Merger decision: It’s about real people, with real families, in real communities


By Jeff Keeling

It took a self-effacing grandfather to convey the true import of a drama that’s been unfolding for more than two years now, the results of which could impact every person, community and business in the region for decades.

When Dick Brownlee stepped to the podium inside a room at the Southwest Virginia Higher Education Center Thursday evening, that day’s chapter of the drama had lasted more than three hours. The retired University of Virginia business professor has acted as one of three expert resources for board members of the Southwest Virginia Health Authority (SVHA) as its board considers whether to recommend approval of Wellmont Health System and Mountain States Health Alliance’s “cooperative agreement” request.

SVHA approval, if followed by the same at Virginia and Tennessee’s departments of health, would pave the way for an anti-competitive, regulated merger shielded from standard antitrust scrutiny and unprecedented – for hospital systems – in its size and scope. You’ve probably heard plenty about that proposal.

I got a good feeling about Brownlee as soon as he cracked a joke about offering his thoughts first among the experts (the others are an attorney and a physician). It may have been because he was the shortest or the oldest, Brownlee said. Then he showed that he was arguably the wisest.

Brownlee complimented the abilities and sincerity of Federal Trade Commission staff, who have registered their opposition to the merger in writing and speech. He later told me he, too, had entered his assignment with a perspective that generally favors market dynamics over regulation. But four-plus decades of experience as a business school professor helped Brownlee understand that, as he put it, “there were not many pure markets where competition could occur as described in the textbooks.”

After he made that statement, Brownlee’s wisdom, and from my perspective his heart, shone forth. He said SVHA board members need to determine whether Southwest Virginia’s healthcare market is, “so filled with imperfections that the traditional market solution simply can’t be expected to function properly and meet the serious needs of the people in the region.”

Then, nearly imperceptibly, Brownlee choked up as he concluded.

“This is not an easy question to answer, and in my opinion, thoughtful, well-intentioned people could review all of the relevant information and actually come to different conclusions. The Authority is in uncharted waters here, and no one has a crystal ball that can help make this difficult decision. I believe all that each of you can do is to carefully review all of the relevant information that’s been provided to you and to reach your own conclusion in a holistic manner by bringing together your mind, your heart and your soul. For the decision that is made by the Authority’s board will affect the lives of real people, with real families, who live in real communities here in Southwest Virginia. I wish you well as you go forward.”

Policies are things. So are diagnostic centers. Ditto for hospital beds, emergency rooms, electronic health record systems, artificial joints and organizational charts.

For 18 months now – more intensively for the past half-year – vast sums of money and the energies of many strong minds have been focused on the hospital systems’ merger effort. The states have hustled to promulgate effective rules and regulations should the merger proceed. The systems have striven to explain their proposal’s merit and win hearts and minds among the public, their own employees, and those who stand as arbiters in the decision-making process. Insurance companies, the FTC and other skeptics have made their opposing arguments.

Many of these arguments are about those things mentioned a couple paragraphs previously. But those things, and how they are deployed in a given region, have meaning only insomuch as they can be used effectively to serve people. I was reminded of that again – particularly as it relates to the difficulties the more rural parts of our region face – Tuesday morning, when news broke that Laughlin Memorial Hospital in Greeneville plans to join MSHA. The pressures to survive faced by rural hospitals were cited as the main driver of the decision, the wisdom of which only the future can reveal.

The players operating at the high level where such decisions are deliberated and made have traveled to and fro in business attire, flying in airplanes or driving dependable vehicles. Just as I am, and I would suspect as most of you are, they are among a fortunate minority in this region – likely not untouched by misfortune, but certainly more protected from it than many.

In the worldview I espouse and seek to live out, the people in this region most affected by these trends are our neighbors. They are many, and health care in all its forms is one area where their needs are great. We’ve been approaching provision of health care under a free market-centric paradigm for a long while now. Soon, a few people will make very important decisions about whether to allow a paradigm shift.

Whatever the decision, as Brownlee said, real people, with real families, who live in real communities will be affected. Like him, I wish the arbiters of that decision well as they go forward.


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