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To the Editor:
The Tennessee Department of Health held a public hearing Monday, June 12, 2023, where the public could comment on Ballad Health’s compliance with the Certificate of Public Advantage (COPA) and to discuss revisions to the Terms of Certification under the COPA.
Ballad Health is the largest regional healthcare monopoly in the country, serving 29 counties of the Appalachian Highlands in Northeast Tennessee, Southwest Virginia, Northwest North Carolina and Southeast Kentucky.
The hearing was held in the Ballad Health Community College Performing Arts Center. Being funded by Ballad, seemed to be a theme for the evening. How could the public expect an impartial hearing to be held in a building named after the monopoly? How could the public expect any institution receiving funding, to be impartial?
The majority of those who spoke in favor of Ballad didn’t have anything to do with the monopoly’s compliance, which was supposed to be the the focus of the hearing.
Those in favor of the monopoly, spoke about how happy they were to be receiving funding for their community service or initiatives.
The hearing could be summed up by saying Ballad Health is really good at funding community initiatives, but not particularly good at what they are intended to provide the community – healthcare.
There was a speaker who was happy Ballad funded their initiative to build community housing, the Dobyns-Bennett Band Director was happy Ballad gave the band funding, the YMCA who liked their funding, two speakers from the Strong Future program who liked that the program is funded, accountable care community who liked their funding, the vast majority of those who spoke in favor of Ballad were receiving a check from Ballad to support their programs.
I will get back to this, but first let’s speak about the majority of those who spoke about the actual service the healthcare monopoly facilities are supposed to provide. Healthcare.
There was a woman who discussed how her mother went to Holston Valley with a brain bleed but since so much of Holston Valley’s capabilities were moved out, they no longer had a neurosurgeon on staff. Her mother had been waiting 90 hours and still hadn’t been seen by a neurosurgeon. The woman’s father had a similar issue pre-merger in 2016 but was seen right away by a neurosurgeon.
Several Carter County Commissioners came to speak on behalf of their area and the concern they have for the recent announcement about Ballad deciding to close Sycamore Shoals ICU. They spoke about the growth their area is seeing and how such growth should support retaining their own facilities.
They spoke about the numbers moving here who believed they would have quality healthcare only to learn that they will no longer have a nearby ICU. They stated this decision is going to hurt the local economy as well as the quality of Carter County health outcomes.
One of the most heartfelt speeches of the evening was from a former registered nurse, Ashley Barnes, who worked at Franklin Woods and used to love her job pre-merger but by 2021 her anxiety and dread of coming to work because of unacceptable patient ratios and the treatment she received for little pay was no longer worth it. “Our patient ratios are higher than they have ever been. If fully staffed our ER ratios were 1:5. The national average is 1:4 and 1:1 with critical care patients. I have spent many shifts with 1:8 or more. We were told daily they didn’t want anyone in the waiting room. That sounds great, but not when our ER beds are full with hospital admissions. We were told to start IV’s, draw labs, give meds, etc. in the waiting room and then move those patients on our tracking board into a fast track area so it would take our wait times down, but those patients didn’t leave the waiting room.”
Dr. Ginger Carter, a local OBGYN who also serves on the Johnson City school board spoke. Dr Carter said, “I am privileged to have been both educated and worked alongside some of the best physicians and nurses in the nation. I began my work in Johnson City, very proud of the area’s ability to meet the health care needs of my patients, having to rarely refer people outside of our region. Now, it is on a daily basis that I am sadly met with this comment from my patients, “please send me anywhere except a Ballad Facility.”
Dani Cook, an activist who tried to help stop the merger from happening, spoke about the hospital ratings before and after the merger, proving that the quality of healthcare in the region has declined.
The evening ended with a bang as a woman yelled out that Miles Burdine from the Kingsport Chamber had arrived after her, yet he was allowed to speak. She believed they knew he was speaking on Ballad’s behalf which earned him preferential treatment.
Meanwhile. many who wanted to speak in opposition, myself included, were turned away.
The speech I had prepared but was unable to share as I was also turned away, focused more on the implications of centralized healthcare and centralized government.
Take control of healthcare, control the people is the first step to communism. Healthcare permeates every aspect of our lives. Therefore it gives the government a rally cry to become intrusive in our lives for “the greater good” as we have seen throughout history. And as we have seen during COVID.
Our founding fathers set up systems that were decentralized with intention. It creates more choices. And choices equal freedom. You don’t have a free country without a free market. And you don’t have a free market with a monopoly that gives the monopoly and the government too much power over the people.
Some people in the audience believe more government is the solution, overlooking the fact that the long wait times, and limited choice is what you get in countries where bigger government control healthcare.
You get the post office of healthcare.
What this certificate of public advantage does, is takes choice away from the consumer, away from the people, and hands it to the monopoly, and to the government.
The monopoly uses the government to shield it from responsibility, from liability, while looking to the government for funding. Like the $82.5 million in CARES Act funding in the fourth quarter of fiscal 2020.
The monopoly system strips the people of choice and sets up a freedom less system. Where government “experts” choose who we do business with instead of we the people choosing based on quality and success.
I went to Nashville to ask our representatives to vote for repeal of the certificate of need laws which would be a needed step back to the free market. And I was told from an advisor to our senator and representatives that slow repeal was better because there would be too many market disruptions. When I asked what the market disruptions were, the advisor could not name a single one. When I pressured again what issues slow repeal was solving he said that I needed to get people who don’t want CON repealed on board because of their “investments?”
The Beacon center published an article calculating all the lost revenue to our Tennessee communities due to denied certificate of need applications. The Cost to Washington County alone was $160,855,577. They claim some of those were eventually allowed, missing the bigger picture. They shouldn’t be denied by our government in the first place.
They’ve continued to chip away at existing service providers outside of the monopoly – Watauga Orthopaedics, a prominent practice that has been on JCMC’s call schedule, but won’t be come February…
The kerfuffle entered the public eye when Watauga released a statement on social media criticizing the decision, which was made in mid-December. The practice said the change would interfere with patients’ rights to choose their healthcare providers, labeling it a “blatant attempt to prevent us from treating our valued and loyal patients presenting to the (emergency department).”
The ideology pushed by monopolies and large healthcare entities is collectivism, asking people to surrender their individual rights for the supposed betterment of the collective.
But health is not one size fits all. COVID hospitalizations were primarily in people with metabolic issues. Unless you want a government so powerful they can tell you what to eat and when to exercise which would mean zero freedom, one size fits all solutions don’t work. Individual solutions do.
The “partnerships” Ballad has created speaking on behalf of the entity on issues outside of the entity’s primary purview is the same control system DEI and ESG ratings have allowed over corporations.
If you speak outside of what is acceptable by those controlling the purse strings. The funding is pulled.
It is China’s social credit system.
Companies are given higher DEI and ESG scores and allowed lines of credit if they allow the Marxist narrative.
“Equity” the “E” from DEI in North Korea meant taking the landowners land saying it would be redistributed evenly and everyone would be equal. They’d have non-repressive order. Instead the landowners were murdered and the people got Communism. To this day if you are related to a landowner you are a lower caste. If you are related to a communist you are a higher one.
If you are able to be controlled and go along with the narrative you will be rewarded. If you don’t. You will be punished.
In China, Mao told students their parents were oppressing them with traditional values and they must overthrow them to have non-repressive order. They also got communism.
Now you have reparations being paid to people who were never slaves by people who were never slave owners. Class wealth redistribution in the name of equity replaced with race wealth redistribution.
Equity in policy is wealth redistribution. Wealth redistribution in practice is communism. Social governance and diversity are anti-traditional values. The ESG and DEI controls are cultural Marxism. Step out of line with the approved ideology and they pull your ability to get a line of credit.
That’s why you have companies abandoning their base customers with propaganda that doesn’t speak to their target market. Because the banks and those approving the lines of credit won’t give them the funding to pay their vendors unless they comply with DEI and ESG demands. Comply with the Marxist narrative or else.
These local Ballad controls have made it so the voices of the local people who care that Ballad is not delivering the product they are supposed to, don’t seem to matter. The voices of the customers don’t matter. All that matters is the paycheck Ballad is cutting the local entities. All that matters is the paycheck BlackRock and Vanguard are cutting the national entities.
Which means the consumers no longer matter. The people no longer matter.
Which means the US dollar no longer matters. Which means the US no longer matters. Who benefits from that narrative? How do we combat it?
Repealing CON laws. Decentralizing. Breaking up these monopolies. Anti-trust legislation. Breaking up the incestuous government corporate relationships. State sovereignty. Individual sovereignty. Reinstating the free market by removing unnecessary regulation. Bringing it back to the consumer being the deciding factor so we have a voice and choice again.

Danielle Goodrich
Johnson City