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Frank Carroll


It’s easy to shake our heads and wonder at the greed and tensions between predatory business and government practices of 150 years ago. It’s harder to look at our government and society today and understand what the past may teach us.

I had the occasion to tour the newest acquisition of Regional Health, the big new Custer Hospital. Built in the style of the Missoula frontier, a place where outsized pine replaces stately marble at similar expense, the soaring great hall, the many spacious offices and waiting rooms, and the general air of grandeur speaks to a new age of buccaneers in private industry.

Shielded from taxes by their “non-profit” status, the medical establishment in the current Age of Big Medicine has hit upon a business model so profitable that it can’t help but flaunt it with massive blue-stained timbers and high ceilings.

We are now shunted from specialist to specialist, each visit compounding the billing from the last visit, with expertise and responsibilities ever more compartmentalized to ensure maximum profits from patients and insurance companies. Shored up by individual self-interest in state government and elected representatives and aided by tireless and powerful lobbyists, we have created and are shamelessly supporting a new industrial juggernaut as rapacious as any of its predecessors from the 19th century’s Gilded Age.

Unencumbered by transparency, the leaders of the current monopoly hospitals are free to create new entities that are, in scope and scale, larger and more rapacious than any seen before. Without the annoyance of being subject to review or scrutiny by government or the public, these entities can and do exercise their opportunities for profit-making in increasingly astounding ways.

Formerly subject to a hospital board that made decisions for the public good about hospital expansion and other matters of public health, the hospitals now pursue whatever course seems good to them and good for their bottom line.

A new sports medicine and “pain clinic” is nearing completion at Catron Road and Highway 16, ironically contiguous to an established sports medicine and orthopedic center belonging to a private company. The building is a strong signal that “non-profits” can compete head-to-head with for-profits without any of the silly tax issues and other dilemmas that constrain private businesses.

This new facility is a perfect expression of medicine gone mad, a place where doctors across the Regional system will send their patients for multiple visits where one visit used to do. This facility will, in turn, send patients into increasingly specialized practices whose buildings are already on the drawing board. It’s a never-ending cycle of medical visits and billing — and an endless profit stream. With no one regulating their baser instincts, the medical profiteers have clear sailing ahead.

Sadly, little conservative states like South Dakota are constitutionally incapable of taking on the tough cynical Captains of Medicine who exploit our aversion to government oversight of industry, even when such oversight is in our best interest. Our tax dollars are the lion’s share of the non-profit revenue.

No longer required to reveal their profits to the public, hospital administrators can funnel spending wherever they like. With no one to monitor their business and shielded from any law that might interfere with their profits, the Hospital Tycoons are perfectly prepared to take our society to new highs in medical expenses. And all of this is aided and abetted by government. Our representatives are actively supporting this brave new world and there is no end in sight.

We need government to police this unbridled profit-taking, not to grease the skids for a new gold rush of medical profiteering.

Frank Carroll is a freelance writer and columnist. He can be reached by emailing or visiting

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