bricks, beds, or “best practice” technology. The process is bureaucratic, unresponsive, bias towards urbanized southern Maine. It undermines local decision-making, increases regulatory delay, and shifts decision making away from institutions and consumers who are held accountable and into the hands of appointed state staffers. It promotes barriers to entry and constraints on trade. This is the process that long opposed Lewiston when it wanted a cardiac surgery unit, which pits EMMC and St. Joseph Hospital against each other.

I seriously wonder if Bangor would ever be allowed a Mayo Clinic under our current certificate-of-need regulations.

Take the PET scanner. Clearly there is a need north of Portland. There are hospitals willing to invest and patients willing to pay. All this is seemingly overlooked in the CON process, which instead focuses on a lagging Medicare reimbursement policy that has little to do with the merits of the case.

CON staffers note that the proposed PET unit does not include a cyclotron unit, a special add-on component that would allow it to benefit the composite wood project at UMaine and other regional research. In short, the applicant is simply damned if it does and damned if it doesn’t. First, it is told the PET scanner is too expensive and, then, that it’s not expensive enough.

Why should we care? The obvious reason is that the Maine’s CON process is relegating health care in northern and eastern Maine to second-class status. In so doing, it is driving health care ownership south to Portland and beyond. We already have corporate ownership moving away from northern and eastern Maine. We are watching the state shift Maine Public Broadcasting out of Bangor and university budgets out of Orono. Among the few major, locally owned large businesses left in our region are our hospitals. Love them or hate them, at least they are ours and our well-being is inexorably tied to theirs.

Consider that Bangor is about the same size as Rochester, Minn. What we have that Rochester does not have is The Jackson Laboratory, Husson College, General Electric, the University of Maine, and so much more. But what Rochester has is the Mayo Clinic.

I wonder if Bangor would ever be allowed a Mayo Clinic under our certificate-of-need regulations. To be sure, we should not fault the CON staff. It’s just that their assigned role is to serve as health-regulator Luddhites in today’s consumer-centered, market-driven health care world. Let us then hope that the sunset is fast upon the CON process and, in the gathering darkness, they can quietly slip away in the night.

Dr. William H. Beardsley is president of Husson College and served on the Governor’s Blue Ribbon Commission on Health.