There’s a serious condition spreading across the Land of 10,000 Lakes — and it’s called health care costs.
In 2024 alone, health care cost Minnesotans a staggering $61.2 billion, according to the U.S. Bureau of Economic Analysis. That’s not a minor symptom — that’s a fiscal fever.
Families across Minnesota feel it every month in premiums, deductibles, and out-of-pocket bills. The trend line isn’t flattening. It’s climbing. The meter is running, and relief hasn’t arrived.
Let’s get the diagnosis right.
In a truly socialized health care system, the government owns the hospitals, employs the doctors, and runs the delivery model. Minnesota is not fully there, yet. Most hospitals remain private nonprofit systems or private enterprises.
But we are far from a free-market system.
Minnesota operates under one of the strictest hospital expansion laws in the country. In 1980, amid rising health care costs, lawmakers passed a hospital moratorium. The goal was cost containment. The law prohibited the construction of new hospitals and restricted adding licensed hospital beds unless the Legislature granted specific approval.
In other words, expanding hospital capacity didn’t just require capital or community need — it required a vote at the Capitol.
Lawmakers feared a “medical arms race,” arguing that competing systems building new facilities would drive up spending. So instead of allowing growth, the state froze it.
The theory was simple: fewer beds, fewer buildings, fewer bills.
More than four decades later, costs continue to rise. That raises a fair question: did that 1980 prescription cure the illness — or merely suppress competition while new pressures quietly built beneath the surface?
Then came 1981.
The Legislature enacted Minnesota’s Primary Service Area (PSA) law for ambulance services. Under this framework, each geographic region is assigned to one licensed ambulance provider. The system is overseen by the Minnesota Emergency Medical Services Regulatory Board, which regulates licensing and service territories.
There is no set “purchase price” for a PSA itself. But gaining control of one typically requires acquiring the existing ambulance service’s vehicles, equipment, personnel, and contracts — often at significant cost. Once assigned, that provider holds exclusive rights within that territory.
Like the hospital moratorium, the PSA system was designed to prevent duplication and stabilize service coverage. But it also limits direct competition. In some areas, staffing adjustments and financial strain have coincided with longer response times. Minnesotans are noticing.
Now flip the chart back to today and check the vitals.
Health care costs continue to climb. Affordability feels anything but affordable. Hospitals and ambulance services alike report financial pressure. At the same time, Minnesotans face rising premiums, tighter bed capacity, and delayed ambulance responses in certain regions.
The system is strained — patients and providers both feel it. My city feels the symptoms of this untreated disease as do my other mayoral colleagues.
In 1980, Medicare reimbursed hospitals under a cost-based model. Utilization was lower in part because chronic disease rates were lower and medical interventions were less complex. Today, Medicare operates under fixed payment formulas while patients present with more chronic conditions and care is more technologically intensive. That has reshaped both reimbursement and delivery.
But regardless of payment model, one thing is clear: regulation alone has not solved the cost problem.
It’s time for a new clinical trial — one focused on reform.
Let’s examine meaningful hospital and ambulance reform with fresh eyes. Let’s review regulations that may have once been well-intended but now protect systems more than patients. Reform doesn’t mean abandoning oversight; it means modernizing it.
Throughout American history, competition has driven innovation, improved quality, and disciplined prices. When markets function with transparency and accountability, inefficiency gets exposed and performance gets rewarded.
Health care should not be immune from those forces.
Minnesota’s health care framework deserves scrutiny. Policymakers should consider whether limiting hospital growth and assigning exclusive service territories continues to serve the public interest — or whether it unintentionally shields incumbents from competitive pressure.
Let competition expose inefficiencies.
Let competition encourage innovation.
Let competition improve response times.
Let competition reward providers who deliver value.
Patients deserve a system designed around access, affordability, and accountability — not one shaped primarily by decades-old regulatory assumptions.
Health care reform is complex. But doing nothing while costs rise and access tightens is not a solution.
It may be time to write a new prescription — one that puts patients first and allows smart, responsible competition to play a role in restoring balance to Minnesota’s health care system.
Jackson Purfeerst is mayor of Crosslake, Minnesota.
The views and opinions expressed in this commentary are those of the author and do not represent an official position of Alpha News.
Jackson Purfeerst
Jackson Purfeerst is mayor of Crosslake, Minnesota.
