The Mayo Clinic’s recent announcement regarding its opening of a “mega-hospital” joint venture in Abu Dhabi was made with the usual fanfare associated with the glossy sheen of well-oiled public relations machinery. The Mayo Clinic “extending its brand” abroad. In the UAE Mayo “can meet patients where they are,” and of course, never worry about their ability to pay since it is being founded as a for-profit entity. Those pesky lower reimbursement rates for patients on Medicaid or Medicare — not a concern in what is the fifth wealthiest country in the world.

The stated mission of the Mayo Clinic is “to inspire hope, and contribute to health and well-being by providing the best care to every patient [emphasis mine] through integrated clinical practice, education and research.” Mayo’s reputation for research and patient care remains unparalleled and indeed, it has long been a Destination Medical Center for many throughout the world, even before it was given that official designation by the state in 2013. In 2018, the Mayo Clinic posted revenue of $12.8 billion (a net margin of 5%) with chief financial officer Dennis Dahlen calling it a “tremendously successful year.” He continued, “We’ve got continuing strong demand for the services that Mayo provides … and a global brand brings people to Rochester and to our other campuses as well.”

But, in its great ambition to expand its global brand, has the Mayo Clinic lost sight of its mission of “providing the best care to every patient?” Has this celebrated health care institution ruthlessly prioritized profits above its rural patients by systematically gutting health care services throughout the upper rural Midwest? Ask the residents of Albert Lea. Mayo took over the hospital there in 1996 and slowly began to whittle away at the services it provided to the community’s 18,000 residents. First, it cut its intensive care unit (ICU) in the fall of 2017. This past fall, it closed its labor and delivery unit, moving all of those services to the hospital in Austin, nearly 40 miles away. Clinic closures or service cuts have also occurred in numerous small towns just over the past three years. Fairmont, Leroy, and La Crescent in Minnesota; Waukon in northeastern Iowa. Last week it announced upcoming closures in Springfield and Lamberton.

Mayo leaders and administrators claim that rural populations have diminished so significantly that it makes no financial sense to keep all these services intact in smaller communities. They use terms like “optimization” and “consolidation” as a kind of neoliberal code for cutting and shuttering services and clinics. They claim that they cannot attract quality doctors or nurses; that such institutions operate at a loss, and thus Mayo, too, loses money. For any modern corporation in our capitalist society, that’s just common sense, right? Except that the Mayo Clinic is a non-profit institution like nearly 3,000 other hospitals across the country. Its tax-exempt status allows it to raise large amounts of charitable money, and it avoids paying state and local taxes. Furthermore, in 2013, state lawmakers approved a massive public spending package worth $585 million for the Mayo Clinic’s DMC expansion. Of that $585 million, $424 million comes from state taxpayers while the rest comes from the city of Rochester and Olmsted County. However, with so much public money at stake (and a substantial portion of that amount coming from outside of Rochester) no provisions exist in this package to motivate Mayo leaders to make assurances about continuing to serve more vulnerable patient populations in rural Minnesota.

And just why does that matter? Sociologists and journalists have opined about the “hollowing out” of rural America since the years of the Farm Crisis of the 1980s, but that process has accelerated in recent years as demographic shifts have resulted in aging populations and declining birth rates. Meanwhile long-promised panaceas to bridge the urban/rural divide like increased broadband access continue to face state funding hurdles. The physical markers of the nation’s disinvestment in rural America run the gamut, from visible landmarks of loss – abandoned barns, boarded up businesses, and as my hometown of Clearbrook in northern Clearwater County recently experienced, shuttered nursing homes. The invisible toll on rural communities though is particularly pernicious, as feelings of anger and anxiety fuel rural resentment. Meanwhile, economic and health disparities between rural and urban populations persist and widen.

Mayo and other health care systems claim that their decisions to close clinics and hospitals are driven by a lack of demand for these services, pure and simple. But in making these purely economic decisions, they contribute mightily to the hollowing out of rural America and essentially undermine their core institutional mission. Indeed, for Will and Charlie Mayo, the institution they helped to grow into one of the world’s most hallowed healthcare systems, it was not only about the bottom line. Visitors to the Mayo Clinic’s Heritage Hall learn that during the Great Depression, for example, they routinely paid the bills of their poorest patients. Decades later, many of those patients paid back the Mayo brothers when they were financially able.

If history tells us anything from the past 20 years, it is that disinvestment in our civic institutions is not the answer. It punishes the most vulnerable among us and has led to higher rates of economic inequality. From our public schools and universities, to community newspapers, churches, and yes, hospitals – the diminishment and/or closure of these institutions affects the very fabric of our regional identity and culture. I humbly propose that any revenues gained from the Abu Dhabi “mega-hospital” venture go not to the already flush Mayo Foundation, but instead to a brand new initiative. Let’s call it the “Rural Communities Revitalized” fund wherein the Mayo Clinic sets aside money to support and enhance its remaining rural clinics. This support might take the form of new technology, highly competitive salaries for doctors and nurses, or the re-establishment of lost services and clinics. Don’t desert these communities and their patients. Invest in their future. Will and Charlie Mayo would certainly approve.

Anna Thompson Hajdik is a native Minnesotan who now calls Wisconsin home. She is a senior lecturer in the Department of Languages & Literatures at the University of Wisconsin-Whitewater and teaches courses in English and Film. She is interested in a range of issues linked to the Midwest and is at work on a book about the cultural and political identity of Iowa.