> NIMBY blocks some nursing homes, but another barrier is that 34 states require a Certificate of Need just to add nursing home beds. You need state approval to build supply. Sixteen states go further with outright construction moratoria.

What kind of communist shit is a "Certificate of Need?"

It was surprisingly hard to find an answer to this, as most sources did not appear unbiased. One source mentioned that in the past there were cost plus billing schemes instead of pay for service schedules. So unnecessary capital expenditures could be profitable, not sure how true this is.

Zoning has gotten WAY out of control in this country. It's a serf/vassal relationship except the government has become the vassal.

oh, it's really cool bullshit, really. you can file a CON for your healthcare facility and then surrounding healthcare facilities that failed to provide proper service to the community can challenge the CON and get it denied!

local hospital system tried building a whole new freestanding healthcare center including outpatient surgery and the failing hospital 30 miles down the road filed a CON objection and killed the whole project so it had to be half-ass converted into "just a bunch of doctors offices". at least they committed to paying property taxes on the land they bought even though they're a nonprofit that was exempt on it!

two years later, the local hospital system acquired the hospital that filed the objection. embarassing, really.