It’s a question we’re all asking: Now what?

It’s not only a question we’re asking about health care in America, but here in Casper we’re puzzling over that question as it pertains to Wyoming Medical Center.

Now what, after the proposed collaboration between the state’s two largest health systems — WMC and Cheyenne Regional Medical Center — fell through.

We applaud Wyoming Medical Center CEO Vickie Diamond for answering the question straightforwardly: The center doesn’t know right know.

What seems inevitable in health care here — and across America — is that change is coming, but we’ll be darned if we know what that will look like in even a few years.

Still, the question brings more than a bit of anxiety for Casper and Wyoming, which relies on Wyoming Medical Center as a regional and, in some cases, the only provider of certain medical care.

We understand that health care is fiercely competitive in this environment and so Wyoming Medical Center might keep its strategy held closely. That’s understandable. But, the questions WMC leaders are asking themselves are ones the community would do well to ponder, also.

For example, what’s our identity worth?

For a state that values in the extreme its own rugged, individual and unique identity, it is reluctant to cede any affiliation to some non-Wyoming interest. That plays out in health care by many communities — Casper included — having its own stand-alone medical providers, down to the doctor level.

But that autonomy and independence may come at a price.

Wyoming is fond of telling outsiders and newbies: We don’t care how you did it back home. But that refrain may not be especially helpful when it comes to considering health care.

In many other communities — and most likely in ours — health care, because of the minuscule margins and heavy demand, has had to consolidate and collaborate. With overhead and increasing red tape from the government and insurance companies, doctors may not be able to afford to keep a stand-alone practice. Newly minted doctors may want to be surrounded by colleagues and business partners.

Consolidation and collaboration may be the best shot Casper and Wyoming have at expanding access to health care providers.

But that would come at a cost.

Diamond has said that Wyoming Medical Center and any partnership, merger or acquisition cannot be a matter of the Casper facility becoming just “a notch in someone else’s belt.”

We agree with that sentiment. Still, if becoming part of another group or system of health care business means more access or better leverage to attract more providers, then how much does our Wyoming or Casper identity really matter? At some point, when you’re sick or in an emergency situation, you probably don’t care about the logo on the name tag or lab coat as much as you need the letters “M.D.” or “Dr.”

Another consideration for the community and not just Wyoming Medical Center is one of cost. What does it cost to be just one stand-alone facility? Does affiliating or being acquired mean that cost of health care goes down?

Finally, any discussions about health care in the community also have to include Mountain View Hospital, which performs surgical procedures, too. What about Elkhorn Rehabilitation? How does it fit into the picture? How might partnerships and affiliations strengthen the marketplace for health care consumers in Casper? Can Wyoming Medical Center survive going it alone with plenty of competition in the marketplace already?

There may not be immediate answers to any of these questions. The answers may only be made more difficult by the implementation of the Affordable Health care Act, often called “Obamacare.” While it is ultimately up to Diamond and her board to determine our community’s most notable health care institution’s future, because the county and community have a significant stake in it, we need to consider what is our identity worth, and how do we improve access here in Casper?

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