America, where every city is a health-care industry mecca

So I'm riding into Louisville from the airport this morning (I was in town to give a speech to the local CFAs), and I asked my host about the local economy. He reeled off a few employers and then said, "health care, health care's really big here."

Funny thing: I was in Winston-Salem a couple of months ago and heard the same thing. My memory's not so clear on Richmond and Buffalo, which I've also visited recently, but I think health care came up as a major local industry in those cities too. I used to live in Birmingham, Ala., which was formerly all about steel but now prides itself as a medical metropolis. And then there's Pittsburgh, and ...

It seems like, in every smallish big city in America, health care is a key pillar of the local economy. To some extent this is natural: as Barbara said when I ran this by her, retail is a key  pillar of every local economy too. But nobody mentions that to you as you drive into town, while they almost always point with pride to the local health care industry as if it's some kind of national leader. Which of course can't be true of every smallish big city in America.

So what's going on? Maybe it's just that I've been going to cities with particularly strong health-care sectors. And it's certainly possible that lots of different cities have particular specialties that are of national or global importance: Birmingham has the knee-surgery guy, Winston-Salem has its cancer center, Louisville has Humana.

But I think mainly its just evidence that the health care industry has grown everywhere, and as it has become more specialized, almost all of that growth has been in cities of a certain size and up. So you get these more-concentrated centers of medical activity, but mainly all they're doing is serving the ever-growing health-care demands of the local population, plus sucking in patients from outlying rural areas and smaller cities who used to stay closer to home. They're not really adding much of any wealth to the regional economy.

Not that I have any quantitative evidence of any of this. No time for that! I've got to catch a plane back to New York. I hear it's got some great hospitals.