Darth Mercy, Iron Fist for the regional Oklahoma Galactic Outpost of the Mercy Health System Empire, travelled from the local death star to their Watonga, Oklahoma colony, a conquered hospital and community, one that now, like many others,  feels strangely dependent on the Emperor.  Imagine Darth Vader addressing the inhabitants of a colony the Empire had taken over, explaining to them the benefits they will enjoy now that they are “affiliated” with the mother ship and you have the feel of the experience.  

Certain members of the audience, undoubtedly suffering from Stockholm syndrome (a phenomenon where hostages mistake a lack of abuse from their captors as an act of kindness), looked deep into the eyes of Darth, confusing love for this tyrant with their dependence on the iron-fisted Vader.   These hostages have long since forgotten how they came to be in their predicament.  Their small community hospital, unable to cope with the federal rules and regulations and complicated payment formulas issued by Uncle Sam in the 1980’s, began to fail.  The large, urban and corporate hospitals had to comply with these rules and regs, as well, but due to their size and massive profits, not only had no trouble with compliance, but actually sought these rules and regs for the very consolidation of the hospital industry they knew would result.  As the rural hospitals failed, physicians in the community became ripe for an “offer” from the big city hospital storm troopers.  This “offer” had strings, though.  They were to funnel  every activity and patient interaction that made money, to the mother ship.

Think of a giant hardware chain, that sought regulations from government to make the sale of most hardware items cost prohibitive for the little hardware stores, a rule, for instance that required a minimum stock of certain “critical” items, regardless of their demand by customers.  The large chain, while able to comply, would publicly complain loudly about this new regulation, while secretly celebrating their political victory, one which would bring ruin to their small competitors and the business consolidation corporations constantly seek.  Many of these small “mom and pop” stores would succumb to Vader’s raiders and would be allowed to make keys, maybe, but anyone needing paint or lumber would be funneled to the mother ship. 

Physicians in the small community, now employees of the mother ship, face the total wrath of the empire if their former patients, stray from the path Vader has chosen for them.  This parasitical relationship works until the referrals to the mother ship no longer produce a net profit.  This small and now hollowed out and devastated community and hospital will at this point be abandoned like bulging ticks leaving a dying dog for their next attachment.  It will be a long time indeed, if ever, that a physician or hospital returns to this community.  Mission accomplished.

But there is dissention in the ranks.  A small group of rural hospitals has figured out a way to survive (temporarily) by banding together to resist the big hospital attack.  They have formed a rural “health network,” an association which brings economies of scale to their enterprise and one which allows for sharing the expense of “compliance (like mandated Electronic Medical Record Systems).”  These rural networks exist due to the abuses of the big hospitals, acted out many times by their paid friends in Washington.  The mission of the big hospitals is inimical to that of these rural ones.  Politically these rural networks are very difficult to attack openly, as these enterprising small town hospitals are in the position of the underdog, a position that by its very nature provides them asylum from the bully’s public kicks. Vader doesn’t seem like much of a legitimate “protector” when seen kicking or killing the defenseless.

How will this end?  Have these corporate hospital bullies overplayed their hand?  Have these rural hospitals had enough?  I think that the formation of these “networks” is a sign that the big hospitals have gone too far.  Not even the rural hospital crushing elements of the Unaffordable Care Act may be enough to bring the small hospitals down, enterprising and cooperative as they are.   I predict that Vader’s small town Vichy will have hell to pay when the empire is run out of town.  

G. Keith Smith, M.D.