And so this May, 16 months after Medarva asked permission to move two operating rooms, the commonwealth in its imperial majesty and wisdom said no.

In language that would have been familiar to a Soviet commissar, the state said the proposal was inconsistent with the State Medical Facilities Plan — and besides, “unused capacity exists and is accessible to the population of” Health Planning District 15, which is located in Health Planning Region IV. For this, Medarva has spent “north of $220,000” on legal assistance, says its CEO, Bruce Kupper — money that could have gone to “screening pre-K kids for vision problems,” investments in new technology, or a host of other, better uses.

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By itself, Medarva’s proposal will not transform the American economy, or even Virginia’s. But it is not an isolated case. In 36 states, medical providers have to waste many months and many tens — sometimes even hundreds — of thousands of dollars seeking ... permission to spend their own money.