I grew up in New Ulm, a southern MN town of about 13,500 people. My mother recently retired after 33 years as an RN (having worked at Abbott-Northwestern and at New Ulm Medical Center) and my brother is an RN in the ER at New Ulm Medical Center and a Flight Paramedic with North Memorial Emergency Services out of Redwood Falls. Needless to say I grew up hearing a lot of banter about healthcare, particularly rural healthcare. The hospital in New Ulm is operated under Allina, a "non-profit" health system, which operates hospitals from Abbott-Northwestern to hospitals like the one in New Ulm, quite a contrast in size and needless to say, revenue. The situation with healthcare in Minnesota and the rest of the U.S. resonates heavily with what is happening to rural education due to the "No Child Left Behind" Act. Non-profit hospitals are funded based on the amount of revenue each brings in, which is largely based on the amount of expensive, invasive procedures that a facility can perform. Since smaller hospitals are not equipped to perform these expensive (and profitable) procedures, they also miss out on the funding and yet are still held to many of the same standards as larger facilities. Anyone familar with "No Child Left Behind" understands this process. Almost every healthcare facility is now switching to computer records as well and this is done throughout a healthcare organization, recently in Allina. This system, distributed by Epic, costs over $2 million a year to operate and is often a lot more work than necessary. Employees at Abbott-Northwestern might only have to worry about having to click their mouse 11 times to sign off on a chart but rural healthcare employees not only have to deal with the hassles of the software but also have to worry about whether they're going to be employed the next day. I know my mother and brother have stood by for years and watched the facilities and information systems get updated and at the same time, many of the administrators have seen significant salary increases (keep in mind that Allina is non-profit). Meanwhile, they have watched many of their co-workers leave because of lack of job security. I can't help but notice a Darwinistic approach to healthcare in the United States. However, the game is rigged, since not all those participating are offered the same advantages. After all of this, it comes down to simple supply and demand. A lack of competition causes higher costs for everyone.