Is it cheesecake? Do we like it?

Last month, the New Yorker magazine published an article titled "Big Med," by writer/doctor Atul Gawande. He described the epiphany he had while eating with his kids at a Cheesecake Factory restaurant.

The health care industry could learn a lot, Gawande thought, from the company that runs middle-American restaurants all over the country. "Our costs are soaring, the service is typically mediocre, and the quality is unreliable," he wrote. The chain restaurant business, he wrote, had solved these problems, standardizing training and quality control and keeping costs affordable.

The article and the questions it raises stuck in my mind as MPR News reporter Jennifer Vogel worked on a set of Ground Level stories about the latest wave in rural hospital consolidation in Minnesota. Fewer than a third of the state's hospitals remain independent, and three billion-dollar-plus-revenue companies have grown steadily -- Sanford Health, Essentia Health and Mayo Clinic Health System.

Here are the affiliations just since 2005:

As you can see in Vogel's stories, the benefit to a community when one of these companies brings a hospital into its system can include more services, less patient travel to bigger cities, faster record handling -- a better and more predictable restaurant meal, if you will. You can also feel residents' angst over losing local control, about becoming a number in a system, about trying to control their own destinies.

Of course, health care presents unique challenges when it comes to payment rates and the requirement that hospitals treat everybody, as Essentia Health president Dan Nikcevich pointed out when Vogel mentioned the New Yorker piece in a conversation.

"I would say, that is fine," Nikcevich said. "I like what you do. Great menu and selection and by the way, when I bring the kids here, they eat the food and I don't have to spend twenty bucks for a grilled cheese. But next time, let's have 60 to 70 percent of the customers come in and only pay 25 cents on the dollar. And another guy 35 cents on the dollar. And then you have another percentage who don't have the means to pay, but you still have to feed them. There are others too, and you have to communicate to them why that slice of cheesecake costs $175. That would challenge their business model."

So, granted, it's not a perfect analogy. But the question still can be instructive. Are the big three bringing us the Cheesecake Factory of medicine? As Vogel reports, there's a certain inevitability about the consolidation wave. Do we like the meal? You get a good sense of what's at stake on our revamped Rural Health Care section.

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