If you're reading this column, the chances are that you read other local publications, and are well aware of the issue regarding a new hospital in Fort Mill. There is an ongoing struggle to determine which of several entities will prevail and "win" the right to construct this new facility. Now, I'm not going to tell you in this space who I think should build this new hospital, though if you call I'll be happy to share my views. But I will say that I am a strong advocate of the concept of competition. Competition keeps people on their toes, honest, and fair. If this is not the way you do business, someone else will and should clean your plate. And after all, do you want one grocery store in this county? Or one restaurant? Or one gas station? Just how do you spell "monopoly"?

But that's not the real topic today. I want us to consider this issue of the contest to see who builds this new hospital. It all hinges upon who is awarded the "certificate of need" (CON). This is an arbitrary proceeding that attempts to consider the "need" for medical facilities in a certain geographic area. If the planned cost of a facility exceeds a certain threshold amount, a CON must be applied for and granted. Twenty five states have such laws (including South Carolina and North Carolina), while the other states do not (California, Ohio, and Georgia for example). Over the past decade or so, an increasing number of states have been moving to strike such laws.

Let's think about this for a minute. Imagine that a fast-food restaurant opened on a busy corner and was immediately successful. Another franchise decided that this was a good intersection, and decided to open a competing restaurant across the street. Good old-fashioned competition. But what if the first restaurant could invoke some piece of legislation that blocked the competitor from getting off the ground? "We don't need any more hamburgers on this side of town." Or imagine the same thing with a grocery store? And how do you think a group of attorneys would respond if they were told that they couldn't open an office in York County because we have enough barristers?

So why is the healthcare sector the only one that is impacted by such laws? That's a good question. The standard response is that if you don't control the amount of medical services in an area, the cost of care will increase. Excuse me? More options for the consumer means that the cost of those options goes up? Doesn't happen anywhere else. And it doesn't happen with medical care. Just the opposite. A recent example is that of CT and MR imaging. Several companies now provide these services in this area, and the cost of these scans has steadily gone down, now being less than half of what they initially cost in our local hospital.

Just so you know how this inequitable process effects you and your family, consider the following: A local group of investors decides that this county needs a free- standing outpatient surgical center. Same-day surgery, performed by local physicians in an attractive, easily accessible facility near the intersection of I-77 and Celanese Bypass. They commit to excellent medical care, competitive prices, and to provision of a reasonable amount of free care for truly indigent patients. Because the facility will be located in South Carolina, the group files for a CON. The way the process works, interested parties have the right to object to the granting of such a certificate. Who do you think will be the first to weigh in? If you guessed the administration of the local hospital and their attorneys, you would be right. And they would fight it tooth and nail. And they would probably defeat the project. It's happened before. A long, drawn-out legal battle costs a lot of money, and most people just give up. It doesn't matter that the facility is actually needed, and that the people of this county desperately want an alternative. Nope, it all has to do with protecting your turf, preventing competition. Restaurants can't do it. Grocery stores can't do it. But for some reason, the heavyweights in the healthcare arena are able to do so. And it has absolutely nothing to do with what's best for the people in this area.

With regards to the issue of a hospital being built in Fort Mill, lest you have any questions of purity of motives, consider the following. The word on the street and in doctors' lounges is that should the local hospital not be awarded the "certificate of need", the building of this facility will be delayed for five or six years, entangled in red tape and other legal maneuverings. Should that occur, whose interests are being championed here? And what has happened to the imperative to provide these needed services to the people of this part of the county? It becomes a little clearer, doesn't it?

So, when you read that a medical development will require a "certificate of need", just remember that the CON might just as reasonably stand for "control of the neighborhood". Maybe it's time for South Carolina to join those other twenty-five states.