A Bigger Health System Is Not a Complete Vision for Healthcare

I’m saddened by how narrow our vision for the future of healthcare has become. Consolidation and growth seem to be the principal answers offered to a crisis that patients experience as difficulty getting care.

The proposed combination of Essentia Health and HealthPartners brings that concern back to mind. The organizations promise better access, greater affordability, and stronger local care. I understand why healthcare leaders want stronger organizations. I want to know what that strength will mean for the communities they serve.

In Minnesota alone, this announcement follows North Memorial Health’s combination with Sanford Health, completed September 1, and Allina Health’s agreement to join California-based Sutter Health, pending regulatory review. Three major combinations involving Minnesota health systems in a single year make this concern larger than any one transaction. Consolidation is becoming the recurring vision offered for healthcare’s future. Communities deserve a clear account of how that vision will preserve care close to home—and what influence they will retain over the decisions that affect them.

These are questions I was asking before this announcement. In my earlier article about the planned Silver Bay clinic closure, I described a public hearing dominated by staffing and financial constraints. Residents could describe the harm, but there was no meaningful opportunity to change the outcome.

The institution had an explanation. The community needed a way forward.

I also described how Aspirus was expanding in Wausau while preparing to withdraw care from Silver Bay. That raised a question that remains unanswered: how will growth at a system’s center sustain the communities around it?

The Essentia–HealthPartners proposal deserves to be examined on its own terms. But it brings that same question into a larger conversation. When leaders say a combined organization will be stronger, what commitments follow? Which local services will that strength preserve? How will communities help shape decisions about their care? How will we know whether the promised benefits reach them?

Nonprofit status does not resolve the tension between institutional stability and community need. An organization can pursue its own survival and still leave people with fewer choices. I’m troubled by how readily we accept a capitalist model of expansion and concentration as the answer, without requiring a clear account of who benefits and who bears the consequences.

Financial strength matters. So do the costs that fall outside an organization’s balance sheet: the longer drive, the missed work, the difficulty arranging transportation, and the care a patient postpones because getting there has become too hard.

Those consequences belong in our definition of whether a healthcare strategy succeeds.

I want healthcare leaders and public officials to put the same effort into preserving local services that they put into combining organizations. Before a community loses care, it deserves serious consideration of alternatives and a real opportunity to influence the decision. That work needs to begin while there is still something to decide.

Minnesota’s attorney general is seeking public input on the proposed transaction. This review is an opportunity to ask for specific commitments about local access and accountability, and a clear way to assess whether those commitments are kept.

That is also why I feel more strongly that North Shore Health needs to remain independent. We face difficult choices too. Independence requires us to take responsibility for them. Local governance means answering to the people whose lives those choices affect, and keeping their needs at the center of the discussion.

My concern about this proposal grows out of what I have already seen and written about: the distance that can develop between an institution’s definition of success and a community’s ability to receive care.

A health system’s survival matters. So does a community’s ability to remain a place where people can live and receive care. Our vision for healthcare has to account for both.

These are my personal views, not those of North Shore Health or my employer.