My Turn: Dartmouth-Hitchcock, GraniteOne merger is a bad idea

For the Monitor
Published: 1/31/2019 12:19:58 AM

I read with dismay in the Jan. 25 Monitor (reprinted from the Valley News) of the proposed merger of two of New Hampshire’s largest health systems.

Dartmouth-Hitchcock Health and GraniteOne Health have signed a letter of intent to combine. GraniteOne includes Manchester’s Catholic Medical Center. The merger, which they prefer to call a “combination,” would allow Dartmouth-Hitchcock a stronger presence in the southern part of the state, despite the already established network of Southern New Hampshire Medical Center in Nashua.

In 2010 Dartmouth-Hitchcock applied for a merger with CMC but then-Attorney General Michael Delaney, likening it to a takeover by Dartmouth-Hitchcock, objected.

I cannot imagine a worse, more foolish time for Dartmouth-Hitchcock to be trying this move again. All around the country we are seeing the harmful effects of mergers and takeovers on workers and consumers, especially in health care.

Congress may be lagging behind, but there is a growing push among activists and political thinkers to reduce monopoly. Many in Congress still subscribe to the “Chicago School” of economic thinking that preaches “consumer welfare.” The term they use is “efficiency,” their theory being that the combining of forces – a.k.a. merging – will result in an efficiency of service that will lower prices for consumers. The flip side of that thinking, and the one we more often see, is the formation of a monopoly that in actuality, as opposed to theory, has no reason – they call it incentive – to lower costs. The health industry, for that is really what it is, says it needs this expansion of services and specialists, especially in an aging and opioid-ridden population.

I was recently diagnosed with spinal stenosis with the addition of spondylolisthesis, fancy names for arthritis, etc., of the spine – a problem of aging. I received a number of treatment plans from various health care professionals in my area, Nashua. I went to a spinal orthopedist who said I didn’t need surgery.

I was relieved but still in a good deal of pain, so a friend who’d been through something similar and had surgery at Dartmouth-Hitchcock persuaded me to see one of their spine specialists. I made the appointment with ease despite the different health care system and drove up to Lebanon to a complex that reminded me of what I imagine the Pentagon must look like. It appeared to sprawl out in a geometric fashion surrounded by a wide skirt of parking.

I entered a ceremonially large reception area where I could hear a piano playing soothing classical music. I was directed down one of the long hallways that fanned off the central reception to a far more modest consulting area.

One of Dartmouth-Hitchcock’s top spinal orthopedists saw me. (My friend and I had already checked the website and chosen him as the best for me.) He told me exactly what the doctor in Nashua had said: No surgery. My spine was stable. When I asked what I could do about the pain, he looked apologetic and said he didn’t really know. Physical therapy? I said I’d tried it. He shrugged sadly.

The point is, aside from the inconvenience of driving a couple of hours from home, the Dartmouth-Hitchcock doctor had nothing more to offer me than my local doctor. I don’t know what the difference was in fees, if any. I have good – and very expensive – insurance. But what is the advantage to the consumer of Dartmouth-Hitchcock and its new prospective partner taking over more of the state’s health care? It may be convenient for doctors and patients to easily share records, always bearing in mind the risk of rogues hacking into them. Nor am I advocating against easy access by patients to specialists. This efficiency is good, but again, the flip side is that in economic terms the competitive incentive can too easily be diminished.

We’re thinking a lot about this these days as we see power concentrated and competition squeezed out. Monopoly is concentration of power. When the antitrust laws were first enacted, the power was industrial. Today monopoly has invaded every sector of our democratic and political economy, and we are beginning to talk about the threat to our very democracy.

Democracy involves liberty, as Louis Brandeis said. “Not merely political and religious liberty, but industrial liberty also.” He believed the Madisonian concept that self-government “hinges on the ability of citizens to control and check private concentrations of economic power.”

We have been forced to recognize the tragically unequal access to health care in our wealthy country caused largely by monopoly. That so many people can’t afford care or any insurance is shocking. For whatever reasons, there are still people in positions of power who claim that additional concentration of power helps people. I don’t see it.

(Katharine Gregg is a poet and essayist living in Mason. She can be reached by email at

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