From Farm Lights to Healthcare Heights: How Cooperatives Solve America's Toughest Challenges

[00:00:00] Before we start, I want to invite you to Rosetta Fest 2026 in Nashville. This is where employers, unions and clinicians who are cutting healthcare costs 20-50% while improving care and outcomes share exactly how they did it. Operators learning from operators with patients at the table. Learn more and register at rosettafest.org. Now let's get into today's conversation.

[00:00:27] Remember those Iowa farmers who built six miles of power line before they even had a power source? They created a national template simply by solving their own communities problem. The same pattern that electrified rural America is playing out right now in healthcare across the country. The system designed to serve us is extracting from us instead. But like those farmers a century ago, pioneers are proving there's a better way. A hundred years later, we're at the exact same moment with healthcare.

[00:00:54] American ingenuity is alive and ready. It's just waiting for us to remember who we are.

[00:01:17] So picture this, Iowa, 1916. A group of farmers start building six miles of power line to their farms. Here's the bold part. They built that infrastructure before securing a power source. They just started digging holes, setting poles, and stringing wires across the prairie. Their neighbors probably thought they'd lost their minds. But those farmers understood something.

[00:01:55] They just started digging holes. They just started digging holes. They just started digging holes, setting poles, and they just started digging holes in the middle of the country.

[00:02:11] I'm Dave Chase, and this is Relocalizing Health. And what those farmers stumbled upon wasn't unique to electricity. It's a pattern that shows up over and over in American history. When people face what seems like an impossible problem. I call it the 3-2-1 framework. And once you see it, you'll recognize it everywhere. Here's how it works. There's three stages that repeat every time. First, there's some plucky pioneers prove it's possible. Second, proof spreads as others see it works. And the

[00:02:41] And then third, some smart government amplifies what's already succeeding. And there's two types of people that make it happen. There's dreamers who actually do the work. There's then pragmatic enablers who help scale it.

[00:02:59] And one trigger that kicks it all off is a market failure. When the system that's supposed to serve everyone only serves a privileged few. So let me show you what this looked like with electricity. Stage one, you know, with those pioneers. In 1914, there was 26 farmers in Stoney Run, Minnesota. And they built their own power system after the electric company said, yeah, it's not profitable enough to serve them.

[00:03:26] And that same year in Iowa, farmers at the farmers electric cooperative did what sounded pretty insane. They built that infrastructure before they even secured the power. And then there was also California farmers forming these mutual associations. And Nebraska farmers in Howard County strung their own lines. These were definitely not big organizations. They were as small as six farmers getting together. But it was neighbors helping neighbors because the market had failed them.

[00:03:53] And then you get into stage two. And the proof spreads. By the early 1900s, hundreds of these little experiments were working. Farmers who'd been told, hey, it's impossible. They were doing it anyway. And their success inspired others. The pattern was clear. Communities could solve their own problems when given the tools and given the freedom.

[00:04:14] And then you get into stage three. And that's when the government amplifies. That came in 1935. The president amplified what farmers had already proven worked. There was a Rural Electrification Administration and a Rural Electrification Act a year later that provided low interest loans and technical support while maintaining that fierce local control.

[00:04:38] And the results were in the results were in the world. And the results were really impressive. In that time frame, only 10% of rural America had electricity. By 1953, 90% had power. And today, as I mentioned earlier, there's 42 million Americans that are getting the power from 900 different cooperatives that cover more than half of the land mass of our country.

[00:05:02] And it was really impressive that they only had a 1% default rate on those loans. That last number tells you everything. When communities own their own solutions, they make them work. And now here's what I really love about cooperatives. They drive ideologues on both sides crazy because they transcend politics. You know, Ronald Reagan called cooperatives people's capitalism.

[00:05:26] Local control, personal responsibility, keeping government out of your business. Bernie Sanders champions their democratic structure. You know, one person, one vote. Well stays local. Workers have power. You know, the reality is they're both right. Cooperatives are fundamentally an American thing. And when the market fails, communities solve these problems for themselves. So that's the pattern. Now let me show you how it's playing out right now in healthcare.

[00:05:53] If you listen to one of our recent episodes about the healthcare system collapse, you know we're facing a massive market failure. The system designed to serve us is extracting from us instead. But like those farmers a century ago, pioneers are proving there's a better way. So over the past several years, I've been documenting these success stories. Ashtabula, Pfeiffer Inc., and hundreds more that have never been publicly shared. These are stories of communities taking back control of healthcare.

[00:06:22] And what I discovered is super impressive. The same pattern that electrified rural America is playing out right now in healthcare across the country. Stage one. Let me tell you about Patrick Blackhaller up in Wisconsin. He runs the Employer Healthcare Cooperative of Wisconsin. Yes, it's an official cooperative. He's built something remarkable by going back to the basics. You know, networks with independent providers that actually put patients first.

[00:06:48] And here's what it looks like in practice. Employees use these high-value providers and have zero out-of-pocket costs. Take the ALBA birth center they partner with. Maternity care that would typically cost families $5,000, $10,000 out-of-pocket completely free for their members. Why? Because high-quality maternity care at birth center costs the plan half of what it would and the hospital charges and outcomes are better.

[00:07:16] So Patrick eliminates the members cost entirely, rewarding the smart choice. Let me tell you about Ashtabula, Ohio. Population about 100,000. One of the poorest counties in that state. They'd become a medical desert with not a single independent primary care physician remaining. And they started what we call a community-owned health plan. And to be clear, Ashtabula is at stage three of six stages of a community-owned health plan development. And they're working towards becoming a full cooperative.

[00:07:46] But they're following the same principles. Local control, transparent pricing, putting community first. The Great Lakes Community Health Plan, that's what they call it, started with a private sector employer, then a school district that was one of the poorest in Ohio. And year one results of that school district, they only had 300 staff, yet they saved $2.4 million, avoided teacher layoffs, avoided transportation cuts, and had better benefits for everyone there. And it's spreading.

[00:08:15] The city of Ashtabula joined in, private employers are, the county, patterns repeating itself. That's when we get into stage two. You know, like Reaver Street Market in North Carolina. They're a grocery cooperative that actually has both consumer and worker owners. And they transform their own health plan using these same principles. Another example is the Health Transformational Alliance.

[00:08:40] It brings together 65 major employers, representing 6 million lives, and $31 billion in annual health care spending. And they're saving over a billion annually by taking direct control. Now, let me just make this personal for a minute. My parents were both in a Medicare Advantage plan run by great organizations. For years, the care was extraordinary. Same-day appointments, doctors who knew them, a full care team that included a health coach.

[00:09:08] And they were all focused on keeping them healthy. And then that's when the for-profit health care monster got involved. Tech critic and author named Corey Doctorow, he has a term for what happens when profit-focused corporations acquire something good and systematically degrade it. He calls it inshittification. In fact, he's got a book by that name. And that's exactly what's happened in my mom's care.

[00:09:34] After the takeover, you had distant administrators who knew nothing about her community started making care decisions. They routed my mom to a pharmacy that wasn't in a great area because they didn't really have that local knowledge about quality and convenience. And the decisions that used to be made locally were now being made hundreds or thousands of miles away with people who had never set foot in Seattle where she lives. So stage one, pioneers are proof.

[00:10:04] You know, they prove it works. Stage two, proof is spreading it to more and more employers, unions, and communities nationwide. Now we need stage three, smart government policy that amplifies what's already succeeding. Let me show you what that might look like. This is a real opportunity. Remember, you know, I said this pattern's happened before. Well, it's happened in healthcare too. We just haven't seen it broadly scale. In the mid-70s, Congress passed the Indian Self-Determination Act. It did something revolutionary.

[00:10:32] It gave tribes the authority to take control of federal healthcare programs that had been managed by distant bureaucracies and delivering pretty horrible results. The Alaska Native peoples went from having what many considered the worst healthcare system in America, data points like TB rates 50 times the national average, to creating what many consider the best healthcare system in the world.

[00:11:00] It's called the NUCCA system of care run by the South Central Foundation. 50% reduction in ER visits. 53% decrease in hospital admissions. 33% lower per capita cost compared to national averages. And all that while achieving 95% same-day appointment availability and 90% customer owner satisfaction.

[00:11:24] In the old model, sometimes you'd literally wait six hours in a waiting room to get in if you got in at all. That's all about going from the worst to the best in less than a generation. Cherokee Nation saw this and followed suit. Other tribes are doing the same. What we need now is a Community Health Self-Determination Act. Legislation that would let any community do what the Alaska Native peoples have done. Think about it.

[00:11:50] We've done it with electric cooperatives and serving communities that are rural and quite small. And imagine support for creating these cooperatively owned health plan utilities owned by the community they serve. Remember those Iowa farmers who built six miles of power line before they even had a power source? They created a national template simply by solving their own community's problem.

[00:12:19] 100 years later, we're at the exact same moment with healthcare. So what does this mean for you? What can you actually do? Well, if you're an employer, even a relatively small one. Ash to do it got started with a single employer with only 38 employees. You can start implementing the Health Rosetta Blueprint today. You don't need permission from anybody. You know, things like direct primary care, transparent pharmacy benefits, removing barriers to high quality care.

[00:12:45] These are proven solutions thousands of times you can adopt right now. And the size matters far less than the commitment. And if you're an existing cooperative, boy, you're a great fit. Credit unions, grocery co-ops, worker owned cooperatives. You're already halfway there. You understand democratic ownership. You understand keeping resources local. Transform your own health plan first and then help others in your network do the same.

[00:13:12] If you're a policymaker, you have proven templates to work from, just like what happened a century ago with cooperatives. And we've got the Indian Self-Determination Act. And, you know, back in the electric cooperative days, they had model legislation to bring into the states. We can apply that same kind of proven framework to healthcare. Again, remember those Iowa farmers in 1916? They started building immediately, taking action while others were waiting for perfect policy.

[00:13:42] And they got power, you know, years and years before everybody else. And when that smart policy came along, the Rural Electrification Act of 1936, it amplified their work into national transformation. And here's why this can work across the political spectrum. Conservatives see local control, reduced federal bureaucracy, personal responsibility, communities solving their own problems.

[00:14:05] Progressives, they see universal access, economic democracy, healthcare dollars circulating locally rather than being extracted to Wall Street, and addressing social determinants of health. The question comes down to serving communities versus serving profits. That's a pretty clear choice. And let me be clear about who's standing in the way. These are specific, identifiable actors.

[00:14:34] These are organizations with the biggest lobbying groups in Washington, big healthcare. They're just seeking profits. These are giant health systems, giant insurance companies, giant PBMs, all extracting billions out of the working and middle class in America. And the politicians they fund are paid to maintain the status quo.

[00:14:57] And, you know, again, I want to go back to that episode on system collapse and how you could argue that's already happened in rural America. And we're really going through a rolling collapse. And it's market failure all over again.

[00:15:12] And, you know, when a system becomes more focused on instruction than service and profits than service, and the costs double every decade or faster while outcomes worsen, and when medical bankruptcy becomes the leading cause of personal financial ruin, that's both a market failure and a systemic collapse happening simultaneously. But I've got a lot of hope. Every collapsing system creates space for something better to emerge.

[00:15:41] Rural electrification happened because the market failed rural America. Medicare happened because the market failed elderly Americans. The Indian Self-Determination Act happened because the government was failing tribal communities. Now it's healthcare's turn. All right. Here's what I want you to do. Four specific steps. First, look around your community. Where is the value being extracted? Where are the healthcare dollars flowing out instead of circulating locally?

[00:16:08] Did you know that only 23 cents of every dollar ostensibly spent on healthcare actually goes to the caregivers? And that factors in their benefits. And this is all of the clinicians from, you know, medical assistant through physicians and everything in between. Second, find the innovators who are already doing this work. In Ashton Buell, it started with an advisor named Bryce Heinebaugh and a nurse named Casey Billington. In Wisconsin, it's Patrick Blackholler.

[00:16:33] In Alaska, it was the Alaska Native tribal leaders who refused to accept the status quo. These pioneers exist in your community or they will happily come and serve the community and team up with local pioneers. Find them. Support them. Learn from them. Third, if you're in a position to influence policy, push for enabling legislation. What I would call the Community Health Determination Act happening at the state level would be a great piece.

[00:17:00] Have rural electric cooperative style financing for community-owned health plans. The blueprint exists. We just need political will to implement it. Fourth, spread the word. Share these stories. When people understand that better healthcare is possible, that's not just theory, but it's actually been proven thousands of times, they stop accepting what is really unacceptable, like 100 million people in debt to our healthcare system.

[00:17:27] Now, if you're serious about being part of this transformation, I want to tell you something special. Every summer, we bring together the dreamers and the doers, or as we call them, the enablers. The people actually building the solutions at an event called Rosetta Fest. Last year in Denver, we had over 1,300 people. These are benefit professionals working with employers. It's clinicians like direct primary care docs. It's nurse navigators, healthcare CFOs, union leaders, policymakers.

[00:17:56] This year, we're heading to Nashville, July 29th to 31st. And this is where the enablers and dreamers refine and expand on these ideas, where you can learn practical steps, meet the people doing this work, and get the tools to transform healthcare in your own community. And here's something I'm really excited to announce. I'm publishing a new book. It's been several years since I did the last book.

[00:18:20] This new book is called Relocalizing Health, Taking Back Healthcare, Rebuilding Communities. This book documents the thousands of success stories from the last several years that most people have never heard about. Ashtabula, Pfeiffer, Inc., you name it. Employers saving millions while improving care. Communities taking back control from the extractive system. It's one of America's greatest comeback stories ever, and it harkens back to the electrification of all of America.

[00:18:49] Because here's what I realized. That same 3-2-1 pattern we've been talking about, the pioneers, the proof spreading, the smart policy amplification. It's not just a metaphor. It's an actual blueprint for how America has always solved its biggest problems. The book launches at Rosetta Fest. You can get one of the first copies. Get it signed if you want. More importantly, you'll meet the people in these stories.

[00:19:12] The Bryce Heinebaugh's, the Patrick Blackhawler's, the Casey Billington's, the pioneers who have proven it works every day. And if you're serious about this work, Rosetta Fest is where you need to be. You can find the details at rosettafest.org. And here's what you need to understand. You can make a profound difference today by transforming healthcare in your sphere of influence. One employer with under 100 employees. Add their families, you get up near about 200.

[00:19:41] That's a lot of people, but not a ton. And it's a great place to start. That employer can save money. The employees get better care. Word spreads. Other employers follow. We see it over and over. 300 lives becomes 3,000. 3,000 becomes 30,000. And suddenly you've transformed a community. That's exactly what's been happening in Ashtabula. Proven reality. Repeatable. Anywhere. All right. Here's what I want you to remember.

[00:20:10] When you ask a traditional business, what should we do? The answer is always, what maximizes profit for our shareholders? However, when you ask a cooperative, what should we do? The answer is, what maximizes the benefits for our members, our stakeholders? Same question now. Totally different answer in each of those two instances. That's the difference. That fundamental shift from extraction to circulation.

[00:20:37] From distant shareholders to local stakeholders. That's what transforms communities. You know, a century ago, farmers proved that communities could solve their own problems. Government amplified what was already working. And rural America got electricity. This is actually starting to happen now. We have pioneers proving communities can transform healthcare. Government just needs to amplify what's already working. And America can reclaim the healthcare system from those who've weaponized it against us. I've been documenting hundreds of these stories.

[00:21:07] And a bunch of them will be in Realizing Health. And it's proof that it's not theory. It's happening right now across America. All across America. The pattern works. The blueprint exists. The proof is everywhere. All we need is the courage those Iowa farmers had when they started digging holes and stringing wire across the prairie before they even had a power source. American ingenuity is alive and ready.

[00:21:35] It's just waiting for us to remember who we are. This is Dave Chase. Thanks for listening to Relocalizing Health. And hope to see you at Rosetta Fest.