Evan Ramstad
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Fairview Health Services and the University of Minnesota are going through a terrible breakup.

As with many breakups, one asks: what about the kids?

By kids, I mean the doctors, nurses and thousands of people who work for the system known in recent years as M Health Fairview.

And the rest of us.

Minnesota's health care scene is akimbo over Fairview's November announcement that it wants to merge with Sanford Health, the Sioux Falls-based system that dominates health care in the Dakotas and western Minnesota.

The University of Minnesota, whose hospitals have been partnered with Fairview for 27 years, last week said it wants its campus facilities back, the merger should wait and that it needs a lot of money from us kids.

At a brief news conference on Thursday, U leaders laid out an "innovation vision" that was thin on details, most importantly cost. There was confusion about ongoing work with Fairview. If not for the Fairview-Sanford deal, I suspect U leaders would have waited to unveil this vision.

"The Fairview-Sanford merger proposal prompts the need for a fuller discussion about how the state, university and health care providers can and should place the health of Minnesotans at the core of upcoming decisions," Myron Frans, the U's finance chief, said at the news conference.

Does it ever.

The U's vision includes a new $1 billion-plus hospital on the Minneapolis campus and spending that's sure to be hundreds of millions more to improve other hospitals. Extricating the U's hospitals from Fairview may also cost huge amounts. A court battle seems likely.

Two big not-really-answered questions hang over the entire drama.

First, why weren't the U and Fairview, after all these years working together, on the same page when Sanford came around? They had gone through this before. The state and U halted a proposed merger between Fairview and Sanford 10 years ago.

"They didn't talk to us about that when they started" new merger talks, Frans said. But it was surely discussed within Fairview's board, which includes Frans and the U's medical dean, Dr. Jakub Tolar, before emerging in public last November.

And then, in a note to employees after Thursday's news conference, Fairview CEO James Hereford said he hadn't been told about the U's new plan. "The University's comments raise significant questions about its desired future with Fairview," he added. A U spokesman said Fairview leaders were briefed about it a few days earlier.

Second, why are Fairview and Sanford in such a hurry to close the deal? Executives say they aim to conclude it in March, four months after the Nov. 15 signing of nonbinding letters of intent.

Two possibilities. There are business reasons for expediency, with Fairview eager to reduce its operating losses and Sanford seeking to finish a deal after recent attempts to merge with systems in Utah and Iowa failed. The other possibility is they want to get the U, a slower-moving entity, to act.

The top executives of Fairview and Sanford say they will save Minnesotans money by combining their systems, but they haven't shown how. With more time, perhaps they will.

Lying underneath this breakup are hard truths about the changing Midwest.

Health care is becoming more difficult to deliver in rural areas. The prospect that some Minnesota towns may lose their hospitals or doctors spooks political leaders. The U, Fairview and Sanford all profess a commitment to rural health, but none can guarantee they will be able to maintain service to all places.

And, as I noted in my first column two weeks ago, Minnesota's population is leveling off and its economy is slowing. That will force hard tradeoffs, perhaps over building a new hospital at the U. When Frans began the U's news conference by erroneously saying Minnesota has one of the nation's fastest-growing economies, it was another sign of the disconnection between the people driving this affair and the rest of us.

Fairview, Sanford and the U have competing ideas for navigating all that. We can now see they didn't work them out before conflict spilled into the open.

Sure, all the niceties were observed and the leaders all said they are willing to talk to each other. But no one in this is being completely straight and open with the public.

It must have been very dispiriting to be an employee in the M Health Fairview system last week.

And as for the rest of us "kids" in this breakup? It's obvious what will happen to us. Everything the leaders of Fairview, Sanford and the U are doing right now will make health care more expensive in Minnesota.