David McElroy

We’ve been told over and over that problems with health care in this country prove that the free market has failed. But what if the medical industry is already so regulated that its problems have nothing to do with the free market?

There hasn’t been a free market in health care for a long time, certainly not in my lifetime. Probably not since sometime in the 19th century. An item in the local news this week is a stark reminder of that to me.

In 2008, Trinity Medical Center in Birmingham proposed relocating from an older part of town to a fast-growing area along U.S. 280, very close to affluent southern suburbs. A major hospital company (HealthSouth) had built a state-of-the-art building already, but the company was hit hard in an accounting scandal involving the company’s founder and former CEO. The company unloaded various properties around the country just to survive, including this hospital which was about 90 percent complete. (That’s the new building above, framed by a nice sunset I shot last year.)

Trinity is currently in an older part of Birmingham near downtown that’s declining. The hospital was founded as Baptist Medical Center-Montclair many decades ago, but the Baptist system sold that hospital to a private company a decade or more ago. Before too long, the new management was looking to relocate to a newer facility closer to a suburban population that didn’t have a hospital close by.

In the current location, the hospital competes with various huge hospitals downtown. Although most people don’t realize it, Birmingham is a major center for medical research and health care. The medical industry — clinical and research combined — is the biggest in the area by far.

After an aborted plan to move to the suburb of Irondale, Trinity decided that moving to the unused HealthSouth building was more economical and would provide access to a better market. There was only one problem.

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Why would someone tear down a $4.5 million building that’s only 13 years old? If you’re a government agency, you do it because you simply want to build something else. After all, you’re not spending your own money.

In Birmingham, the local mass transit agency built a fancy new central terminal for buses in 1999. It’s across the street from the Amtrak station, and the Greyhound bus station is a few blocks away, in a location where it’s been for many decades. When the new terminal, shown above, was built, it was supposed to be the first phase of a larger project that would combine a terminal for Amtrak, Greyhound and local transit buses. The agency has been talking about an “intermodal facility” for years.

The Birmingham-Jefferson County Transit Authority is a county-wide, inter-government agency, but it’s the Birmingham city government that drives the bus, so to speak. Mass transit is important to a substantial number of people who live in the inner city, but it’s irrelevant to almost everybody who lives in the suburbs. (I’ve never been on one of the buses and I see many of those big buses riding around the area virtually empty.)

So why is this very expensive new building being torn down this summer? That’s not clear. Nobody seems to ask hard questions — and make them stick — when it’s “government money” involved.

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I’ve been thinking a lot lately about emotional vulnerability. I wrote about this subject about 15 months ago after I discovered social work researcher Brené Brown. I found her TED talk on the subject terribly compelling.

As I’ve continued to think and read about this, I keep uncovering new things to understand about myself — sometimes things I’m not so happy to discover. I knew that the dysfunctional home in which I grew up left all of us feeling shame and fear, but I seem to keep uncovering new layers of the effects it’s had on the ways I’ve lived my life so far.

Over the weekend, I had an epiphany of sorts when I realized the role that shame and lack of vulnerability played when I lost someone important to me about four years ago. I think I’d sort of already known, but it somehow came together in a very clear way that dropped a load of bricks on my head. Or heart. I’m not sure which.

I didn’t realize this for a long time, but I don’t like to take emotional risks, because I’m afraid of being hurt. If you happened to see the piece I wrote for Mother’s Day last week, you might understand why I have a long-term fear of losing women I love. I’ve understand that piece of the puzzle for years, but I don’t think I’d been clear on the fact that I set myself up to lose someone I wanted badly by not being vulnerable — by pulling back when trusting more was the healthy and loving thing to do.

So here’s what I realized.

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