Five Economists Diagnosed American Healthcare. They Found the Same Disease.
State university health systems are absorbing private medicine. Not through competition. Through acquisition. With your money.
Something is happening to American medicine that doesn’t have a name.
It’s not single-payer. The government is not actively acquiring hospitals.
It’s not private equity. There are no leveraged buyouts to blame.
It’s something else.
Something quieter.
Something dressed in the language of public good.
IN TODAY’S ARTICLE:
What soft nationalization looks like when no one calls it that
Five frameworks for seeing what’s actually happening
The structural pattern repeating across university health systems
How to recognize it in your own market
Bonus deep dive podcast for today’s material.
Glossary at the bottom of today’s article.
THE PHENOMENON
State university health systems are absorbing private medical practice. Not through competition. Through acquisition. They’re buying what they couldn’t beat.
And they’re doing it with your money.
A physician builds a practice over twenty years. Takes the risk. Signs the leases. Makes payroll. Builds relationships with patients who chose her over the alternatives.
A state university health system offers to buy it.
The physician gets a guaranteed salary. No more business risk. Pension. Benefits. The system handles billing, compliance, and HR.
Patients see the same physician at the same location.
But something has changed.
The practice that once competed in the market now operates outside it. The physician who once bore the consequences of her decisions is insulated from them. The prices patients pay increase by fifteen to twenty-five percent for the same services.
The independent practice is gone. In its place: a node in a system that receives state appropriations, issues tax-exempt bonds, pays no property tax, and files no public disclosure of executive compensation.
This is happening and has happened in all fifty states. Across the country, state university health systems are absorbing the independent practices that once provided alternatives.
No one voted for this. No legislation authorized it. No public debate preceded it.
Every week you're not reading this, someone is making decisions about your market. They are reading it.
