When the billionaire owner of the Minnesota Vikings football team decided last year he wanted a new, $1 billion stadium, he did what sports franchise owners often do: threaten to relocate to another state—at least implicitly—and thereby wrung nearly $500 million dollars from taxpayers. In May the Democratic governor, Mark Dayton, had to scramble to shore up large funding shortages for the stadium, proposing new taxes to rescue the wildly profitable sports team.

That negotiation tactic is hardly uncommon in the sports world. But this year, a different kind of local juggernaut threatened to take its business elsewhere unless Minnesotans helped pay for a multibillion-dollar new development: The Rochester-based Mayo Clinic, one of the world's premiere destination medical centers, wanted to double its already massive campus, and its president and CEO, Dr. John Noseworthy, said in an April interview that "there are 49 states that would like us to invest in them."

Point taken, the state legislature in May approved $585 million in city, county and state funds for infrastructure upgrades to accommodate Mayo's 20-year, $5.6 billion expansion. (Mayo itself is covering $3.5 billion of the cost, while healthcare-related businesses are expected to contribute $2.1 billion.)

Worried that Obamacare will hurt its bottom line, Mayo is betting its future on its ability to lure an greater percentage of the wealthiest and sickest patients to its dazzling high-tech hospitals. The goal is to become not "one of," but the premier destination medical center of them all—the first choice for even the most winter-phobic of the global rich and sick. This race for supremacy includes not only American centers like the Cleveland Clinic, Houston's MD Anderson Cancer Center, and Baltimore's Johns Hopkins, but also ultra-toney destination hospitals sprouting in medical-tourist hotspots abroad, like Bangkok and Singapore. (Mayo’s patients come from all fifty states and about 150 countries.) A windfall awaits the winner: Worldwide, the market for medical destination is in the $60 billion range and growing at a 35 percent clip, according to a 2009 Deloitte & Touche report.





In order to accomplish this, though, Mayo has decided that Rochester, population 108,000, needs to double in size, too—that a small Midwestern city surrounded by endless cornfields must transform itself into one of America’s most dynamic, overachieving medium-sized cities: a Boulder, Colorado, or Madison, Wisconsin, but overrun with doctors instead of outdoorsmen. “The Mayo Clinic as an entity is a five-star experience. We want Rochester to be able to offer the same. We need more options,” Bradly Narr, Mayo’s head of anesthesiology and director of the Mayo’s new destination medical center division, said.