Have you noticed how institutional lines are being blurred? I see it in news headlines, and in Michigan bills as I summarize them for the MHF Guide to State Health Policy.

Institutions – many of them – have strayed from their core purpose. This breaks down public trust.

State health policy in Michigan – from both executive branch and legislature – has driven the wedge deeper.

Warning signs like Silicon Valley Bank are everywhere. I don’t just mean the financial woes, but a deeper departure that preceded them. Let’s take a closer look.

Blurring the definitions

The most basic definitions seem obvious – banks do banking, hospitals care for the sick, schools teach. But the distinctions are being blurred.

For example, the failed Silicon Valley Bank’s website boasts of commitment to ESG. Did it place sociopolitical goals above sound investing when approving loans to healthcare startups? If so, the attempt to impact healthcare in a “non-bank” way may have led to disappointed investors, and even patients.

Another headline reports hospital CEO activism for gun control. This is a radical departure from their primary mission – a step over the wall between hospital and community, as well as breaching the barrier between hospital and politics.

Late yesterday, MDHHS issued a press release just as radical:
“MDHHS Director Hertel discusses how budget supplemental funding signed by Gov. Whitmer will address community violence – Local leaders provide valuable insight as MDHHS develops new Office of Community Violence Intervention Services”

Michigan’s largest department crosses lines between health and law enforcement, state and local, public and private institutions.

What happened to caring for the sick?

Many of us remember healthcare suddenly being all about “wellness.” Behind the scenes, hospital boardrooms quietly dropped the sacred mission of caring for the sick to a lower priority.

The shift to wellness marked a pivot away from locally-based patient care, to prioritizing centrally-directed population care. Ambitious hospital mergers and acquisitions feed the same trend. So do electronic health records, notoriously claiming hours of clinician time performing data collection for government and other research. Healthcare shortages, financial instability, and diminishing trust have deep roots in lost mission and blurred boundaries.

Blurring the lines between hospital and insurance

West Michigan is home to an early hospital – health insurance merger. Spectrum, now merged with Beaumont Health and renamed Corewell, continues to own Priority Health insurance.

Blurring the lines between hospital and insurance comes with a cost. Within the “integrated” system, patients have noticed their doctors simply accepting insurance denials. As an additional erasure of traditional boundaries, employed physicians generally do not fight for patient interests with the same force as independent contractors.

I recently wrote about ESG in Michigan healthcare institutions.
Spectrum Health (Corewell) is also deep into ESG, as shown in this screenshot from its website.

Blurring lines between Public and Private

Public Private Partnerships (PPPs) take down boundaries between government and private institutions for specific projects. Often hyped as a brave new solution, they can turn out more like government and corporate ganging up against regular people.

Despite their advantages, public-private partnerships are often criticized for blurring the lines between legitimate public purposes and private for-profit activity, and for perceived exploitation of the public due to self-dealing and rent-seeking that may occur. – Investopedia

MDHHS claims “partnerships” with multiple private and public institutions in communities across the state.

It is unclear from the state website how many of these are public-private partnerships.

We’ve been told as a society to “Just accept people for who they are.” As banks fail, government grows, and hospitals struggle with finances, maybe it’s time for our institutions to return to who they are.

No man can serve two masters: for either he will hate the one, and love the other; or else he will hold to the one, and despise the other. Matthew 6:24a