The public hospital illustrates the faults of American health care

By Alec Williams, Minnesota Reformer

With a split House and no budget to pass, even legislative leaders predicted an “unproductive” year at the Capitol. But one urgent priority is the fiscal crisis facing Hennepin County Medical Center: The state’s largest safety net hospital is on the verge of collapse, threatening a regional calamity that will affect hospitals and patients for hundreds of miles.

The story behind this budgetary emergency illustrates the inequities and structural weaknesses of a frayed safety net and a health care system built around profit incentives.

To start, it’s important to understand the massive reach and irreplaceable importance of HCMC.

HCMC treats roughly 115,000 unique patients each year, including almost 95,000 in the emergency department. It provides services that few Minnesota hospitals can replace, and some that no others offer, including the state’s only 24/7 emergency hyperbaric oxygen chamber; one of the nation’s busiest burn units; and the largest emergency department and trauma center in the state, caring for the most critically injured patients in the upper Midwest.

It is also an essential teaching hospital, contributing to the training of a majority of physicians practicing in Minnesota.

But perhaps most importantly, HCMC is the hospital that doesn’t turn people away.

In 2023, 48% of their patients were on Medicaid, which reimburses at a fraction of the rate of Medicare or private insurance. On top of that, HCMC now provides more than $100 million per year in uncompensated care to patients without insurance or who are unable to pay their bills. That figure has more than doubled since 2020, and includes nearly 25% of care provided to patients outside Hennepin County. In total, HCMC provides 20% of all uncompensated care in Minnesota. The next-highest hospital provides just 12%.

Losing HCMC would pose an existential threat to the health care system of the entire Upper Midwest. Not only would many severe trauma patients have nowhere to go, but its large volume of high-cost, low-reimbursement patients would overwhelm other area hospitals, bringing with them similar financial troubles.

But, beyond the immediate, disastrous impact of losing HCMC, its circumstances reflect the broken structure of our current health care system.

By accepting any patient who walks through its doors, HCMC bears the burden of our collective failure to provide preventative care; to house those dealing with mental illness; to provide meaningful addiction services; or to build a social safety net that keeps people out of emergency rooms in the first place.

In most countries, these high-risk patients are grouped in with everyone else to smooth costs across the system. Only in the United States are for-profit insurers and providers allowed to cover the wealthy and healthy — while the public is left to foot the bill for the costly and uncovered.

American health care: private profits for Mayo, socialized losses for HCMC

Nowhere is the failure of this system more apparent than in the contrast between HCMC and Minnesota’s most famous hospital — the Mayo Clinic.

Unlike HCMC, Mayo is selective about the patients it serves. The Minnesota Attorney General found the hospital discouraged certain patients from seeking charity care and reached a settlement with the state to change its billing practices. Even so, Mayo spent just 0.7% of its total revenue on charity care last year, far below the national average of roughly 4%.

In 2025, the same year it closed six rural clinics, Mayo took in $1.5 billion more than it incurred in expenses — something we would call profit if the world-renowned cancer hospital wasn’t a tax-exempt “nonprofit.”

HCMC, by comparison, lost $9.5 million in 2024 and has struggled to break even for years. In fact, Mayo’s operating surplus was almost as high as HCMC’s total revenue of $1.7 billion.

While HCMC catches patients who have fallen through the cracks of our porous health care system, Mayo caters specifically to the wealthiest patients through initiatives like its Executive Health Program, designed for “busy CEOs, business leaders, and executives.” Hospitals like Mayo specialize in caring for the richest people in the world, leaving unprofitable care to institutions like HCMC.

This is not just a jealous comparison or an argument about one hospital versus another; it is a reflection that our health care system rewards high-cost, highly specialized providers and punishes those attempting to provide basic care to people in need.

HCMC’s financial situation was not caused by mismanagement or fraud; it results from a system that reserves basic health care for those who can afford it, leaving underfunded public hospitals to pick up the pieces, and taxpayers to pick up the bill.

For now, the Legislature must act to save HCMC.

The leading proposal is an expansion of the Hennepin County sales tax, which funded Target Field, from 0.15% to 1%, which would place the burden on many working-class families. In a perfect world, Hennepin County taxpayers would not be saddled with a regressive tax to support this statewide asset. Perhaps hospitals like the Mayo Clinic — with billions in annual profit and more than $16 billion in net assets — should pay to uphold the inequitable system that enables their profits.

But, of course, nothing is more regressive than allowing the primary health care provider for poor families to close, so we will take whatever solution we can get in the meantime.

Ultimately, instead of a health care system built to provide the best possible care for the wealthiest few, we need one that provides care for everyone, allowing us all to live with dignity and achieve our full potential.

That would be a system worth paying for.

This article first appeared on Minnesota Reporter and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.