South Carolina’s hospitals have long been seen as anchors of their communities – economic engines that support jobs, deliver care, and keep the system moving.
But what happens when those anchors grow so large… they become liabilities?
Over the past decade, two health systems – MUSC and Prisma – have expanded aggressively, now controlling roughly 65% of the state’s staffed hospital beds. With that growth comes billions in debt, growing reliance on federal subsidies, and significant consolidation of care.
And the bigger the system, the harder it falls.
A Lesson from the Supply Chain
If the last few years have taught us anything, it’s this: when everything is centralized, everything is fragile.
In 2021, a single ship stuck in the Suez Canal blocked 12% of global trade for six days. During the height of COVID, patients couldn’t access care because systems built for efficiency had no buffer. When baby formula manufacturers were consolidated, a single plant shutdown created a nationwide crisis.
The more centralized the system, the more catastrophic the failure.
Healthcare is no different.
Hospitals Are Essential – But Not Invincible
Hospitals absolutely have a vital role to play – particularly in delivering complex, specialized care. But when they become the one-stop shop for all services – from ambulatory visits to urgent care to diagnostics – they displace more nimble, local options that offer lower costs, greater flexibility, and stronger patient relationships.
That may seem efficient on paper. But in reality, it creates a brittle system:
- One cyberattack on a centralized hospital IT network can grind care to a halt.
- One labor strike can impact hundreds of thousands of patients.
- One funding change at the federal level can put entire systems at risk.
These are not hypotheticals. They’re already happening across the country.
Redundancy = Resilience
In engineering and public safety, redundancy is built in for a reason. Backup generators. Multiple fire exits. Overflow plans.
But in healthcare, we’ve done the opposite – merging, consolidating, and acquiring until only a few major systems remain.
That might serve the bottom line, but it does not serve patients. Decentralization isn’t inefficient – it’s resilient. More independent practices, more outpatient options, more regionally distributed care reduces system-wide risk if one provider falters.
The Question Isn’t Just “How Big Is Too Big?” – It’s “What Happens If They Fail?”
We’ve seen what happens when a major utility project collapses (V.C. Summer), or when financial systems over-leverage themselves (2008). South Carolina’s healthcare infrastructure is following the same pattern – and unless we pay attention now, we’ll be paying the price later.
We Still Have Time. But Not Forever.
This is the first of several pieces I’ll be sharing as part of a larger effort to spotlight the structural weaknesses in our healthcare system – and the real, practical steps we can take to address them.
If we want better care, lower costs, and stronger communities, we have to build smarter – not just bigger.
👉 Want to dive deeper? Read my recent guest column in the Post and Courierhttps://www.postandcourier.com/opinion/commentary/sc-hospital-systems-financial-risks/article_587947…
