The Price of Getting Bigger Healthcare

For the billions invested, mergers and technology - American healthcare is worse.

There’s an old saying: a hog that gets fat enough to fill the pen isn’t necessarily a hog that feeds the family. Keep that in mind when someone tells you American hospital systems have never been stronger.

By the numbers most commonly cited, they’re right. The fifteen largest hospital systems in the country, ranked by 2024 revenue, are formidable enterprises. HCA. Ascension. CommonSpirit. Advocate Health. Names that sound less like places of healing and more like the credits roll of a corporate merger film — which, in several cases, is exactly what they are. CommonSpirit, Advocate, Corewell: none of them existed in their current form a decade ago. They were assembled in boardrooms between 2019 and 2022, stacked together like cordwood, and handed a revenue ranking as a birth certificate.

So when we ask whether these systems are better than they were ten years ago, we are, in part, asking whether the thing we’re comparing even existed ten years ago. That’s not a minor footnote. It’s the w…