By Shannon Brownlee and Vikas Saini

One hundred and twenty-five years ago, Louise Wotring Lyle, a doctor and widow of a Presbyterian minister, opened the six-bed hospital that would ultimately become the University of Pittsburgh Medical Center (UPMC).

UPMC has since evolved from this modest, charitable hospital to a $16 billion global health enterprise. Somewhere along the way, the institution seems to have lost track of its stated mission to serve the surrounding community.

As a public charity, UPMC receives about $200 million in tax breaks annually. By law, non-profit hospitals are required to provide medical services or other support, such as donations to community groups, that improve the health of the community they serve.

However, unlike many other hospitals of similar size, UPMC is not putting resources into services that are needed most by Pittsburgh. Rather, it is prioritizing activities with the greatest opportunity for profit. The proposed $2 billion UPMC expansion, involving three new specialty hospitals, will not make Pittsburgh any healthier. But it will make UPMC richer.

If UPMC is allowed to continue down this path - while it continues to acquire other hospitals in the state - more Pennsylvania communities will see their health needs play second fiddle to UPMC's cash reserves.

Allegheny County's health problems have been widely documented. They include obesity, asthma, binge drinking, and tragic health disparities among those with low to middle incomes and people of color.

In 2016, 15 percent of residents of the county said they didn't have a primary care provider, an increase from previous years. Pittsburgh needs more community clinics, more access to primary care for its residents, and more investment in nutrition and fitness programs. UPMC's own community needs assessment calls for more preventive care, like smoking cessation programs, and better care for people with chronic diseases like diabetes.

That's not what UPMC is investing in.

The high-tech vision center it wants to build is not intended to primarily serve the people of Allegheny County. In fact, UPMC will cater its marketing and outreach to rich patients from abroad. The other two hospitals UPMC wants to build are located in suburbs.

Why?

Because, as bank robber Willie Sutton once said about banks, that's where the money is. People who live in the suburbs have better insurance policies. The people who most need help improving their health generally do not.

UPMC officials argue that the new hospital centers will boost Pittsburgh's economy, by bringing paying patients into the city and creating jobs.

But UPMC makes no similar promises regarding jobs at their new facilities. Most of the statements UPMC has made in the press, at hearings and in materials submitted to the City of Pittsburgh have been curiously free of any discussion of jobs. Even worse, UPMC's service and administrative workers regularly report they are paid unlivable wages and are subject rampant union-busting, which makes the community poorer.

Pennsylvania is fooling itself if it believes in "trickle down health." Real health is created by direct investment in jobs with real wages, education, safe and affordable housing, and healthy food. The experiences of Cleveland and Boston show what happens when this best practice is ignored.

Cleveland Clinic has faced criticism for expanding its services to attract international patients while investing little in the impoverished and unhealthy neighborhoods around it. The Massachusetts Health Policy Commission recently called out the Boston Children's Hospital for its expansion plan that will make Children's a near monopoly and increase health costs by millions.

There's a better way.

One that's focused on the needs of communities. Hospitals in Maryland are rejecting investments in high tech, hospital-based care and are instead moving out into the community to prevent unnecessary hospitalization. That approach can create many more jobs for more communities.

This year, Maryland switched to a global budget system where hospitals are paid a set amount each year and then get to keep more funds if they keep more local residents healthier and out of the emergency rooms.

With consent decrees and other recent regulatory actions, Pennsylvania officials aren't unfamiliar with what it takes to hold UPMC at least somewhat accountable to the mission of its founding.

Now that UPMC plans to spend $200 million of taxpayers' money, it's time for regulators to take action.

UPMC should either be stripped of its tax-exempt status or face restrictions on this proposed expansion and be required to make a more meaningful investment in community health.

Imagine what $2 billion could do for addiction recovery programs, for care at home and in community clinics, for programs for fitness and nutrition for the elderly, and anyone else who needs them, for school clinics and more. Imagine what that could do for the health and jobs in the region.

That could be part of the new approach Pennsylvanians need to solve their most pressing health problems.

It's the strategy we need in communities across the country. UPMC has the power and wealth to become a leader of that kind of investment, and serve as a model for hospitals nationwide.

Shannon Brownlee is senior vice president of the Lown Institute, a healthcare advocacy group in Brookline, Mass. Vikas Saini is its president.