Almost 40 years ago, E. F. Schumacher published Small Is Beautiful: Economics as if People Mattered. He advocated “technology with a human face” and believed an organization’s size should be appropriate to its task. His insights are again relevant and widely read in the book’s recent edition.1
Seattle is home, and I am proud of its beauty, arts, innovative business environment, and more. My friends and patients work at Boeing, Microsoft, Costco, Nordstrom, Starbucks, the University of Washington, the Bill and Melinda Gates Foundation, Amazon, Benaroya Research Institute, Amgen, and countless other creative companies and nonprofit organizations. Each of us is attached to our own locale for its uniqueness. In spite of their diversity, I expect the same trends in health care policy are playing out in communities across the country—the relentless industrialization of health care driven by large and larger organizations. The seemingly inevitable result, in Seattle and elsewhere, is that a few megasystems will control regional health care at all levels. Those planning this future are accomplished and well intentioned but view the world through the perspectives of the large systems in which they trained and worked.