DECISION TO SUPPORT CATH LAB WAS BASED ON MANY FACTORS

After a great deal of listening, reading, soul-searching and fact-gathering, I decided to support the application of St. Francis Medical Center for a second cardiac catheterization laboratory at Wednesday's meeting of the Missouri Health Facilities Review Committee. This wasn't a decision to which I came lightly. In my brief time in public life, it is one of the toughest decisions I have had to make. People whose opinions I respect among the highest of anyone I know counseled me to oppose the application. I respect them and their viewpoints, weighed their arguments carefully and hope they will continue to accord me the same consideration.

My task as a committee member, however, wasn't merely to listen to one side, still less to be swayed by emotions or prejudice for or against either of Cape Girardeau's excellent medical centers, but to listen to all sides, carefully weigh all the facts and come to my own conclusion. This I tried honestly and sincerely to do.

Two heart programs. I have been told by opponents that Cape Girardeau is something of a national joke in that we are a town of 35,000 people with two heart surgery programs. In fact, one physician for whom I have enormous respect told me that while attending a medical meeting in a distant city, he introduced himself to one of the nation's leading consultants on cardiological procedures, and the fellow responded with a chuckle: "Oh yes. I know all about Cape Girardeau. You're the small town with two heart programs."

Toothpaste is out of the tube. What wasn't immediately clear to me was what conclusion should be drawn, in September 1994, from this fact. Perhaps -- I hasten to add that I wasn't on the committee in 1990, possess no special expertise and haven't reviewed all the facts and arguments on both sides -- just perhaps I would have voted against Cape Girardeau's having a second heart surgery program. But it is crucial to emphasize that this wasn't the question before us for decision. If it were, in fact, a mistake for Cape Girardeau to have been granted two heart programs, that decision is four and a half years in the past. I had to deal in the backwash of that decision with no opportunity to go back or even review it -- much less change it. At the risk of mixing metaphors, I was being asked "to put the toothpaste back in the tube" by exercising a measure of alleged cost control that would deny to St. Francis state-of-the-art facilities the need for which is testified to by at least four cardiologists. This I declined to do.

Antitrust issues. Federal anti-trust issues are said by some to be, and by others not to be, controlling. After looking into the matter I was persuaded that they couldn't be ignored. In any case, there is literally nothing I, as a state official, can do about federal antitrust law. Perhaps it should be changed. Most people in and around Cape Girardeau would like to see increased collaboration between the hospitals. I am told the prevailing rule applied by the feds is that if a combination of hospitals would result in the one new facility's having more than 45 percent of the market, the feds wouldn't permit it to occur. The combination of Cape's two hospitals would control roughly 80 percent of the market. As long as federal antitrust law places a stop sign on this road, therefore, some measure of competition will obtain. In such a circumstance, I believed it best to allow each facility to acquire state-of-the-art equipment and go about their business.

Southeast not opposed. I find interesting the fact that Southeast Missouri Hospital didn't oppose the St. Francis application. Among those who urged me to oppose this application were some few who remind me of the boy in the schoolyard who said to two chums, "I tell you what: Let's you and him fight."

Lessons from other communities. The experience of other communities was at least partially instructive. Joplin, Missouri is close to Cape Girardeau in size and, like us, has two hospitals. Until recently Joplin had four cardiac cath labs, and -- at our July meeting -- was granted a fifth. If Joplin can have five labs, and no controversy, why can't we have four?

No debt. St. Francis is incurring no debt to build and equip the new lab. The entire $1.7 million cost will be financed out of cash reserves. This has to gladden the hearts of the thrifty people of Cape Girardeau and surrounding territory. To me, this took some of the starch out of the argument, advanced by the Southeast Missouri Business Group on Health, that a second lab at St. Francis necessarily meant an increase in local health care costs. Perhaps I am wrong, but it at least seems fair to make that assumption.

Public hearing. Our committee held a well-attended public hearing Aug. 9. Testimony was nearly evenly split between proponents (nine in number) and opponents (eight). Both sides marshaled the facts and made persuasive cases. I have been lobbied publicly and privately, and at all times these efforts at persuasion proceeded in an honest and forthright manner. I am keenly aware and accept the fact that I would be criticized no matter what decision I made.

Abolish the committee. Finally, I feel constrained to announce my support for the immediate abolition of the committee on which I sit. Frankly, decisions such as this one place me, or anyone else similarly situated, in an impossible situation. Occasionally -- not always, but occasionally (and not necessarily in the current instance) -- raw political power determines the outcome. This isn't the way such decisions should be made.

Fallacy of central planning. The Missouri Health Facilities Review Committee is essentially an exercise in grand central planning, second-guessing the decisions of the marketplace. As such it suffers from what Friedrich Hayek, the late, great Nobel prize economist and philosopher of freedom, called the "fatal conceit" of socialism and of central planners everywhere. By "fatal conceit," Professor Hayek meant the notion to which central planners everywhere cling: that by virtue of superior knowledge or special expertise, they know and can command economic affairs better than the marketplace can.

Limit politicians' power. For a host of reasons, I am self-consciously interested in limiting the power of politicians such as myself to make these decisions. I passionately believe that we don't know better.

Eschewing any faith in the superiority of central planning, I would leave to the market the making of such decisions. A solution to problems caused by excessive government involvement won't be found in more government. I would abolish my committee, dismiss its staff, free our legal counsel for other work and save the money we spend chasing our tail. The difference between central planning bureaucrats and me is that they believe government works well in this task, while I operate under no such illusion.

Peter Kinder is associate publisher of the Southeast Missourian and a state senator from Cape Girardeau.