IT HAS BEEN NEARLY a year since Lifespan and Care New England announced their plans to merge into one giant entity that would provide almost 70 percent of hospital services in Rhode Island. The message from CEOs involved in the proposed merger resembles a marketing pitch more than it does a substantive discussion of the many challenges facing our health-care system.

A few weeks ago, the hospitals filed their merger application with the state Department of Health and the Department of the Attorney General — documents in the hundreds of thousands of pages. But both the DOH and the AG deemed the application incomplete because it lacked a small but significant piece of paper: an attestation form that serves to assure us — like a witness before a courtroom — that they are telling the truth, the whole truth, and nothing but the truth.

So maybe it’s time we look a little bit more closely at the details. The long delay in filing and the refusal to certify the complete truth of the application could be attributed to the sheer scope of the proposal and the fundamental requirements of the Hospital Conversions Act. However, it is also a good indication of how much is at stake.

Would such a merger actually benefit the state? How can we even begin to judge this proposal? If it is approved, how will we be able to measure its success or failure down the line?

Would Rhode Islanders be healthier? What are the consequences of failure? If we had only one major system and something went bad in that system (e.g., mismanagement, corruption, price-gouging, a decline in the quality of care), what would be our back-up plan?

During the past year, the DOH and the attorney general’s office conducted searches outside of their respective departments for additional expertise in evaluating the merger proposal. But if we are unable to properly evaluate this application without beefing up our current capacity, how can we even begin to expect to oversee a much more dominant hospital system?

The state law covering hospital mergers, the Hospital Conversion Act, prescribes many specific criteria that the attorney general and Department of Health director must use to determine if a transaction is appropriate under Rhode Island law and standards, including: whether patients — especially in traditionally underserved communities — can access affordable health care; whether essential medical services would remain available for safe and adequate treatment, appropriate access, and balanced health-care delivery; how much of the hospital market the new entity would control and whether the hospitals would continue to safeguard the public trust.

The law was first created when Columbia HCA — a large, for-profit hospital corporation with a less-than-stellar reputation — proposed buying Roger Williams Hospital, and permanently altering the voluntary nonprofit nature of our hospital system. Thankfully, this never happened. Nurses and other health-care workers, professional and labor organizations, and community-based health-care advocates worked together to win the passage of the Hospital Conversion Act, and Columbia HCA backed down.

As we have seen in a recent debate involving cutting Medicare payments to physicians, federal policy has a big impact on our state. Undertaking a major reorganization of our health-care delivery system in Rhode Island — without knowing the full extent of the upcoming changes to federal health-care policy and financing — seems unwise.

Also consider that community hospitals are at risk. As everyone in northern Rhode Island knows, the loss of a community hospital could have huge economic and health consequences for the surrounding community. The majority of community hospitals have lost money in Rhode Island over the past few years. A recent report of a state task force says that unless “systematic changes are made, most community hospitals will face continued financial trouble in the coming years, . . . and one community hospital [Landmark] is in dire financial trouble right now.”

Further, health insurance is increasingly costly and out of reach: The number of Rhode Islanders with insurance is rapidly declining, due to the loss of employer-based coverage and the decision of state government to reduce health coverage under the RIte Care program. In 2006, over 100,000 Rhode Islanders (11 percent of us) were uninsured. This trend will likely increase the uncompensated care at all hospitals, and further drain hospital resources. A recent DOH report found that Rhode Island hospitals had an increase in uncompensated care from $24.6 million in 2005 to $26 million in 2006, up nearly 6 percent.

According to a report by the Rhode Island health-insurance commission in 2006, “the average cost of family coverage is now equal to the annual salary of someone earning the minimum wage.”

Would a hospital merger help address the loss of employer-based coverage? Would it increase the number of Rhode Islanders who are insured? Would the further consolidation of the health-care system do anything to slow the increase in the cost of insurance premiums?

In fact, it is likely to do the opposite: We already have two dominant insurance companies (Blue Cross & Blue Shield and United Health). Thus, if the hospitals increase their clout, it is clear that the weakest parties would be the purchasers of insurance and care — employers and individuals — and any new costs would likely be passed on to us.

Then there’s the shortage of frontline nurses. The current nursing-vacancy rates are too high and many hospitals rely on “travel” nurses, many from other countries. Creating a “super employer” that is far and away the largest employer of nurses, with dominant purchasing power of their labor, is not a solution to expanding the workforce of nurses and other health professionals. One of the significant challenges facing those looking to become nurses and other caregivers are the long waiting times to get into classes. These bottlenecks are directly related to a shortage of faculty at our colleges. How would a merger help us grow the number of needed health-care workers?

Finally, what commitment will the hospitals make to ensure that all Rhode Islanders have access to primary-care services? Boosting primary care is our best shot at reducing overall costs to the system and avoiding costly procedures and hospitalizations. Heroic measures at the end of life and expensive trauma care, while necessary and valuable, are not a substitute for the overall wellness of the state’s population.

We don’t think that consolidating extreme power over our hospitals into very few hands helps get us to a better health-care system. We have achieved very high levels of patient satisfaction within Care New England, while operating alongside Lifespan. The burden remains on the proponents of this merger to demonstrate how it helps address all of the health-care challenges of Rhode Island.

Jay Drapeau is a registered nurse in the Kent Unit of Butler Hospital. Wendy LaPrade is a registered nurse at Women & Infants Hospital. They are both members of the Service Employees International Union District 1199 Executive Board. Their employing hospitals are part of Care New England.