Ordinarily, if you want to start a new business or offer a new service there is a simple test to find out whether your new business is needed: You open the doors and tell the world. If people need your business, you will have customers. If they don’t, you won’t. That experience—of learning what people need and how new types of services can fit in—is familiar to anyone who has ever been an entrepreneur. Indeed, it is familiar to anyone who has ever been a customer.
It is also an experience that the state of Virginia turns entirely on its head for people who want to offer new healthcare services. If you want to offer new healthcare services, even something as routine as opening a private clinic, you have to obtain special permission from the state government. And permission is not easy to come by: Would-be service providers have to persuade state officials that their new service is “necessary”—and they have to do so in a process that verges on full-blown litigation in which existing businesses (their would-be competitors) are allowed to oppose them. Not surprisingly, this process can be incredibly expensive, and it frequently results in new services being forbidden to operate at all.
To be clear, this requirement (called a certificate-of-need or CON program) has nothing to do with public health or safety. Separate state and federal laws govern who is allowed to practice medicine and what kind of medical procedures are or are not permitted. Virginia’s CON program only regulates whether someone is allowed to open a new office or purchase new equipment; it is explicitly designed to make sure new services are not allowed to take customers away from established healthcare services.
In short, Virginia’s CON program is nothing but a government permission slip to compete. It ensures that more money flows into the pockets of established, politically connected businesses, and it accomplishes this by trampling entrepreneurs’ economic liberty and reducing Virginians’ choices for medical care.
But patients and doctors—not state officials—are in the best position to decide what healthcare services are needed. That is why Colon Health Centers of America, headed by Dr. Mark Baumel, MD, and Washington Imaging Associates Maryland, LLC, headed by Dr. Mark Monteferrante, MD, have joined forces with the Institute for Justice to challenge Virginia’s protectionist CON program. Theprotects individuals’ right to earn an honest living free from unreasonable government interference, and it prevents states from putting up unnecessary barriers to interstate commerce. The Virginia CON program does both, and that is why the federal courts should strike it down.
Prof. Mark LeBar considers what kind of social or political ideal we ought to have, with a specific focus on equality. There are numerous types of equality, and philosophers tend to be concerned with what LeBar refers to as normative equality, which is concerned with how we as individuals ought to treat others.
Within the realm of normative equality, LeBar discusses four plausibly defensible candidates:
• Equality of welfare
• Equality of resources
• Equality of opportunity
• Equality of luck
After reviewing each item, he finds some common problems:
• Incompatibility: If, for instance, equality of welfare is pursued, it renders the other types of equality impossible.
• Measurement: What does it mean to have equal opportunity? How do you compare my opportunities to your opportunities?
• Subjectivity and vagueness: What is welfare? Is a scholarship to a dance school as valuable as a scholarship to law school?
• Production: The theories above deal with the provision of goods but ignore the production of goods. In almost all cases, however, altering the provision of goods affects the production of goods.
Despite some of the issues with normative equality, LeBar still thinks that equality is an important human ideal. Specifically, he thinks that moral equality, looking at the equality of relations with one another, is important.
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