Good Mayo, Bad Mayo: How Minnesota got the treatment

Opinion editor's note: Star Tribune Opinion publishes a mix of national and local commentaries online and in print each day. To contribute, click here.

•••

Well, that was fast.

During the pandemic — remember the pandemic? — our political leaders and nonprofit hospitals were tripping over themselves in praise of nursing.

While COVID-19 raged, Gov. Tim Walz, Mayo Clinic and the Minnesota Hospital Association all exhorted us to keep the sacrifice of these front-line workers foremost in our thoughts.

As a health reporter covering those grim news conferences, I remember feeling unmoved by the suggestion of adding another valentine to the tall pile of stories celebrating our RNs.

Wasn't their stellar performance self-evident?

Flash forward two years and all the above have since repaid our bedside providers by showing them, as it were, to the underside of a motor coach.

To understand this reversal, we must first consider the split personality of the state's largest, most beloved private employer, a benevolent entity that functions in our imagination as Good Mayo.

Its reputation precedes it.

One of the more remarkable subplots of the remarkable legislative session now completed, however, was the destabilizing emergence, after a decade in hibernation, of Bad Mayo.

A seldom-spotted alter ego to the Good Mayo of lore and hagiography, Bad Mayo seeks to weaponize its considerable economic resources in pursuit of personal objectives, all the while striving to keep its Good Mayo image intact.

Last seen asking for decades of state-funded infrastructure in exchange for continuing to invest in the southern Minnesota location that had supplied its stable employee base for a century, Bad Mayo in 2013 at worst arm-twisted the statehouse in exchange for creating something good.

This time, Bad Mayo brought the Legislature to heel in order to derail something good.

Specifically, it acted to frustrate the express wish of voters that their representatives address a growing instability and lack of affordability in our spuriously nonprofit hospital system.

Facing a years-delayed request from their supposedly trusted heroes in nursing, Mayo told lawmakers that if they did not grant the hospital an exemption from the Keeping Nurses at the Bedside Act, the medical center would take a secretive and enormous building project out of state. In a plus for appearance purposes, they asserted that other hospitals should qualify as well, enough of them to render the bill meaningless.

A measure in the works for years without comment from Rochester, the bill asserted the apparently untenable notion that nurses should be consulted in staffing decisions affecting their ability to provide care as they show up each day envisioning it.

"For Mayo to move forward with the investment … ," according to an email from Mayo's lobbyist Kate Johansen first published by the Minnesota Reformer, "the bill must include a path to full exemption" for providers who met high standards and used a special staffing software.

Because if there's one thing everyone can agree on, it's that special software always does what it says it does.

Though fully half the staffing committees could and surely would be populated by hospital administration heavies, abiding just 35% membership in the form of direct-care nurses was a bridge too far for the No. 1 Hospital in America.

Stiff-arming the nurses must have triggered fleeting spasms of dissonance in its Good Mayo side of the brain. Welcoming nurses to the table merges seamlessly with a familiar Good Mayo narrative the clinic has long nurtured about itself — as a place of clinical excellence, teamwork and group practice, concerned only with patient needs.

And yet. Enjoying hundreds of millions in surplus revenue — last week Mayo Clinic reported first-quarter operating income of $150 million — Bad Mayo didn't want nurses involved in its team approach when it came to their staffing.

Corporate thinking is surely in play. Mayo has undergone the same drift into managerialism that has industrialized medical services across the overcharging, underperforming health care landscape.

Administrative bloat is why your doctor stares at a screen more than at you, and it's why your interactions with the system so often leave you feeling like a set of risk factors for down-regulation, rather than a beneficiary of care that reduces illness and early death.

It might not come as a surprise that such an automated system can't fathom the "antiquated and harmful" committees needed to keep nurses from fleeing the profession, in Rochester or anywhere else.

Mayo has fallen under the spell of technocratic utopians and TED-talk styled visionaries of so-called platform care. Apostles of progress have arrived in Rochester bearing a gospel of thinking machines that will improve on the observations of humans.

AI has supplanted enthusiasm once reserved for biological pharmaceuticals, which supplanted our unbridled faith in medical devices, which appears to have swallowed up precision medicine and genomics as the New Big Thing.

Lawmakers throwing a lifeline to a profession drowning in burnout were instructed to trust the assertion that special software has been designed to anticipate the needs of Mr. Philips in 16C.

An attempt to address runaway hospital price increases was deemed "extremely problematic" for the Rochester-based provider of white-gloved care, as if the existence of our problem was not in fact their problem.

Mayo's Johansen asserted in her email that opposition to the legislative measures was only meant "to avert their harms to Minnesotans," adding that failure to abide by Bad Mayo's ultimatum would mean "we cannot proceed with seeking approval to make this investment in Minnesota."

It is not consistent to oppose a bill you believe will harm Minnesotans, and then pivot to threatening to harm Minnesotans if you do not get your way. You are either worried about harming Minnesotans or you are not. But that's where a lobbyist must earn her pay.

When asked about backtracking on the bill, DFL House Speaker Rep. Melissa Hortman told a news station that "Mayo is different … . There are not other hospitals in the state that have kings and princes flying in to stay to get treatment."

This likely only made Good Mayo squirm.

"Our position is about patients," the clinic wrote in a letter shared on local news. "It is about our staff and our communities. It is about whether and where Mayo Clinic can push the boundaries of innovation to cure, connect and transform health care for patients everywhere."

Sure.

Paul John Scott is a writer living in Rochester.