ROCHESTER, Minn. — Mayo Clinic was thrust into the presidential health care debate on Friday, Dec. 13, when Bernie Sanders sent out a tweet accusing the health network of "corporate greed" and "putting profits over people" in its decision to close a number of rural clinics.

"Mayo Clinic executives have decided to strip away access to health care from tens of thousands of rural Midwesterners – putting profits over people," the Vermont senator's tweet said. "Under Medicare for All, we will end the corporate greed in health care that is leaving rural Americans behind."

The Sanders tweet was linked to a MinnPost article written by Anna Thompson Hajdik, a native Minnesotan and college English teacher. The article was titled "The Mayo Clinic prioritizes profits over patients as rural communities are left behind."

Hajdik and the Sanders campaign argue that Mayo Clinic and other health care systems are contributing to the "hollowing out" of rural America by closing rural clinics in response to declining demand.

"I just think the optics look so bad for them, when they extend their global brand as the disparities continue to widen between rural and urban America," Hajdik said in a PB interview.

In response, a Mayo Clinic spokesman said the clinic is committed to serving all its patients.

"Mayo Clinic is proud to serve over 500,000 patients in the health system," said spokesman Karl W. Oestreich. "We remain committed to providing high-quality services to all of our patients, whether here in Minnesota or abroad, and continue to work to find creative solutions for serving rural communities in the future."

Two months to caucuses

The Sanders tweet also comes less than two months before the first-in-the-nation Iowa caucuses on Feb. 3 kick off the Democratic Party's presidential nominating process.

Health care has figured prominently in Democratic presidential debates. And it has divided the candidates. Some, such as Sanders and Elizabeth Warren, argue for a root-and-branch reshaping of the health care industry, while others, such as Amy Klobuchar and Pete Buttigieg push for a more incremental approach.

Mayo Clinic has lately been the target of critics who say its bottom-line focus has caused it to stray from its foundational principles embodied by Will and Charlie Mayo.

Mayo has, over the last three years, closed or reduced services to small towns, including Springfield, Lamberton, Fairmont, LeRoy and La Crescent in Minnesota, and Waukon in northeastern Iowa. Mayo has also reduced services in Albert Lea, including a labor and delivery unit, and moved them to the hospital in Austin.

At the same time, Mayo is opening its first hospital outside the United States in Abu Dhabi, United Arab Emirates, one of the wealthiest nations on the globe.

Health care ties

A lecturer at University of Wisconsin–Whitewater, Hajdik wasn't aware that the Sanders' campaign had tweeted out her article.

Hajkid lives in Madison, but was raised in Clearwater, a small Minnesota town of 1,700. Two years ago, her hometown's nursing home closed, "something felt acutely" there, she said. She described herself as intensely interested in rural-urban divide issues.

Though not a health care policy expert herself, Hajdik said she has a number of family members employed or retired from health care-related fields. Her mom, Mary Thompson, is a retired Houston County public health nurse. Her sister, Emily Thompson, is a health data planner for Hennepin County who lives in Rochester

Hajdik said her decision to write the article was triggered by the dissonance between Mayo's global ambitions and its retreat from rural America.

"Why are they having all this global expansion when we see such disparities in our own backyard?" Hajdik said. "That just really ticks me off."

In her article, Hajdik argues that Mayo's business model makes sense in the for-profit corporate world. But its status as a non-profit entity that doesn't pay state and local taxes and was recently the beneficiary of a $585 million spending package approved by the Legislature in 2013 imposes a greater "humanitarian" responsibility toward the rural patients it once served.

In previous closure announcements, Mayo officials have described the increasing difficulty of recruiting and hiring physicians to rural clinics. For many such clinics, physicians aren't required to be on call full-time. And many rural places don't offer the cultural amenities that many health care professionals are looking for.

Hajdik doesn't deny that rural parts of the U.S. are in demographic decline, with aging populations and declining birth rates. But disinvestment of those communities is not the answer, she argues. And Mayo, which posed $12.8 billion in revenue in 2018, may be in a stronger position to help than many financially stressed hospitals.

She proposes that the revenue generated by the Abu Dhabi "mega-hospital" go toward a fund to support rural clinics. That would help strengthen the fabric of rural America. It would also be true to the spirit of the Mayo brothers, who paid the bills of their poorest patients during the Great Depression, she said.