“Money makes the world go round” was a famous lyric sang by Liza Minnelli in the Broadway musical “Caberet.” It’s true now more than ever as we see it played out in the debates over our health-care facilities’ location plans.

Although heath care continues to evolve, the “golden hour” to get people experiencing life-threatening emergencies to an emergency room and then helicoptered to a city trauma center has not. You would think that these facilities would be planned geographically where they would do the most good with people’s health in mind. But it’s money that dictates where emergency rooms go. There is so much money involved that it now far outstrips the ability of smaller local communities to afford them.

Most small hospitals merge or affiliate with a larger system to survive. Westfield was a lucky survivor when it became part of the Allegheny Health Network that Saint Vincent’s in Erie, Pa., is involved in. More typical is what happened to Tri-County Hospital. Instead of following up on its post-flood rebuilding, the University of Pittsburgh Medical Center network, which administered Tri-County’s finances, determined the Gowanda area was too medical-insurance poor to support a nearby emergency room equipped facility and we were lucky to salvage a part-time urgent care unit.

No matter all the state and federal elected officials at the groundbreaking ceremony, much to their embarrassment, the rebuilding plans for Tri-County Hospital were scrapped.

Health officials now have pieced together the downsized post bankruptcy TLC with the money-losing Brooks under the Kaleida Heath Network and it’s now dependent on the dictates and deadlines of state government grants to modernize.

From a financial standpoint, when you see the way hospital costs are reimbursed, it would make more sense to relocate the Brooks facility to Fredonia.

Hospitals deal with life-threatening medical problems with an emergency room. But whether it’s a life-threatening emergency or not, hospitals are required to treat everyone, insured or not, whether they can pay or not.

It is a sad fact that because it’s convenient. People inappropriately use the emergency room as their doctor. This is toxic to hospital finances. You would have much fewer cases like this in Fredonia, where no one would walk to the site as opposed to where Brooks is now where you have pedestrian traffic in all directions from the residential areas that surround the hospital. The trade-off is the critical extra time Dunkirk people would have to drive, (up to five miles), to a Fredonia emergency room.

Along with “liberty”and the “pursuit of happiness,” many think of “life” as an “inalienable right.” But as the publisher reminded us in his column on Feb. 22, Brooks and TLC President Chris Lanski’s view is that local access to the miracles of modern medicine that vanquish life-threatening emergencies is not. Having local heath care is a “prize”— not a right.

There is a lot of behind-the-scenes Victorian novels that have played out over the years involving money and power in planning local health care. And you wondering about the lack of public transparency? To quote a Bob Dylan song lyric: “Look out kid, they keep it all hid!”

The bottom line: The money and power “tail should not be wagging the dog” of what is good emergency medicine for all. But as a Catholic Health Network official told me years ago: “Even the nuns have to work on a margin!”

William Cain is a Gowanda resident.