The proposed lineup of for-profit “specialty” hospitals along the Massachusetts border in New Hampshire, like the existing state stores that offer cheaper alcohol and cigarettes, is an extension of New Hampshire’s longstanding efforts to serve the Massachusetts market with lower-taxed and less-regulated products and services. In most cases, Massachusetts consumers and New Hampshire businesses have benefited, while Massachusetts officials have stewed in their Boston offices, realizing that there is little they can do to stop it.
Indeed, the responsibility for this latest proposal rests chiefly with the government of New Hampshire, and it would do well to recognize that hospitals are not retailers. While greater competition to provide basic health care services is needed to drive down prices, government still bears a responsibility for maintaining standards of quality care. This is especially true when the services being competed for aren’t X-rays and MRIs, but treatment of deadly diseases. In such situations, it would be truly unconscionable if patients responded to slick advertising claims and ended up measurably worse off than if they had stuck with existing hospitals.
That’s why it’s alarming that the New Hampshire House of Representatives has moved to short-circuit the “certificate of need” process that vets any new hospital, in order to provide a smoother path for these for-profit clinics. In addition, the House has asked the federal government to exempt such institutions from Medicaid taxes, on the grounds that for-profit institutions already must pay business and property taxes. It’s an unimpressive argument. Medicaid taxes help the federal government cover care for the poor. Business and property taxes, which go to federal, state, and local governments, are part of the overall business plan for any for-profit institution. If they aren’t prepared to pay all the applicable taxes, they can set up as a nonprofit.
Still, an exemption might be justified if policymakers seriously believed these hospitals would drive down health costs. But few are even making that claim. In fact, the first proposed hospital, an outlet of the national chain Cancer Treatment Centers of America, bases its advertising on the idea that it can tackle “advanced and complex cancers” that other hospitals, presumably, have given up on. (Testimonials in the ads from healthy, vigorous patients allude to the idea that other doctors were pessimistic, to say the least.)
Whether this particular type of competition drives down costs or drives them up — by offering last-ditch hopes to people who’ve been discouraged from getting further treatment — is an open question. Studies repeatedly show that terminally ill patients do not suffer from a lack of treatment. In fact, they’re overtreated, often causing unnecessary pain and suffering, because doctors are reluctant to level with them about their true condition. If they and their families had known the full prognosis, they might have opted for palliative care, and been far healthier in their last months and years.
Government still bears a responsibility for maintaining standards of quality care.
Nonetheless, Cancer Treatment Centers of America has a 30-year track record in other states, and responsible regulators should be able to determine whether it can deliver on its promises, and if it would provide a worthwhile alternative to existing options for local patients. But rather than embrace this process, New Hampshire legislators — some of whom were treated to a free trip to Cancer Treatment Centers of America’s outlet in Philadelphia — are seeking to upend it. There may well be a place for specialty hospitals along the Massachusetts border, but New Hampshire owes a burden of due diligence to patients in both states, and beyond.