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[Note: This material is copyright by the Des Moines Register, and is reproduced here as a matter of "fair use" for non-commercial, educational purposes only. Any other use may require the prior approval of the Des Moines Register.]

But unlike the situation in 2003-04, the seeds of a rational approach to communitywide hospital facilities have been planted. The leadership at Iowa Health/Des Moines and Broadlawns conceived a plan that keeps our county hospital viable without $80 million in renovations by relocating it on the current campus of Iowa Lutheran Hospital. Lutheran would then relocate to West Des Moines.

Meanwhile, Mercy Hospital announced its intention to close the scarcely used Mercy Capitol Hospital and build a new facility in West Des Moines.

At first look and taken together, these proposals appear to make sense. They modernize Central Iowa's total hospital facilities while closing two hospitals and, one hopes, creating a more efficient one.

Wellmark supports the closure of the two hospitals, the move of Broadlawns and the construction of additional hospital capacity, if properly sized, in West Des Moines. And we have so advised both hospital systems.

We have also proposed a very logical solution to who would control the coveted western suburban hospital market. We suggested the two hospital systems resurrect their own 2002 idea to build a jointly owned hospital in West Des Moines.

This would ensure that the community doesn't end up with two new West Des Moines hospitals that would actually create over-capacity instead of solving that problem by closing Broadlawns and Capitol. It would also meet everyone's needs - the hospitals, physicians and the employers and individuals who pay for health care.

So what's stopping this from happening? First, when the two systems went to the federal government to see if it would allow a jointly owned facility, they reported that the Department of Justice said that such a facility would be anti-competitive. As a result, they abandoned the joint ownership idea.

We think it's worth another try. As the largest private payer, Wellmark has offered to go with the hospitals to urge the Department of Justice to look more positively on this venture.

If the department says no, then we have asked the hospitals to go voluntarily before the state Health Facilities Council with their separate proposals and let it determine which should receive a certificate of need. Wellmark has promised to remain neutral because we trust the council to make decisions that are in the best interest of Iowans and consistent with its charge to ensure cost-effective, affordable health care.

As logical as this all sounds, Mercy Hospital refuses to go along with it, even though it promised the council in 2004 that it would not build for at least five years and supported the notion of a jointly owned hospital the year before that.

To its credit, Iowa Health has indicated its agreement to proceed on the course we outlined.

Unfortunately, there is also a second potential stumbling block. The Iowa Department of Public Health may be making it even harder to follow this rational path because of its interpretation of an administrative rule that may allow "replacement" hospitals to be constructed within the same county without any public review at all. We have challenged that administrative rule as inconsistent with the certificate-of-need law. We also challenged the rule because it makes no sense to preclude the public review required by the certificate-of-need law, as this case dramatically illustrates.

If the department issues both hospital systems "letters of non-reviewability," it would, in effect, be approving two hospitals by default, something that couldn't possibly be what was intended by the certificate-of-need statute.

It is time for reason and common sense to prevail, for both hospital systems to step up to their civic responsibilities as nonprofit community hospitals to work together to form a single hospital or, at least, to go through the certificate-of-need process to ensure public review and debate that should result in the right decision for Central Iowa.
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CLIFF GOLD of Clive is group vice president, Wellmark Blue Cross and Blue Shield, and president, Wellmark Health Plan of Iowa.