When people hear the phrase relocalizing health, a lot of them assume it is a slogan, a policy proposal, or someone's political talking point. This episode explains what it actually means.
Dave Chase defines it plainly: treating your community's healthcare dollars as a community resource instead of an extractive expense that leaves town the moment it is spent.
Most communities, healthcare is the biggest industry. Most companies, it is the second biggest cost item. And most of the money flows straight out to distant corporations and shareholders. Dr. Michael Fine calls it medicine as colonialism. Dave calls it extraction dressed up as care.
In Ashtabula County, Ohio, roughly $450 million leaves the county every year. That is not a healthcare problem. That is an economic development catastrophe.
Relocalizing means keeping that money home.
But this episode goes deeper than a definition. Dave explains why every major reform effort has failed, regardless of ideology, and why they will keep failing until two structural flaws are addressed. The first: healthcare and social care are funded and governed in entirely separate silos, even though 80 to 90 percent of health outcomes are determined by things outside of the healthcare setting, like food, education, housing, and transportation. The second: healthcare decisions are made at the wrong scale, either way too large at the federal or state level, or way too small at the individual provider level, missing the Goldilocks zone of roughly 25,000 to 700,000 people where community-scale governance actually works.
He then shows what right-sized governance looks like in practice. Jonkoping County in Sweden. The Nuka System of Care in Alaska. Rosen Hotels in Orlando. Ashtabula County in Ohio. Different politics, different governance structures, different geographies. Identical in two things: integrated funding and right-sized governance.
And he closes with the most American story he knows. Rural electrification. A century ago, less than 10 percent of rural America had electricity. Private utilities said serving rural America was impossible. Communities formed electric cooperatives and did it themselves. By the 1950s, 90 percent of rural America had power. Today almost 900 cooperatives serve 42 million Americans across 56 percent of the US landmass.
That is the playbook. The pioneers in this book are the farmers laying line before anyone in Washington figured it out.
Key Takeaways:
- Relocalizing health means treating your community's healthcare dollars as a community resource instead of an extractive expense
- Dr. Michael Fine frames the status quo as medicine as colonialism: colonial powers extracting both money and wellbeing from communities through the healthcare system
- Ashtabula County: $450 million extracted annually from a county of 100,000 people. That is not a healthcare problem. That is an economic development catastrophe.
- Two structural flaws explain why all reform fails regardless of ideology: (1) healthcare and social care are funded and governed in separate silos even though 80 to 90 percent of health outcomes are determined by social factors, and (2) governance operates at the wrong scale
- The Goldilocks zone for right-sized governance is roughly 25,000 to 700,000 people. County scale. District scale. The size of Iceland.
- The master key: when one entity invests in prevention but a different one reaps the savings, no one has a reason to invest upstream
- Jonkoping County, Sweden: unnecessary hospital days for complex patients fell over 90 percent. One hospital cut staff beds by 30 percent. Cost of care in the last two years of life cut nearly in half. Population: 120,000.
- Nuka System of Care, Alaska: ER visits down 43 percent, hospital admissions down 53 percent. Went from worst health outcomes in America to some of the best.
- Rosen Hotels, Orlando: cut healthcare cost inflation to match regular inflation. Savings poured back into employees and the surrounding community.
- Sweden used a county council. Alaska used a tribal council. Ohio used public and private employers. Florida used a hotel company. Different every way except two things: integrated funding and right-sized governance.
- Multi-stakeholder cooperatives serve 12 percent of the population in Italy and provide 85 percent of care services for elders, children, and the disabled in Bologna
- Rural electrification: by the 1950s, 90 percent of rural America had power through cooperative ownership. Today 900 cooperatives serve 42 million Americans across 56 percent of US landmass.
- Father José María Arizmendiarrieta built Mondragón from a technical school in a war-scarred Basque town under Franco's dictatorship into the largest cooperative complex in the world. If it could be done there, American communities reclaiming their healthcare is not idealistic. It is almost modest by comparison.
- Ronald Reagan praised cooperatives as people's capitalism. Bernie Sanders praises them as democratic institutions. Cooperatives are genuinely post-political.
Resources Mentioned:
- Relocalizing Health by Dave Chase: pre-order on Amazon now
- On Medicine as Colonialism by Dr. Michael Fine
- RosettaFest 2026: RosettaFest.org
- Health Rosetta: healthrosetta.org
- Nautilus Health Institute
Learn More:
RosettaFest 2026 - https://rosettafest.org/
Health Rosetta - http://healthrosetta.org/
Nautilus - https://www.nautilushealth.org/
Kynexions - https://kynexions.com/
Dave Chase - https://www.linkedin.com/in/chasedave/
Podcast Website - https://relocalizinghealth.com/