Windsor, Ontario is a city of 217,000 in a region of 400,000. It has been called "the end of Canada"—it's the country's southernmost city of any size, located across the Detroit River from Detroit, Michigan. Like Detroit, Windsor has a substantial automobile industry, and like Detroit, it's core neighborhoods have experienced disinvestment and population and job losses in recent decades. Even as recently as 2000, Windsor was at a record high number of 28,100 automotive jobs—but by 2007, the city had been buffeted by recession and that number had fallen to 18,200.

Windsor's population is aging, and growth is expected to be flat or declining after 2031. Given this situation, the smartest planning approach for the city would be to double down on its core strengths and prioritize essential maintenance of existing infrastructure and levels of service.

Instead, Windsor is short-sightedly chasing growth on its far suburban fringe—and a $2 billion new hospital is the wedge it's using to try to kick-start this growth.

Windsor has two acute-care hospitals, one downtown and one about 4 kilometers outside the core. They are run by the same entity, Windsor Regional Hospital (WRH), which is the region's second-largest employer, with about 4,000 employees. (In Canada, hospitals are funded by the provincial government, and an elected board runs each individual hospital much like a private business, with a CEO and administrative team.)

In 2012, WRH conducted a review of the two aging hospitals and determined it would be better to close them and consolidate their services into one new, state-of-the-art facility. In a series of town hall meetings, WRH went out to the community and talked up the benefits of a brand new hospital. Private rooms, the latest technology—what city wouldn't want that?