The Pluralist Commonwealth is a systemic model, developed and refined over the last forty years by political economist and historian Gar Alperovitz, which attempts to resolve theoretical and practical problems associated with both traditional corporate capitalism and traditional state socialism. A central emphasis is the reconstruction of communities—and the nation as a community—from the ground up. Hence, it might also be called a Community-Sustaining System. The term “Pluralist Commonwealth,” however, is offered to stress the inevitability—for functional as well as scale reasons—of different (plural) institutional forms of wealth democratization.
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Despite Cleveland Clinic’s global presence, the vast majority of the system’s operations are based in Ohio, where the system is the largest employer in the northeast part of the state and second largest in the state. Cleveland Clinic’s main campus alone employs more than 26,000 people, has revenues of nearly $4 billion, and procures more than $1.5 billion in goods and services annually. In recent years, it has adopted a variety of anchor strategies, including shifting a percentage of procurement locally and to minority-owned businesses, participating as an anchor partner in a comprehensive neighborhood revitalization effort, implementing childhood wellness programming in local school districts, and positioning itself as a leader in sustainability.
A 125-bed facility with more than 950 employees, Bon Secours Baltimore is the flagship of the nine-hospital Bon Secours Health System, a $3.3 billion not-for-profit Catholic health system stretching from New York to Florida. As Southwest Baltimore’s primary anchor institution, Bon Secours Baltimore Health System has adopted an approach to community and economic development since the 1990s that focuses on revitalizing neighborhoods and rehabilitating housing, providing family and women’s services, offering youth employment and workforce development, and expanding financial services. As a result, Bon Secours’ larger system has since institutionalized these practices through its Healthy Communities initiative, which is modeled on Baltimore’s approach and requires each system hospital to develop community-specific initiatives that reflect the social determinants of health. Bon Secours Baltimore has also refocused efforts to increase local purchasing from minority- and women-owned suppliers.
Representing the center of a $8.5 billion health system, Mayo Clinic’s hospital operations in Rochester employ more than 33,500 people and maintain 1,132 beds. Mayo operations here also procure more than $1 billion in goods and services annually, profoundly impacting the economies of the state’s third largest city and the greater region of southeast Minnesota. Recently assuming a larger role in spurring local revitalization of the surrounding region and Downtown Rochester, Mayo has begun to consciously target local and diverse suppliers in the area. It also served as the principal funder for First Homes, a community land trust that has to date developed 875 units of affordable housing available to all community residents.
Operating across parts of western Wisconsin, northeastern Iowa, and southeastern Minnesota, Gundersen Lutheran Health System employs more than 6,000 people and has revenues in excess of $1.3 billion. Anchoring the system is its 325-bed hospital and multi-specialty clinic in La Crosse, Wisconsin. I n 2008, Gundersen established an aggressive program called Envision to achieve environmental leadership in the areas of energy conservation and renewable energy, waste management, recycling, and sustainable design. In order to accomplish its goals, Gundersen has set local food-purchasing goals, developed local alternative energy sources, established a multi-stakeholder food cooperative, rehabilitated old buildings into affordable housing and other facilities, built environmentally friendly infrastructure improvements, and offered financial incentives for local homeownership.