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Carolina Journal Radio No. 771: Fatal attack helps expose problems in N.C. prisons

Carolina Journal Radio / Donna Martinez and Mitch Kokai
The Truth Network Radio
February 26, 2018 12:00 am

Carolina Journal Radio No. 771: Fatal attack helps expose problems in N.C. prisons

Carolina Journal Radio / Donna Martinez and Mitch Kokai

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February 26, 2018 12:00 am

Problems have been festering for years at North Carolina’s state prisons. A fatal 2017 attack on officers at a Pasquotank County prison helped push the issue into the headlines. The latest Carolina Journal cover story focuses on the issue. Associate Editor Kari Travis discusses key findings from her investigation. Two recent federal law enforcement investigations have focused on the major protagonists in the 2016 presidential election. Andrew McCarthy, senior fellow at the National Review Institute and a former federal prosecutor, says the two investigations present a major contrast. While the investigation linked to Donald Trump has been aggressive, the one involving Hillary Clinton amounted to “kid-glove” treatment. McCarthy explains why this contrast presents problems for federal law enforcement and our system of government. State lawmakers continue to debate the best way to select judges in North Carolina. You’ll hear highlights from a recent N.C. Senate proposal that would replace judicial elections with an appointment process involving the state Supreme Court chief justice, the General Assembly, and the governor. As N.C. lawmakers consider potential changes to the state’s public school funding formula, some of them want to ensure that local school systems get as much flexibility as possible. Rep. Hugh Blackwell, R-Burke, made that point during a meeting of the legislative task force exploring school funding. You’ll hear Blackwell’s comments and reaction from Terry Stoops, John Locke Foundation vice president for research and director of education studies. Hospital mergers have generated headlines in recent weeks. UNC Health Care and the former Carolinas HealthCare System, now known as Atrium, are pursuing a partnership that has raised red flags for some observers. Atrium is also pursuing a merger with a Georgia hospital system. Katherine Restrepo, John Locke Foundation director of health care policy, discusses pros and cons of hospital mergers. Restrepo focuses on the potential impact for health care consumers in North Carolina.

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From Cherokee to current attack from the largest city to the smallest and from the statehouse into the schoolhouse Carolina Journal radio your weekly news magazine discussing North Carolina's most public policy events and issues welcome to Carolina Journal radio why Muskoka during the next hour, Donna Martines and I will explore some major issues affecting our state. During a recent visit to Charlotte, a former high profile federal prosecutor raised questions about the contrasting federal investigations involving Hillary Clinton and Donald Trump will hear his concerns. State lawmakers are considering changing the way North Carolina selects its judges to learn details of one of their proposals. A task force studying school funding in North Carolina might focus on increased flexibility for local school systems to hear reaction from the John Locke foundation's top education expert will discuss recent high-profile discussions about hospital mergers in the Tar Heel state will consumers benefit if these mergers go forward.

Those topics are just ahead. First, Donna Martinez joins us with the Carolina Journal headline they were horrific tragedies the deaths of North Carolina corrections officers public servants who died at the hands of prison inmates. Their deaths in the continuing challenge to staff North Carolina prisons shine the light on a system with very serious needs. In fact, it is the cover story of the February issue of Carolina Journal Carrie Travis is associate editor of Carolina Journal and she is the reporter is bringing us this story. Gary welcome back to the program. Following that the killings of these corrections officers in Bertie County passed to take County and the scrutiny really came fast and furious. Take the story from their so the Department of Public Safety was already reviewing operations at its present secretary hooks had already requested that people look at how the budget was being spent across the board, how prisons were being managed and then he kind of got handed this this huge set of tragedies during his first year and from there he commissioned a couple of additional studies, one from the national Institute for corrections which looked at the Pasquotank incident and everything that happened there, one from the Gov.'s crime commission and Duke University researchers and his goal was not only to identify the specific ease of what happened at Pasquotank but also to look at what was wrong in the prison system in general because, as you mentioned, we had the Bertie incident was also very tragic. Sgt. Megan Callahan was beaten to death with fire extinguishers, extinguisher and so what all these reports brought in was an awareness that we have had these problems for years and were just kind of having a media wake-up call.

What should we do about it before we get into the specifics of what those studies found and what the legislature is starting to to look at.

Give us a sense of the type of money were talking here for North Carolina prison system and in the number of inmates were talking about. So the overall budget for the Department of Public Safety is about $2 million of that 2 billion, about 1.2 billion is spent on presents just under a million or excuse me, just under a billion goes to salaries to benefits. Basically all of those you compensations for officers for staffers that type of thing we have about 37,000 inmates in our prison system.

We have 55 prisons.

About 37,000 inmates and many of those inmates.

We don't have an exact number have mental health issues which, as you alluded to earlier is one of the many issues that were struggling to solve right now. Indeed, there so many different angles to this story. Let's start first with with the challenge that state officials have to even recruit people into North Carolina's prisons corrections officers you mentioned money going to salaries.

Some people say to salary problem you have to pay people more other people say this is simply job that a whole lot of people to want to take because frankly it's not glamorous and it could be dangerous and the fact is, both are true. It is not glamorous and were looking at many prisons that are in rural areas.

Many high-security prisons that are in rural areas.

We have situations where officers corrections officer staffers are traveling an average of an hour a day just to get to and from work. Sometimes more.

Would you work for $35,000 as your top number in an institution where your on the road for an hour and 1/2 a day and you don't know if you can come home and see her family again and those are the types of challenges that that were dealing with in terms of recruiting. The numbers are compelling. We had a 16% understaffing in prisons last year, up from 9% the previous year, and I know carried in some of your reporting. There even been instances because of this difficulty in hiring people where you have people who have accepted the job and they are on the job and they still haven't had some of their basic training I was at a Gary that's here for them. It's scary for the inmates. It's scary for those of us who are paying for all absolutely and you have to wonder I'm the number that was turn out secretary hooks presenting the legislature a committee at the legislature a few weeks ago said that there were as many as 700 officers who were on the job four months last year without their basic training, which is roughly a three week program and so what they had to do is go back identify all of the officers that hadn't received basic training and then make time over the course of very few months to make sure that they had all the information that they needed you have instances like the one in Pasquotank where the understaffing is so poor. One officer was assigned to oversee about 30 inmates in a sewing plant where they had access to scissors sharp objects and then you see what happened there.

The horrific tragedy for officers killed and so you do you have this problem of understaffing, lack of training. This sense of him coordinated efforts. I think I think the department of public safety is at a point where they very much want to make changes. Question is how do we do that efficiently.

How do we do that safely and even water.

The extent of the problems of the worst issues to address first carry in your reporting again. It's the cover story of the February issue of Carolina Journal, you talk about problems on almost the other side of the house, so to speak in the prison system that involves the inmates themselves a lot of mental health issues.

A lot of drug addiction.


So what we do about that.

That's a great question is a great question Donna and I think that's one of the things people are struggling with right now. Legislators trying to look at that and come up with some sort of solution comes back to money. You know you have you have the largest percentage of de facto mental health providers are in the prison system, but you don't have enough to care for prisoners and there aren't enough social workers either. I spoke with some folks over at NC disability rights and they told me that caseworkers to care for mental health. You prisoners with mental health issues are overloaded.

They don't have time doctors are scarce and there was a incident.

We talked about in the front page story of a prisoner who was locked in solitary confinement for weeks without his medication. His water turned off you. This is a schizophrenic veteran of the United States Army. We have these issues. How do we provide mental health care. How do we find the money in the budget to take care of this issue and where do we put those programs in place. The other thing it's fascinating about this whole story. Carry is that it seems to have gotten the attention across the political and ideological spectrum. You have talked with folks at the ACLU you've talked with folks who are very conservative who would normally align with the ACLU on an issue, but does that mean that there really is more momentum to try to sit down and hammer it. Hammer out what is clearly really really challenging stuff. Yes, absolutely.

The trump administration took up a roundtable discussion about this a just a little over a month ago. I think it was gathered.members of all political factions and viewpoints in one room and the general consensus is that we need more rehabilitation for prisoners losing your freedom as punishment is the task of prisons to retrain and basically turn into productive citizens.

These members of society that have fallen out of step.

And that's what were facing. I think there's bipartisan support across the board for that. We been talking with Carrie Travis. She is associate editor of Carolina and Carrie has written a really comprehensive great piece. It's the cover story of the February issue of Carolina Journal carry treaties thank you very much for joining us. Thank you.stay with us much more Carolina Journal radio to come in just a moment government plays a key role in your life affecting your paycheck the way you educate your kids the way you do business. How can you tell if government is doing a good job making the right choices. Spending tax dollars wisely. Carolina tackles those questions every day.

The John Locke foundation publishes Carolina Journal imprint each month and on the web each day at Carolina. you'll find exclusive investigative reports on topics. No one else is covering what else a rundown of the best new stories, editorials and opinion columns in North Carolina. John Hood's daily Journal news stories and important public and the voices of the newsmakers themselves at Carolina Journal radio imprint on the air and on the web. You can find the information you welcome back to Carolina Journal radio why Michiko guy.

It's a tale of two federal investigations involve the most recent Democratic and Republican candidates for president, Andrew McCarthy of national review is a former federal prosecutor. He says the cases have been handled very differently. He explained held during a recent speech in Charlotte for a joint John Locke foundation review audience joins us now with more details how these cases differed were seeing two different situations inescapably because one of them was a very public criminal investigation, even though it involved classified information and emails. It was essentially a criminal investigation. So it was handle in a different way, whereas the current investigation that's being looked out involving president trump, and Russia is a counterintelligence investigation that has a criminal aspect to it. So, the nature of the investigations was different and in that way, they were unavoidably different, but I think objectively, any person who looks at the way these two things were handled has to say that Mrs. Clinton got the kid gloves treatment the molar investigation and its predecessor Russian investigation there sort of scorching the earth to make the case to people without a law enforcement background know about the differences. The easiest thing for people to lay there was on in and see is that in the molar investigation.

What we see is that when you light of the FBI. You actually get prosecuted, which is the way it works in 99.9% of cases that don't involve coins in the Clinton investigation. If you lied to the FBI. It was like Thursday no basically what they did was whenever anybody got close to providing incriminating information you gave him immunity with a cut a deal with them, they prevented the agents from asking the obvious questions. I think the whole thing. The more we look at it appears to be a situation where what they essentially did was try to stage something that looked like a thoroughgoing investigation at the end of the rainbow, of which one she was going to be exonerated with was politically very important. Why should this concern us well because we want everybody to have the same standard of justice, the rule of law and the reason that we can have ordered liberty in the societies because we believe that the results will come in the criminal justice system have integrity and the reason we think they have integrity is because everybody gets treated the same.

Every person, whether he is the president or the lowliest person is supposed to be equal not only before the bar of justice but also how they are regarded by the federal and the and the other policeman intelligence agencies in one. When we see that you know if your one particular striper person. You get one quality of justice and that everybody else gets a quite different quality of justice. I think that's very alarming to the trip were chatting with former federal prosecutor Andrew McCarthy right now for national review has the molar investigation proceeded as you would expect, or think there's a lot of noise around that investigation and it's to someone like me it's more important to you.

Tell me what he's done. Show me the charges and so forth a people can take confident that the confidence that even if the investigation has been very aggressive and even though he's he's got no stable people, which I think is far beyond what you would think one would need to do the investigation is doing. Look at the charges he's brought there. The role justifiable in them except I don't think that can be said about the first investigation, where there appears to have been a mountain of evidence and that they basically contorted themselves to avoid bringing charges, including not prosecuting people who clearly lied to the government giving immunity to people who should have been squeezed for cooperation and contorting criminal statutes really distorting them to avoid applying them as their written to people like Mrs. Clinton, who seem to culpability on federal law enforcement agencies under such scrutiny is there an opportunity to make positive changes. We have to look at it and the main reason we have to work out it not just for the public reputation of how or federal law enforcement agencies conduct themselves, but there's a real strong national security angle to this and good national security intelligence collection and enforcement is really reliant on the idea that the public can trust the agencies because so much of it is in this black box of classified information and so much of it really is about a need to protect sources of information and methods of gathering intelligence that in many ways they really have to tell you of trust us and we have to be able to trust them because they're not just out there trying to make cases directly out there trying to protect the country from people who were trying to do harm to American so it's important that we have some transparency and it's important that we get our agencies to a point where most Americans when they say trust us. They think there were stress how important is it to fix whatever problems exist within these agencies is extraordinarily important because you know we people don't think maybe have a historical enough perspective of this. I'm an older guy now than I was when I started as a prosecutor many years ago, so I still remember what crime was like in this country in the 60s and 70s when I was growing up. I think a lot of people don't have that historical perspective anymore, so we've had a generation of record low crime and I think when you when you assume that is your everyday reality. You forget how hard it was to get to that point how we had to go from high crime to what we have now and really that was on the basis of number one superb performance by our law enforcement and to some extent our intelligence agencies but also our ability to trust them that they were doing what we need them to do and we can't as you see the prosperity that we have in the country. We had record prosperity at the same time, we had record low crime they go hand-in-hand. So when the enforcement piece of it breaks down you have to worry about the prosperity piece of the breaking extraordinarily important what should people be watching for course the most important thing on the enforcement side and was with respect to special counsel.

Molar is what. Let's see what charges we see. I think that they've now been investigating the Russian collusion angle of this for about two years and from everything we can tell, at least publicly. In this been a lot of leaking so we know a lot more probably than we should. It sure looks to me like whatever they may have in terms of the troubling stuff about Pres. Trumper's campaign certainly doesn't rise to the level of a conspiracy to commit espionage or some other actionable offense and I think because of the importance of war or the detriment to the country of the situation where the president tries to govern with a cloud over his head. I think at the very least, if the if that's a dry hole. If they don't have a collusion case to come out and say we don't have a collusion case that doesn't preclude them from continuing to look at obstruction. I personally don't think legally what we have here comes close to obstruction, but I could be wrong right so there's no reason why that that thread can be continued. But you know this whole idea of having a president for over year govern with the suggestion out there that he was involved in a sinister corrupt conspiracy with an adversary regime you know if that cloud can be lifted it all to be lifted. It's better for the good stuff.

The president trumpets better for the country.

That's Andrew McCarthy national review of former federal prosecutor discussing Clinton, Pres. Trumper, and federal investigations overture for Carolina drone radio with a moment if you love freedom we got great news to share with you now.

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Support the John Locke foundation. Welcome back Carolina journal Radio One coca state lawmakers are considering possible changes in the way North Carolina selects judges judges are elected now but there's been talk about changing to a merit selection process. Republican Sen. Paul Newton explains why we are all looking for the best plan we've heard a lot of ideas a lot of approaches to selecting Heico highly qualified judges and the purposes let's find the best model for North Carolina so this is a balance between independence and accountability independence for those who haven't been steeped in these issues means making sure our judges are independent from undue influence from executive, legislative branches, and arguably frequent campaigning and donor so we need to make sure our judges have independence to rule the way they see fit. Independence is not equal to illegitimacy, which could occur if the pendulum were buried on independence instead of being balanced with accountability. Accountability at at bottom, is to the citizens of North Carolina to interpret laws as intended by the Constitution, so we need to make sure there is some level of accountability for judges all the while ensuring their independence along the way but accountability like independence can't be so extreme that it impinges on that independence. Newton and his colleagues have outlined a plan that would help the state Supreme Court Chief Justice set up a new seven or nine member group. It would screen potential judges and label them qualified or unqualified. You'll see transparency there be no ministries. It will be a back room smoke-filled room is going to be a transparent independent merit selection process Gen. assembly will reviewed qualified nominees submitted by the independent merit selection committee and forward at least three of those nominees that they consider best qualified to the governor. The governor, he or she will review those qualified nominees submitted by the Gen. assembly and appoint the nominee that he or she considers the most qualified to serve the state what questions remain unresolved questions about the screening group questions about the term of office.

Questions about retention elections. Sen. Bill Rabe in response to the questions group in your recommendation on everyone else's recommendations, not the recipe guidelines like recommendations from other members of the committee and how to improve step for step three step through here would scrap go to bed listening to discussion of a plan to change the way North Carolina selects its judges. Any change would require a state constitutional amendment overture with more Carolina drone radio development really influence you either have it or you don't and at the John Locke foundation.

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Expand your choice of schools for your kids. Widen your job opportunities and improve your access to doctors. The recipe for stability and a bright future. The John Locke foundation were dedicated to making North Carolina first and freedom were dedicated to you. Welcome back Carolina journal radio amateur coca North Carolina lawmakers are considering major changes in the dollars and cents linked to the state's public education system, a joint legislative task force is focusing on education funding issues but task force member Hugh Blackwell of Republican state representative Burke County is looking beyond the numbers as I think about education in my mind at least, it's not about being sure that we spend equal amounts of money on students. It's about being sure that students receive the education that they need to be successful. Whatever that means. As an adult citizen and provider for themselves and their families and so forth. Blackwell says he likes a proposal from a group called the education commission of the states it would focus on an education funding formula with more electability and adaptability that would allow districts under a high-quality funding formula to have more flexibility to meet their unique needs, which I interpreted to mean the unit needs for their students and to be adaptable so that the state is not forcing programs and policies on them that prevent them from changing how we deliver services to the students that were trying to educate Blackwell reminded colleagues that the answer will not be simple. The problem that we run into is that when we give flexibility and adaptability to our districts, they don't always spend the money, the way some people in Raleigh think they should. My inclination is to go with the flexibility in the adaptability, but it some point and does the state say to a district okay will debut they saw items we get a high-quality funding formula. We maximize durability to meet the unique needs of your students and to adapt the delivery systems that you're not getting it done.

So therefore we going to do things differently were not going to have flexibility and adaptability to the same extent that's the voice of state representative Hugh Blackwell Republican from Burke Kelly speaking at a recent meeting of the joint legislative task force on education funding.

Joining us with some reaction to Blackwell's comments is Dr. Terry stoops.

He is the vice president for research and also the director of education studies at the John Locke foundation, welcome back Terry, thank you so first of all, as this meeting was underway, and there were discussion about this number and that number Hugh Blackwell said wait a minute while we talk about numbers.

Remember that the main point here is to come up with a system that is the that is best for educating our students, so he basically was asking his colleagues to remember, it's not just about the numbers. How important is it to keep that in mind it's extremely important.

So one point that many people forget about is that this money is actually used for something and we want to use of the most productive way possible. Get the most bang for our buck. And so when we think about the way that money is distributed. We need to think about issues like teacher quality and class size and administrator quality and all the things that money pays for that will increase student achievement. So I think he's right on target and I get the sense both from what he said and what from others of said is that there is no magic number that if you spend X amount everyone's good be fine yeah that's right.

And this is an important point to remember is that there isn't a specific dollar amount that they're going to be targeting and looking at making sure that every student meets a certain targeted dollar amount.

All student needs are different. There are some students that will require extra services and of course that require extra money so I think it's important to note that when we look at any type of funding systems that we have won the make sure that it meets the needs of individual students want the ideas that cropped up that they represent Blackwell responded to. We heard earlier in his comments was this notion of having some type of funding formula that has increased flexibility at the local level and also adaptability so that you could change the formula on the fly when there are new developments and you get. You don't just stick with this rigid formula that's hard to adapt, how important are those two factors. Flexibility and adaptability. I think they're very important.

It's worth mentioning that it's really the school systems that know the students the parents and the school systems that are closest the students know the best and are able to meet their needs. With that knowledge of right now we have some flexibility available to our school systems, but probably not as much flexibility as they would like and the legislators are really looking at how the money is given to school districts.

At this point and looking for ways to maybe school districts would have some flexibility for the money that they received from the state. Other monies that they receive, such as from the federal government is very little flexibility in the use of that so I know that school districts would pressure any sort of flexibility. The state could give them in providing they be large almost 2/3 of the funding of budget that they receive every year. Now one Yacht that represent Blackwell also threw in that the end of his remarks was okay, adaptability, flexibility, sounds good.

What happens when we make this change in and there's some school districts. It is all down on the job is sticking to go back and say you failed so you're going to lose your adaptability and flexibility.

Is that something that has to be accounted for. Well, one of the things that legislators need to look at are a clear sense a clear set of expectations measurable expectations for districts so that you make the deal with them that if they're able to meet a certain type of standard than they can use the money anyway they see fit.

If they're not able to meet those measurable benchmarks, then there flexibility is going to be decreased and I think that that's probably the best and most appropriate way for them to set up a new funding system you been following this process very closely what from your vantage point is the best way for lawmakers to proceed as they're trying to tweak or completely overhaul their education funding formula. I think it's important they attach the funding to the students look at what the individual student needs give a base amount to every student and then look to see what various amounts could be added to that base that would benefit those students that may have special needs that may be in gifted programs the maybe her career and technical programs. That's probably the best way that they can go about creating a program that's both transparent and provides accountability for the districts that receive the funds from the state. I get the sense that no state has come up with a silver bullet of a program that works perfectly that everyone else should adapt, but is there another state or group of states out there that are moving in the right direction that North Carolina ought to emulate. Most recently, California has switched to a system of student based funding and I think that that is a good model for us to look at and it is a difficult process. Considering that a lot of states fund their public school system with property taxes, which is what we don't do here in North Carolina and the fact that most of the funds come from the state gives us some kind of unique opportunity here for us to create a system that might not look like what a lot of other systems have a lot of other states have provided a funding system that allows the majority of funding to be attached to the student and allows districts the opportunity to use that funding in a flexible manner. In the brief amount of time that we have left you get the sense that we will see some sort of major change based on the work of this task force I think we will see a major change but I don't expect it all to be implemented at once.

I think were more likely to see a change will be implemented over two or three years that would initially include a hold harmless provision for districts allow them to get used to what this new funding system would look like after two or three years of implementation and then make it a permanent system. From there on out. Dr. Terry stoops is the vice president for research and director of education studies at the John Locke foundation. Terry thinks about think you will have more on Carolina journal radio in just a moment. Full color throughout every issue more visual storytelling.

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The proposed merger of UNC healthcare and atrium health formerly known as Carolinas healthcare system.

This deal does go through North Carolina could be home to one of the largest hospital behemoths in the entire country.

The question is, how might North Carolinians be impacted by this. What about care what about costs. Catherine Restrepo has been looking into all of these question.

She of course the John Locke foundation's director of healthcare policy Catherine welcome back. Think now this is an interesting story for a number of reasons, not just because this is to major companies looking at merging UNC healthcare is actually estate owned entity so every one of us has an interest in the story and that's a great point that you make the public is asking for more transparency with this Megan marriage that's happening between you and seeing Carolinas healthcare, but I would add that Carolinas healthcare has since changed their name to atrium health because they've just announced that they like to merge with another hospital in Georgia. So they like to extend their name beyond just the Carolinas.

It can be much more in regional focus, so it makes it even more complicated story to figure out yet. I was going where and all that gives us a sense of of these two systems.

People are we talking yes.

So when you look at the mergers, the Crimean mergers. This increasing trend across the healthcare sector you have more hospital consolidation more provider consolidation and when you look at you and seeing Carolinas and combined of your $14 billion operating budget and the be overseeing over 90,000 employees and managing over 50 hospitals mean if this merger this partnership that's technically what it's called.

Where to go through me in this entity would be one of the largest hospital systems in the nation and Carolinas healthcare is already one of the largest in the nation itself know what they are saying is that this will be a really great deal for North Carolina. Essentially what's their argument partnership and their reasoning behind this partnership is that they once you have more integrated care across any of healthcare where patients get their care in the different levels of care they receive the really looking to extend their care into more genome maybe have more satellite campuses in rural areas of rural healthcare Earl access to care is a big issue now lawmakers are currently talking about that. They also like to expand their reach on for patients who need mental health services so that there that's their mission behind this proposal you've been looking into some research and data on mergers. What if you found well it's interesting is when you look at when you look at other parts the economy outside of healthcare mergers tends to increase efficiencies and lower prices for consumers for the product that those companies sell, but healthcare is different because it's so heavily regulated is really not the mergers and valves on me. No big question here is to be up costing on other sectors of the economy.

Like I said, you have lower prices when you see mergers generally in healthcare. It's different. In fact, like when you look at the evidence from mergers across the country past 10 years or so. Some healthcare cost prices have increased by as much as 40% for patients and not simply because when you have two large entities merging together. They have more leverage when they read when they negotiate reimbursement rates with insurance companies and so in order to bear that cost insurance companies pass that along to consumers in the form of higher health insurance premiums will speaking of insurance companies sounded pretty interesting that Blue Cross Blue Shield of North Carolina that the behemoth in the insurance industry in this state. They have publicly stated that that they oppose this and what's there yes and it all goes back to healthcare costs know their mission is to meet right now there's there's a coalition, the North Carolina coalition coalition of fiscal health. That's the part of Blue Cross Blue Shield and their campaign is to let let's talk about healthcare cost.

So that's a big part of their mission right now. How can we contain healthcare costs and so that seems to be two different points of view to Eve that that the two organizations looking to merge in there saying hey we will bring down costs will be much more efficient what the major insurance company is saying no, we see exactly opposite. And why would they see it as opposition and well that's again because we have two large hospital systems they have more negotiating power to get higher reimbursement rates and so when you look at mergers themselves. It's really not the mergers themselves, as in whites causing these higher prices for healthcare consumer since the fact that there's so many regulations in healthcare compared to other parts of the economy that are leading to higher prices, and any gives these large hospital systems. The advantage of charging an artificially higher rates because there's less competition. There's so many regulations in healthcare that prevent competitors from entering the healthcare space from competing against these big players and it just allows the big players like Carolinas or atrium.

How to keep getting bigger.

Catherine, are you write that one of those sound regulatory barriers that exist right here in North Carolina is called certificate of need quickly explained to us what that is in and how that keeps competition out certificate of need laws. It's it's if you want to ask if you want to expand your business. They hospital wants to expand a new wing for inpatient beds or hospital wants to get in a purchase another MRI machine or say that a group of providers and doctors want to band together and build their own surgery center. I mean so many. A large percentage of surgeries can be performed in an outpatient basis now and and that's a continuing trend across the healthcare is less costly than going to understand them on their independently run on the patient's pay a lot less out-of-pocket.

Compared to the same procedure being done in a full-service hospital but what certificate of need, as it prevents those entities from competing her from expanding their business because how it works is that you have this body, this body of bureaucrats that really determine what is needed across the state for certain services like how many MRI machines are needed and they all calculate that, based on population projections and volume percentage increase is always other complex formulas instead of just allowing the market to determine themselves and the risk that they wanted take themselves to serve patients in a better, more efficient way because you would think that if you are a group of doctors, you wouldn't be expanding your service in an area that you don't have a lot of data that shows you that you can have patients, you have customers that they're there bearing at risk, and you would think that the communities themselves would know where they're willing to take that risk to enhance patient care, or offer a lower cost services for their patients, but instead instead of the marketing market determining what's in the best interest of their patients.

The state has this centralized planning system. The certificate of need process and try to determine you know what are the necessary resources that should be equally distributed across the state as a way to contain healthcare cost but in fact is produce the opposite results over time. One of the really curious things that certificate of need that you have written about and we may have discuss this some on this show is that when someone applies for the certificate that is required for them to be able to do expand or add something that the person who is actually in existence already essentially their potential competition can say no I don't want that person is able to do that yes they can deny they can write a petition saying you know that these surgeons don't. There is no need for another surgery center. You know we already offer these services. And that's when just add duplicate of services or increase healthcare costs over also the certificate of need process itself.

That's just one month. Is this the most severe example of barrier to entry into the healthcare space.

Not just goes back to how when mergers happen easier mean they have more leverage in negotiating high reimbursement rates for insurance companies, which ultimately increases the overall cost for patients we been talking with Catherine Restrepo. She is the downline foundations, director of healthcare policy and thinking all the time we have for the program this week.

Thank you for listening on behalf of Mitch. Okay I'm Donna Martinez come back next week for more Carolina journal radio Carolina journal radio is a program of the John Locke to learn more about the John Locke foundation donations and support programs, Carolina journal radio send email to development John Locke done 66 jail info 166-553-4636 airline journal radio station airline is Carolina running system. All opinions expressed on this program nearly station. More information about the show or other programs and services foundation is John not very many like to thank our wonderful radial cross North Carolina and are sponsored Carolina radio listening again

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