The rules are no game

"By recognizing that rules can be broken, we recognize that rule-governed systems are open to innovation"
- Anthony Wilden

Though displaying the elements of ceremony one would expect, the inaugural meeting of the Destination Medical Center Corporation governing board was mostly theatre. That it was theatrical is as it should have been and will most likely always be for that is the nature of such meetings. Set pieces prescribed by tradition and  - as these proceedings soon will be -  Brigadier General Henry Martyn Robert. Among the pieces performed by the newly minted board was the election of its chair with roles properly cast and the right words spoken down to each and every "aye". Little will be ex tempore with this bunch.

 

Not that there was not a modicum of drama - subtextual mainly - arising even before the chair's election in calls for retaining the services of legal counsel for purposes of reviewing what most might regard as the dry and tedious language of the articles of incorporation and the by-laws. These documents are of great interest to the governing board (and others) for they represent the rules under which the governing board will operate. The rules are no game. This call to retain legal counsel was the onset of what will be the struggle to answer a question not yet resolved: "Who will make the rules?"

 

What will come next is the making of a great many rules all of which will say either "You can" or "You can't". 

 

Remember what Stacy Mitchell said: "...there is nothing inevitable about the current structure of our economy, it's the not the product of some kind of evolution. It is the logical outcome of a certain set of policies."

 

DMC of futures past



"This is a global destination...We think of ourselves globally."
John La Forgia, former Chief Marketing and Public Affairs Officer at Mayo Clinic

  

"I had a sense that all of us all the time are living in someone else’s past." - Wm. Gibson 

The first Mayo Clinic "destination medical center" was nestled between teddy bears and All-American Girl dolls. It had the life span of less than a single two-year lease at the Mall of America.

AUGUST 2011

The internationally known medical center based in Rochester gave reporters a peek at its "Create Your Mayo Clinic Health Experience" the day before its opening. The facility sports three-dimensional computer monitors, kiosks for the casual shopper and "navigator" specialists to help people assess their health and map out a wellness program.

"We consider this a lab as we try to decide what we want to offer in a permanent facility, if we do that," said Dr. David Hayes, medical director for the mall project.

The idea is to gather customer and patient opinion to guide development of a facility Mayo would like to build in the Phase II expansion of Mall of America, officials said. 

http://www.startribune.com/business/127497038.html

FEBRUARY 2013

Mayo Clinic is pulling up its stakes at the Mall of America and closing its “Healthy Living” outpost at the end of the month.

http://www.startribune.com/business/191414711.html

 

MAY 2013

"We learned what people would pay for with cash versus an insurance card," Shirley Weis, chief administrative officer and vice president at the Mayo, said in a presentation at the Minnesota High Tech Association conference on Tuesday. "People like to have things covered by insurance."

http://www.bizjournals.com/twincities/blog/in private/2013/05/one-lesson-mayo-learned-from-its-moa.html


 

EPILOGUE

 

Plan B

08.16.2013: The inaugural meeting of the Destination Medical Center Corporation board.

"DMC" Pudong Style



Shanghai 1987 | 2013

In case you are wondering what Big Development can accomplish in just a few decades, well....

In 1990, Communist Party leaders in Beijing unveiled plans to develop the area to the east of the Huangpu into a "Special Economic Zone" and three years later "Pudong New Area" was officially founded.

http://www.telegraph.co.uk/news/worldnews/asia/china/10220444/Shanghais-26-year-mega-city-transformation-captured.html

The pursuit of happiness



"There is an affluence that is used to the type of restaurants that you can get in New York City," he said.*

One 

But those executives and world leaders will need to be kept happy  as well. That's why Destination Medical Center includes expectations that five-star hotels and fine-dining restaurants will spring up in Rochester — because Mayo patients able to afford high-end, out-of-pocket medical care will also expect high-end service at restaurants, hotels and other venues in Rochester.

http://www.postbulletin.com/business/the-affluent-will-be-big-part-of-destination-medical-center/article_3c7d39f8-3234-5e1f-9336-faed86be0345.html

Two 

Also, as Brede pointed out, not all of the 35,000 new jobs projected for Rochester over the next 20 years are high-paying positions. In fact, a large portion will be in the hotel and restaurant industry, paying lower wages, and that means more people in Rochester struggling to get by. 

http://www.postbulletin.com/news/local/mayo-clinic-s-dmc-initiative-sparks-more-meetings-on-impact/article_b0bd4221-7838-525b-8e12-ddd428d7d062.html

Three

That's the kind of DMC private development Carlson thinks will cater to the niche market of affluent international patients. Those will not be the only patients attracted to a destination medical center. But their presence will help offset low reimbursement for Medicaid patients and uncompensated care.

*http://www.postbulletin.com/news/local/destination-medical-center-hold-on-to-your-hats/article_0b514897-5d55-55dc-b786-dcce34308ce8.html

Summary

1. The affluent patients will offset the costs of Medicaid patients.
2. The affluent patients must be kept happy.
3. To keep the affluent patients happy one must provide five-star hotels and fine dining.
4. Hotels and restaurant service workers are paid low wages.
5. Low wage service workers become Medicaid patients.
6. The affluent patients will offset the costs of Medicaid patients.

For discussion

If the problem is the cost of Medicaid patients, then where in the above does a solution suggest itself?



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50 ideas for a new city: #4 | Swadeshi



"In some ways, it's almost like building a new city."

Swadeshi - the genius of the local - honors and celebrates the local economy, the genius of local knowledge and local skills.

 

PRESS - Coffee and Tea Shop | 315 S. Broadway | Rochester, MN

 

Why We Can't Shop Our Way to a Better Economy: Stacy Mitchell at TEDxDirigo

A remarkable TED talk, that starts with a what the Boston Tea Party was really about (a big corporate bail-out using a big corporate tax loophole granted the too-big-to-fail East India Company by the British crown) and then proceeds to patiently make the point that "...there is nothing inevitable about the current structure of our economy, it's the not the product of some kind of evolution. It is the logical outcome of a certain set of policies."

 

Concluding with an important reminder that it is not having choice that matters most, or making a choice that matters most, but that from which one has to choose. The former is all we can do as consumers, the later requires of us to act as citizens.

 

Stacy Mitchell is a senior researcher at the Institute for Local Self-Reliance.

Top Ten reasons to Think Local - Buy Local - Be Local 

Buy Local -- Support yourself: Several studies have shown that when you buy from an independent, locally owned business, rather than a nationally owned businesses, significantly more of your money is used to make purchases from other local businesses, service providers and farms -- continuing to strengthen the economic base of the community.(Click here to see summaries of a variety of economic impact studies; these include case studies showing that locally-owned businesses generate a premium in enhanced economic impact to the community and our tax base.)

Support community groups: Non-profit organizations receive an average 250% more support from smaller business owners than they do from large businesses

Keep our community unique: Where we shop, where we eat and have fun -- all of it makes our community home. Our one-of-a-kind businesses are an integral part of the distinctive character of this place. Our tourism businesses also benefit. “When people go on vacation they generally seek out destinations that offer them the sense of being someplace, not just anyplace.” ~ Richard Moe, President, National Historic Preservation Trust

Reduce environmental impact: Locally owned businesses can make more local purchases requiring less transportation and generally set up shop in town or city centers as opposed to developing on the fringe. This generally means contributing less to sprawl, congestion, habitat loss and pollution

Create more good jobs: Small local businesses are the largest employer nationally and in our community, provide the most jobs to residents.

Get better service: Local businesses often hire people with a better understanding of the products they are selling and take more time to get to know customers.

Invest in community: Local businesses are owned by people who live in this community, are less likely to leave, and are more invested in the community’s future.

Put your taxes to good use: Local businesses in town centers require comparatively little infrastructure investment and make more efficient use of public services as compared to nationally owned stores entering the community.

Buy what you want, not what someone wants you to buy: A marketplace of tens of thousands of small businesses is the best way to ensure innovation and low prices over the long-term. A multitude of small businesses, each selecting products based not on a national sales plan but on their own interests and the needs of their local customers, guarantees a much broader range of product choices.

Encourage local prosperity: A growing body of economic research shows that in an increasingly homogenized world, entrepreneurs and skilled workers are more likely to invest and settle in communities that preserve their one-of-a-kind businesses and distinctive character.

 from Sustainable Connections http://bit.ly/bEB7N

 

Toward a Localist Policy Agenda 



 



 

Toward a Localist Policy Agenda from Stacy Mitchell

This presentation was delivered on June 14, 2013, at the BALLE Conference in Buffalo, New York.  Download a PDF version of the text. 

Boat people

A rising tide and all that

A rising tide lifts all boats....

-John F. Kennedy, October 3, 1963.

The provenance of this phrase has been traced to the slogan of the New England Council, a regional business organization. It is a phrase we hear from our own chamber and its satellite organizations, even more so recently. These days the phrase usually poses as an easy answer to difficult questions regarding who benefits from the economic development promised by the promised development of Rochester as a destination medical center. It goes something like this: "A rising tide lifts all boats," someone declaims. Those who own the boats nod approvingly.

"A rising tide lifts all boats" brings with it certain assumptions like, one has a boat. Some do not have boats. Some boats are not in good-repair. Some boats are very crowded. Rising tides swamp some boats. Other boats sink. Folks without boats drown (or, as we also hear to approving nods, they "sink or swim" and that seems to be all that needs saying about that).

President Kennedy also said that day, "I would like to see us in this decade preparing as we must for all of the people who will come after us." The conversation we must have in this decade cannot be just about the rising tide, it must also be about boats.

50 ideas for a new city: #3 | "Epistemic community"

"In some ways, it's almost like building a new city."

...[C]onscious efforts to develop a shared understanding of the region amongst diverse constituencies seems to make a difference for blending the imperatives of equity and growth.....[E]pistemic refers to what you know (what facts, figures, and perspectives) and community refers to who you know it with (whether alone or in collaboration with others). When such collective knowledge includes not just the “usual suspects” of urban growth coalitions, but a broader constellation of community interests and perspectives, it seems to make a difference.....

- Just Growth, Benner and Pastor

I think whenever one gets an opportunity to use the word, "epistemic," one should but, it's "community" that gets our attention here. How often do we think of what we know in light of with whom we know it?

"Usual suspects" are words of caution, not condemnation. And we are gathering - as usual.

What remains to be seen is whether or not "a broader constellation of community interests and perspectives" is embraced. Embraced in a manner that does not simply relegate those who hold these interests to subjects of focus and survey or reduce their perspectives to data points and cameos in promotional videos.

These other lives should not be overlooked, but neither can they just be visioned. They must appear in the places where coalitions form and be seen at the tables where knowledge is collected.

The way ahead requires more of us than a broad knowledge of the community, it also requires a broad community of knowledge.