South Carolina guts this corrupt healthcare monopoly

Hopefully more states will now follow their lead.


Columbia, SC might be, physically, one of the hottest spots in the country, but this week, it’s also intellectually hot.

Gov.  Henry McMaster has officially signed a bill to gut the state’s government-granted healthcare monopoly laws known as Certificate of Need (CON). This follows a massively successful campaign by activists on the ground like Americans for Prosperity (where I am a consultant) with tremendous leadership in both chambers, especially from House Speaker Murrell Smith, Representatives Sylleste Davis and Mark Smith, and Senators Wes Climer and Tom Davis.


Get this. The vote count was unanimous in both chambers.

Astounding. Historic. If you’re not laying prostrate on the floor in awe of that you’ve clearly never worked a CON repeal bill before.


As someone with tried and true battle scars from such efforts, let me tell you, I’ve never seen anything like this before. And to be sure, it didn’t happen overnight. No, this is the result of a dedicated and concerted effort that took several years and powerful amounts of persuasion, because getting rid of these laws has been a David vs. Goliath-like battle.

(To be clear, we are David in this scenario).

For every person who wants to blame capitalism for the failures of our healthcare system, there is a government law that has directly contributed to skyrocketing costs, reduction in the quality of service, and scarcity of providers. CON laws are one of the top contributors to all three.

We often say monopolies are rarely found in capitalism unless they’re government created and backed. Such is the case with CON laws where the government started essentially granting monopoly power over healthcare services to hospital associations and other healthcare corporations in each state. 

Essentially they demand that people argue before a government board on the “need” for their service before they can add more hospital beds, new equipment, or open new facilities. And at the same time, their competitors (who’ve been granted this monopoly power by the state) get to come in and argue against their “need.”

The result? More often than not the state sides with the monopoly, new services are not allowed to open or expand, and Americans—particularly those in rural areas—are left with long wait times, higher healthcare costs, and often no healthcare services at all.

These laws are corrupt to their core, and unlike many laws that were put in place with good intentions and just little forethought, these laws are functioning how they were always intended to. They were meant to keep healthcare prices artificially high by restricting the supply side in healthcare.

And yet they’re extremely hard to get rid of, typically, for a few reasons. One, most Americans are wholly unaware of these laws, much less the broader ways our government has wrecked our healthcare system. Disingenuous leaders don’t help this by often allowing capitalism to become a scapegoat for the bad laws and regulations they’ve put in place. 

Secondarily, the people who are aware of these laws and who want to get rid of them are typically ideologues—like myself, who know true free market healthcare is the only way to ensure quality goes up while prices come down—are up against a well-funded opposition machine in the healthcare monopolies. 

These associations spend big working against repeal campaigns, they donate to the politicians who need to vote against their scam, and they fear monger both politicians and grassroots into believing that without CON laws hospitals won’t operate. It’s a bully campaign that doesn’t make a ton of sense beyond the money flowing, but it’s been effective enough to keep CON laws on the books in over 30 states.


Not so in South Carolina though, where it seems both Republicans and Democrats alike decided to take stand for their constituents and slay Goliath. 

Billy Graham once said when a strong man takes a stand the spines of others are stiffened. Let’s hope this display of actual leadership out of the Palmetto State encourages other neighboring states to follow in their footsteps.

Hannah is a consultant for Americans for Prosperity.

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Hannah Cox
Hannah Cox
Hannah Cox is a libertarian-conservative writer and co-founder of BASEDPolitics. She's also the host of the BASEDPolitics podcast and an experienced political activist.