The future of health care in Minnesota

Opinion editor’s note: Star Tribune Opinion publishes a mix of national and local commentaries online and in print each day. (To contribute, click here.) This commentary is included among a collection of articles that were submitted in response to, or are otherwise applicable to, Star Tribune Opinion’s June 4 call for submissions on the question: “Where does Minnesota go from here?” Read the full collection of responses here.


Hopefully the fingers have healed from the vicious finger-pointing that went on for months between the University of Minnesota (physicians and administration) and Fairview Health Services. The merger between Fairview and Sanford Health has been set aside. We can now move forward, hopefully, constructively, and address the health care needs of Minnesotans.

Gov. Tim Walz has taken an important step forward by creating a task force to look at the future of health sciences at the University of Minnesota. He put the task force in the capable and very accomplished hands of Jan Malcolm (recently retired commissioner of health for the state). As the governor stated in the announcement, the university’s health sciences programs provide “critical education, training and research to support the next generation of health care professionals and provide high quality care for Minnesotans.”

What will this mean vis-a-vis Fairview? Undetermined. The university needs a community partner. Fairview has been the logical choice. If the bruised egos of the leaders of the two organizations heal, then the collaboration between the two entities may well continue — in the best interests of both, and their patients.

But my concern is not with the university and Fairview’s relationship; it is with the task force and its goals. What will be the priorities? Should the task force look more broadly at the health care needs of Minnesotans?

Health care is a mess. It is fragmented, way too expensive and often very difficult to access. The current health care system is exhausting providers. There was a high level of burnout among both nurses and doctors that has only worsened as a result of the pandemic. We are in the midst of a very serious shortage of nurses and primary care physicians. And in the months and years ahead we are likely to see massive resignations, if the current surveys of both nurses and doctor hold true. The perception, with which I concur, is that the current health care industry is concerned more about profits than patients. Many, many nurses and doctors find this amoral and are leaving.

This grave situation is directly impacting current health care in Minnesota. The Minnesota Department of Health publishes weekly statistics on the occupancy of Minnesota hospitals. This started during the pandemic so health system leaders could cooperate and identify available beds for sick patients with COVID and other ailments.

Now the pandemic is over. COVID is endemic; very few people are requiring hospitalization. Yet in the Twin Cities metro area the adult beds are still 97% occupied, both ICU and medical/surgical beds. Due to a shortage of transitional and long-term care beds, many patients can’t leave the hospital. Consequently, many patients who need admission spend hours and days extra in the ER, waiting for a bed.

This is a precarious situation. There is no margin to handle a future crisis, whether it be an infection surge or a mass casualty event. We actually don’t lack physical beds. We lack nursing staff for those beds, both in the hospital and in transitional and long-term care.

The facts are daunting: We spend 20% of our GDP on health care — that’s twice the average of other developed countries. Yet we have worse health outcomes than all of those countries. Our life expectancies are declining and they are lower than all European countries. We have dramatic increases in “deaths of despair” from loneliness, drug overdoses, suicide. Many hospitals and long-term care facilities are in desperate financial situations. Yet companies like UnitedHealth, along with the biotech and pharmaceutical industries, are making enormous profits. Many people, even those with insurance, and even many with six-figure incomes, are faced with debilitating medical debt.

People do not seem to understand that the value we get from medical treatment is marginal. Medical care is responsible for only about 10% of the factors that reduce premature death. The major determinants of our health are our genes (our parents), our lifestyle choices (smoking, drinking, exercise, etc.) and our socioeconomic status. We give medical tests and treatment far too much credit.

So how is the governor’s task force going to solve these frightening problems? It can’t. What it can do is task the University of Minnesota with the job. Not just the Academic Health Center. The entire university: the School of Public Health, the School of Nursing, the School of Hospital Administration, the Law School, the School of Business Administration. The University of Minnesota is the academic and research heart of the state. It is a land grant university with a mission and duty to serve the citizens of Minnesota. We need all of our best minds working to solve these problems.

So, Ms. Malcolm and Gov. Walz: Tell the University of Minnesota to fulfill its mission. Let’s create a Center for Evidenced-Based Health Care — so we can eliminate unnecessary/unwanted medical treatments (30% of medical care). A Center for Shared Medical Decisionmaking — so patients can make more informed medical decisions. A Center for Geriatric Medicine — not present at the university since 2001. A Center for Medical/Nursing Workforce — so we can anticipate and address shortages in doctors and nurses. A Center for Medical and Nursing Burnout — to understand and address the etiology of this critical issue.

Health care is terribly oversold and underperforming in our country and our state. Let’s task the University of Minnesota with the job of solving these challenging problems. The only thing we have to fear is a decrease in profits from some of these enormously wealthy companies.

Dr. Vic Sandler is a geriatrician and hospice and palliative medicine specialist.

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