In a commentary piece published June 12 in The Carolina Journal, business developer David Hogg argues that North Carolina’s “centrally planned healthcare economy” has contributed to some of the highest healthcare costs in the nation.
Here are 10 key takeaways:
1. Mr. Hogg writes that state “central planners” have failed to create a healthcare system that delivers efficient, low-cost care. “Only the free market can do that,” he says.
2. He points to North Carolina’s certificate-of-need laws, which allow the state to regulate when and where new healthcare facilities — including ambulatory surgery centers — may be added.
3. The state legislature is currently reviewing proposals that would repeal CON laws for ASCs and some other healthcare providers.
4. Mr. Hogg argues that this regulatory structure has led to high healthcare costs, noting that North Carolina ranks last in the U.S. for healthcare affordability.
5. He criticizes the North Carolina Department of Health and Human Services for inconsistent projections in its annual state health plan. In 2024, the agency projected a need for 407 additional hospital beds; in 2025, it increased that estimate to 1,042. “The rationale? Their ‘methodology’ changed,” Mr. Hogg wrote. “Which methodology is correct? No one knows. Central planners never get it right.”
6. He cited a February 2025 Journal article that reported the state health department denied six projects in September 2024, blocking 11 surgical rooms and 176 acute care beds. “That’s nearly $1 billion of new capital investment DHHS denied the local community, just this year, in Wake County alone,” he wrote.
7. Mr. Hogg contends that the CON process has created a healthcare “oligarchy” that favors entrenched providers.
8. He gave the example of UNC Health, which received bed approvals for a new hospital in Durham County incrementally from 2021 to 2023. He argues that this approach disadvantages new entrants that cannot compete for partial approvals.
9. He says small, independent ASCs are disproportionately affected. He shared a personal anecdote about a surgery he underwent in 1996 at an ASC, which he said was high-quality and cost half as much as a hospital-based procedure. “Now as a North Carolinian, neither I nor my insurance company have that option, due to CON,” he wrote.
10. Mr. Hogg concludes that repealing CON laws would expand access and lower costs. “The federal government rescinded national CON requirements nearly 40 years ago. Since then, 21 states have abandoned these outdated requirements. NC is overdue for a CON healthcare cost overhaul,” he wrote.
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