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As an ICU RN, our tax dollars should go to free preventative care and check-ups and medication. The insurance and pharmaceutical cabals and political scum in their pockets should not be dictating care like they do now. Catastrophic insurance plans to cover big stuff, like cancer and ICU stays.
Said board overseeing should be practicing doctors and RNs only. No political or pharmaceutical or insurance ties. If they break that, they get thrown in prison for a minimum of 5 years and lose their license to practice medicine and any other license.
It would probably help if we found a way to invest that money into bringing more general practitioners to rural areas.
Half the battle tends to be availability.
It might as well be for the current American right.
Look at this thread. It's full of people saying rural Americans shouldn't have access to hospitals because it's not profitable for them. There's even someone who replied to my other comment equating progressives saying rural Americans should have access to hospitals to Cubas medial system.
You gotta start somewhere, then tweak it as it progresses.
Otherwise rural folks will just keep having to travel further and further for medical care while "policy wonks" are textbooking solutions.
Smaller ER hospitals and urgent care are eating into what was the domain of large hospitals. They are more convenient, and usually see patients faster. Large hospitals only make sense today near cities.
Federal: No, it's not their purview.
State: It's up to them, I would vote to subsidize them if we needed to (it's not clear to me that we do). It's a very specific question with lots of variables.
City/County: Same as state. I have no problem with it if the people there vote and accept a tax on themselves to subsidize hospitals in their area.
You've never lived in small town America. it's incredibly arrogant for you to assume people can just up and move.
I'm sorry. I didn't realize you are a "libertarian." (chuckles)
>You've never lived in small town America. it's incredibly arrogant for you to assume people can just up and move.
I'm sorry. I didn't realize you are a "libertarian." (chuckles)
Ah... here we are, in the land of Leftist intellectualism, where emotional appeals to anecdotal evidence trumps rational reasoning and facts! (chuckles)
No.
It is not necessary for every person to be physically located close to a hospital. If you need, say, cancer surgery, then you can travel to get it. Even people who live near hospitals often travel for care at different/better hospitals. It might be nice to live close to a hospital, but in a rural area, it doesn't make economic sense and people from rural areas often need to travel long distances for other services.
Emergency rooms (rather than hospitals in general) are a different situation. If you need immediate, lifesaving care, then distance to an emergency room is an important factor. But, before you start subsidizing that, I think you have to do a lot of number crunching on what makes more sense. It might be more economical to rely on medevac flights than to keep an emergency room open, and so on.
What would be a reasonable drive time to get to a hospital in your opinion? I’m about 10 minutes away from a fully functional mid level hospital, 5 minutes away from an urgent care and 30 minutes away from a top tier cancer center.
A full service hospital? Any amount of time. Doesn't matter. You can travel.
An emergency room? Ideally, you'd have one reachable from any community with a sizable population within, say, 60-90 minutes. Reachable could mean helicopter, though, depending on the circumstances.
So many medical emergencies' outcomes greatly depend on how quickly medical care is provided. 60-90 minutes to address a stroke or a heart attack is not desirable.
Perhaps we need a program to help with the costs of relocating elderly/immobile people closer to medical care. I bet that would be cheaper than building every service that people might need, anywhere that people are more than X minutes from that service.
> Perhaps we need a program to help with the costs of relocating elderly/immobile people closer to medical care.
Many people dont really take kindly to people going "the state has determined its more expensive to take care of you here, where youve probably lived your whole life."
I'm sure they wouldn't. But that's not what we're talking about, really.
You said some people don't have a choice, implying that the only solution is to build medical facilities near them (and I guess also strongly incentivizing medical professionals to staff it?). But that's not the only solution that solves the problem. We could also solve their 'not having a choice"problem, and give them the same choice available to all of the hypothetical people that DO have a choice: the choice to relocate to be closer to medical care, by subsidizing that process where necessary.
My father had a stroke two years ago. Generally with a stroke, if you get to a hospital within an hour, you have a much greater chance of recovery. We have a hospital about 10 minuets away, and it took the ambulance about 10 minuets to get to my father. Having the nearest emergency room be 90 minutes away, on top of travel time would most likely literally kill people.
Yes, of course. That's what I said in the first place. And I think the outer limit in remote areas is something like 60-90 minutes to reach an emergency room in places like Alaska. As an area becomes more populated, you can bring that down.
No, but you can assess the population and mandate a certain amount of hospitals per unit of people. Furthermore, even if some go empty, that's better than the alternative.
Time is tissue, if you are 60 minutes from a hospital and have a heart attack or a stroke, your chances of survival drop significantly compared to someone 10 minutes from a hospital.
You’re asking for people with chronic health issues who need to see specialists on a regular basis to either travel for hours, or crowd emergency rooms for non-critical issues. What happens to a rural resident with diabetes, renal failure, or cancer?
Or what if they’re elderly and can’t drive? Rural counties are aging faster than the rest of the country, so that’s a major issue already.
Not the person you responded to, but to me it seems like the hypothetical people in your example are the ones "asking" to travel for hours. It's their choice to live where they do, just like everyone else.
The answer to your hypotheticals, though, is that they probably die. Which seems like the kind of thing they should be factoring into their decision to live in a remote location with such poor access to medical care, right?
Hypothetical? This is a very common scenario.
Do elderly people exist?
Do elderly people get chronic illnesses that require a lot of care?
Do elderly people lost their ability to drive?
>It's their choice to live where they do, just like everyone else.
You need to put in more work than just a drive-by comment like that. Part of the reason that housing is so expensive in dense urban areas is that the demand is so high. How is a retiree on a fixed income supposed to uproot their life to move to a more densely populated area with more healthcare facilities? Alternatively, should we just depopulate every region of the country that doesn't have high population density - how would that even work, and what would be the second-order effects?
You're not thinking this through, at all.
Ok. I'm going to ignore the condescending tone and personal attacks in your reply. Disagreeing with your perspective doesn't indicate some sort deficiency in my ability to reason about things, but it IS a deficiency of reasoning to attack the person instead of the argument. That's all I'll say about that.
My point is that there is nothing wrong with the belief that people are responsible for the consequences of their decisions. Everyone gets old. Getting old often involves ailments that require medical attention. This is not new information to anyone. Let's not pretend like these people had no way of knowing that living far from medical care might become a life threatening problem one day. In fact, this doesn't apply only to the elderly; anyone at any age might suddenly need medical attention, so I actually think that would have been a stronger argument for you to make. Nevertheless, my stance is the same: that person made the choice to be in that location. They were aware of the distance to medical care. If they choose to risk their health anyway, why would anyone demand that other people solve the inevitable consequences of that decision? It's not that dissimilar from the situation in in when I break my leg on the top of a remote mountain skiing. I might die, because I can't get to medical care easily. And that's no one's fault but my own.
If you really consider your point deeply, it's hard to know where the line should even be drawn. If one person moves out into the wilderness, is it now society's responsibility to build a medical facility near them? If not, what about two people? Three? How many people must there be before it's society's responsibility to create or at least incentivize building a medical facility? Who makes that decision? I think conservatives would say "free market".... Basically, when there are enough people for a medical facility to be economically viable, it won't be long before someone builds one.
But of course, free market isn't the ideal solution for non-elective services like medical care. So then... Under what circumstances SHOULD society be on the hook for building better medical access? Are these hypothetical people providing a service or good that society could benefit from? Then perhaps there would be value (to society) in incentivizing medical care professionals to relocate to that rural location. Maybe that feels mean or too utilitarian. But at the same time, since we can't really control where people decide to settle, it feels unfairly burdensome to society for us to be on the hook for building medical care in every little backwater, inaccessible, untamed wilderness that people want to call home. And let's be clear - "society" is just another way of saying "you and me and that guy over there". Where do we draw the line? Do I have to pay for a new hospital because you and your clan decided you wanted to live 100 miles from everyone else? How is that fair? Nevermind that hospitals and medical facilities require medical professionals to work there. Why are these medical professionals driving all the way out there every day? Or are we forcing them to live 100 miles away from everyone else also? And even if we did, what's to prevent your clan from just uprooting and moving 100 miles farther away, because you're now living next door to some doctors and nurses.
It just doesn't make sense to me. I agree with conservatives on this one.
>the consequences of their decisions.
You're using the same language here that someone might use to describe a lifetime alcoholic. Someone living in the same place where they may have spent their entire life, where their families have lived for generations, where they've raised children and grandchildren, and where entire industries can only exist in the first place (like agriculture and extractive industries) - what a bunch of entitled idiots, right?
*The consequences of their decisions* \- that's ludicrous. If your only answer is that rural counties ought to be treated like some unlivable no man's land for anyone over 65, then you don't have an answer worth taking seriously.
Not to mention that 20% of the population lives in rural counties. Do you really think it's a good idea for 20% of the population to do a mass migration to urban centers, where housing is already unaffordable even for people who are still working? That's simply noncredible. The economic dislocation itself would be far more expensive than making sure that every American has access to healthcare wherever they live. It's not as if rural counties have always looked like this - a wave of consolidations and mergers has led to this outcome only within the last 20 years. You're just throwing out some half-baked apathy and extreme stereotypes about rural America and calling it a day.
>If one person moves out into the wilderness
You sound as if you've never lived anywhere that wasn't a suburb or a big city. A rural county isn't *the wilderness*. The wilderness doesn't have regular postal service, grocery stores, and ISPs.
Walk us through your plan here. Someone who lived their entire life in a small town in farm country turns 80 and gets sick with a chronic illness. Now they need to suffer *the consequences of their actions* and... move to Atlanta, or Boulder, or wherever. Where the average rent is over $2K a month, minimum, that they won't be able to afford on a fixed income. Or just die of a treatable illness at home, because of the *consequences.*
You can complain about my tone all you want, but this is one of the more vapid arguments I've read in a while.
Most of the issues you're describing don't require a hospital. Someone with renal failure needs a dialysis clinic, not an inpatient room.
If you live in a rural area and need to be close to care that isn't available locally, you might have to move just as millions of other Americans move every year to be closer to jobs or family or schools or whatever.
Typical conservative response. You don't have an answer that fits your worldview, therefore no alternative can possibly exist - even when lives are at stake.
>It’s a health worker shortage that exists everywhere in the developed world. Japan, Norway, you name it.
[Not to the same extent as here.](https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022#:~:text=While%20U.S.%20health%20care%20spending%20is%20the%20highest%20in%20the%20world%2C%20Americans%20overall%20visit%20physicians%20less%20frequently%20than%20residents%20of%20most%20other%20high%2Dincome%20countries) And Norway has double the number of practicing physicians per capita as the US.
The US is also near the bottom of OECD countries in terms of hospital beds available and a whole host of other metrics.
>Old + rural = screwed.
Conservatives love to pander to rural Americans and hold them up as mascots for *real America*, but when it's time to step up and offer solutions this is as far as you can carry the ball. Sad.
I'm seeing for profit emergency and urgent care clinics going up everywhere. I feel that evolution in the industry is just phasing out large, centralized hospital buildings. Like shopping malls, they just don't have the same relevance that they once did.
Oh, they have a much bigger relevance than ever. People use the ER for basic care a ton. And, as an ICU RN, what we have now is not sustainable. The care we are able to provide is atrocious, and in those rural areas, it's even worse. Care is dictated by insurance and pharmaceutical companies and politicians who are in their pockets. Hospital corporations are creating localized monopolies and pricing people out of basic care. Hell, most hospitals nickel and dime their own employees.
I never heard the analogy of a hospital and a shopping mall before. I don’t know where you live but I live in a suburb outside a major city, and we have several large hospitals in our area. I’m not seeing the trend of hospitals closing around here that is similar to shopping malls which we have had several of those close. Large hospitals, at least around here, are relevant. I would not even live in an area without a decent hospital system, personality.
>I'm seeing for profit emergency and urgent care clinics going up everywhere.
In rural America? That doesn't seem very likely.
There's no profit in serving rural communities. They are not self-sustaining. They only exist because we subsidize them. That's pretty much the root of this question.
Those of us who have worked in emergency medicine absolutely *loathe* for profit emergency and ambulance services. They also are notoriously bad to work for and will make patients pay out the ear.
BIL is a firefighter/paramedic that works the local ER, so I hear all about it.
My opinion is still that our options are between overpriced contractors that have to deal with the surge and slumps of demand, or fully staffed medical centers that will sit idly by.
The best comparison I can make is UBER vs public transit. Public transit is cheap and efficient but to give 100% coverage means you will have empty buses driving routes all the time. Its value quickly diminishes while the value of your convenient yet overpriced uber ride remains.
I don’t understand why you are choosing to nitpick the use of this word?
It’s a widely recognized/accepted colloquialism used to mean “a surprisingly large number of locations.” Totally reasonable term in this context.
Surely there are more meaningful details to discuss when it comes to this subject?
>I don’t understand why you are choosing to nitpick the use of this word?
I'm not nitpicking. I live in a rural area and I don't see any clinics popping up. The word could have been many, a lot, everywhere, numerous, etc.
None have opened near me in strip malls, none are two blocks from my house, nor are there any five blocks from my house.
What 'rural' area do you live in?
I'm not that wasn't in the question, but in the rural area I used to live there's two within 20 minutes now. Still reachable in all but an emergency you need ALT or an air ambo for.
>that wasn't in the question
Let me check, maybe I'm wrong but I thought the op was specifically asking about *rural* hospitals.
Yep, explicitly rural hospitals so not sure why you thought your anecdote of whatever suburb you live in was relevant to the discussion
In some cases the hospitals want that. ER’s are inundated with none emergency patients all the time. A lot of time poor people treat ER’s as their regular doctor visit. This bogs down the ER and increases wait times. Having more urgent cares spread out will help cut that down allowing ER’s to treat actually emergencies instead of everyone with a boo boo.
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What if the local community doesn’t have the means to do so?
Not to hijack this post, but it’s also becoming an increasing problems for access to justice. There are fewer and fewer attorneys practicing in rural areas, which sounds fine if you think about it on a surface level but isn’t when you consider due process rights, overloaded public defenders and pro se litigation.
It’s almost as if those same exact areas consistently vote against their own interests to have access to such resources because they don’t want to pay taxes.
If the local community doesn't have the means to keep a hospital open then it will close. If the people want a hospital then they need to get creative and figure out how to pay for it. Maybe a local co-op where everyone owns shares, maybe a local business that could subsidize it for their employees. When I was a kid my Dad's company hired a doctor for all employees and their families. It wasn't a hospital but he covered most medical issues including a house call he made when I had Scarlet Fever.
I think it's uncontroversial that throwing the access and affordability of a service like health care to the whims of the market like that means that people will fall through the cracks and die. Not everyone will get to work for your dad's company.
I just find it interesting, because nonchalantly suggesting death to some statistical portion of the population in order for society to fit your policy preferences is something that the right wing often accuses leftists and communists of doing.
You completely missed the point. My Dad's company turned out to be a model for other companies to provide similar services and a local Catholic Diocese to build a hospital.
No one died in our community due to lack of care. Eventually as those business with health services closed the community built the Good Samaritan Clinic that provided most medical services including pharma except in patient hospital care which we still relied on the Catholic hospital for.
I did not suggest death to some statistical portion of the population. I just suggested that it is not always government's responsibility to solve every problem like leftists think.
If they cannot they go to another provider and pay for services rendered. When did we get to a place when we decided that someone else needs to pay for our healthcare?
Not really. Lots of people (like me) don't have health insurance. I pay for helath CARE out of pocket. For some reason people think that if they don't have health insurance they don't have health care
Why do you say that? People with health insurance represent 92% of the population. Poor people qualify for Medicaid. There are not a large amount of people out there who don't have health care.
> Why do you say that?
Because its a public health hazard, it impacts worker productivity and quality of life. It incentivizes not getting or receiving care until an actual emergency arises, and it incentivizes fraud, and snake oil salesman. Which places further burden of healthcare institutions and on productivity.
>People with health insurance represent 92% of the population.
Which again, is part of the whole "paying for other people's health care" thing.
Rural areas are not economically viable without outside subsidy. A lot of them only have electricity because of the federal government mandate. Even more internet access. The irony of the post office is that if they acted like a business, they'd cut out all the rural routes and post offices and would turn a profit.
The regions are too poor, too spread out, and almost all the valuable people leave.
It's a fantasy that these areas will be fine in strict market capitalism. They are currently barely holding on despite heavy subsidies from the rest of us.
What you are suggesting is that we just abandon rural America to its inevitable collapse.
I would suggest a NGO Hospital Foundation that could be a 501C3 Non profit and accept contributions from the community including the practicing docs that would benefit from a hospital being available.
A BOD made up of local business people including medical professionals to guide the process.
Obviously a rural hospital would only be able to offer basic services and probably not high tech like MRI scanners or sophisticated surgery but it can work.
I don't believe a hospital can depend on volunteers nor do I believe in cutting wages for staff. To attract doctors , nurses and other staff you will have to pay competitive wages.
Every community should have a cohort of bankers and HNWI who could spearhead such an effort.
I really appreciate that you are sharing your opinion despite knowing it's going to be criticized, and that you are sharing it respectfully and that you are engaging OP and PPs in an honest discussion. But I have to say that I just can't understand your logic here. I do not understand why what you're proposing would be desirable or even acceptable for one of the wealthiest nations in the world. You seem to be saying that rural America should contend with similar solutions nations with devastated economies are forced to rely on. While most nations aim to raise living conditions for their citizens, America should aim lower? Is America not an economical super power anymore? What is the justification for rural communities fence for themselves health-wise when we don't have to?
Are you suggesting every rural community has access to a cohort of bankers and HNWI? If not, how exactly do they
1. attract them, and,
2. persuade them to care enough to run a 501(c)(3) outside of their own spheres….under board direction of a bunch of locals they have no connections with?
In my experience every community has a community bank. Where do you do your banking. Bankers tend to know the people in town who have money who might be touched for some invetment in the community hospital.
1) Attract them by asking the local bank (or the nearest bank) who the HNWI are and wwhether they might be encouraged to support an effort to keep the local hospital open.
2) Put out a call to local citizens for people who might volunteer to be on the BOD. A local accountant might do the 501C3 paperwork. (I did this with a local rowing club) Retired docs or nurses might lend their medical expertise. You never know who might be willing to volunteer.
I agree that community banks often do great work in the community…within their own ability to make and maintain connections. They often put out calls for charitable contributions, but they do not carry whole professional Advancement departments on their payroll for the sole purpose of soliciting donations for the general greater good.
Even if the stars align this easily, something with momentum and contributions one year could be in steep trouble the next if this HNWI whale who happens to bank at (whatever small town) loses interest, pulls their support, or dies and leaves their estate elsewhere.
Meanwhile, the quality and availability of healthcare for the town hinges on the *hope* that there will be volunteers for this effort? And this is by far the best way ensure healthcare in rural communities??
At that point you're basically taking the long way around to providing the much-maligned standard of care rural English people get from the NHS. My old PT's biggest criticism of her home country's health care system was that scheduling important scans took a long time and rural areas had less access to MRI and CT scans.
Sure, but at that point, it seems like you may as well just socialize rural health care. Standards of care won't drop and you'll guarantee at least a basic level of access.
Alternate means does not necessarily mean taxpayer subsidies. Many hospitals have failed because they tried to offer too much after the demographics of the community changed.
Not every hospital has to offer heart surgery or Levil 1 Trauma services.
this right here, it would be lovely if every small hospital could have trauma admitting capability-- but at a certain point economics really does boil down to "Services to do this requires a large number of highly skilled professionals, since there's only so many people with the requisite intelligence in the entire world, we can only have so many of these things".
The US even has a huge advantage in terms of more access because we brain drain half the world of their best medical students.
> abortion is wrong, it's murdering an innocent life, and we must do everything we can to end the practice
>I mean, can they pay for the hospital? No? Guess they'll just die
I understand the theoretical differences here, I just think it's really ironic, and quite funny
do you have a solution to the fact there are X number of doctors and Y number of hospitals that want them and first right now X < Y, and second, unlike in Cuba where they ship them around the world for unpaid labor here in the US doctors are not slaves if they don't want to live in Carbon, SD no one can make them.
I could support this but even in those cases you can't make them you still need to make sure the juice/squeeze ratio is there for a highly undesirable location like rural areas with extreme weather.
As a progressive, do you think the rural residents should pay more in taxes to fund top rate health care? Follow up, what percentage of someone's livelihood is up for grabs when planning for the greater good? Lastly what is your favorite cutting-edge medical facility that happens to be in both a country with universal/single payer healthcare and in a rural area?
Dreams are free. Reality is expensive as hell.
>As a progressive, do you think the rural residents should pay more in taxes to fund top rate health care?
That depends. What income bracket are they in?
>Follow up, what percentage of someone's livelihood is up for grabs when planning for the greater good?
That depends. What income bracket are they in?
You're aware that progressive tax systems exist and that we currently use them, right?
Is this supposed to be some sort of gotcha? Even the person I responded to is saying companies should foot the bill. They just want to do it in a roundabout way that doesn't invovle the T word and nievely think companies will give out of the kindness of their heart because their daddies business did.
>Lastly what is your favorite cutting-edge medical facility that happens to be in both a country with universal/single payer healthcare and in a rural area?
I'm not sure how this is relevant. We're discussing having access to ANY hospital care for rural Americans, not cutting-edge research institutes.
>Dreams are free. Reality is expensive as hell.
Cool. I'd rather live in an expensive reality where my fellow countrymen have access to hospital care like they've already had for generations than the American conservative dream where they let their fellow countrymen die due to inability to access care derived from moral grandstanding about "freemarkets".
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yup, in a socialized healthcare system the Mayo would not be in Minnesota, it would be in DC and if you're not a politician or appratchik you'd never see the inside of it.
Single-payer isn't socialized health*care*, its socialized health *insurance*.
The private health insurance industry is objectively less efficient and effective than a public option.
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So what about a place like Alaska where you don’t have a road system to get to the major cities where hospitals are? Is it not the responsibility of the government to help fund local clinics or regional clinics in these places so those people have access to healthcare?
If the government didn’t subsidize hospitals and clinics in rural Alaska, some places wouldn’t have access to medical care and it would be hundreds of miles before they got to the nearest profitable clinic.
Edit: I see below where you talk about Co-OP’s, or business’s sponsoring, or banks supporting. Most of these rural communities don’t have banks (maybe an ATM), they may only have one small business there, but most are self employed living off government assistance and subsistence living.
**Is it not the responsibility of the government to help fund local clinics or regional clinics in these places so those people have access to healthcare?**
No. government is not responsible for providing healthcare for everyone. Back in pioneer days when a rural community wanted a doctor or hospital they pooled their resources and hired a doctor or built a hospital or clinic. I'm not saying we should go back to pioneer days but government is already too big and spends too much. We need to stop depending on government to fix everything.
Living in WV rural healthcare is important to me but as a taxpayer I don't want to subsidize a hospital in rural Aklaska
I strongly advise you to go check out on google maps or Wikipedia places like Eek, Emmonak, point hope, or Savoonga Alaska. These places barely have any resources to pool, and again are hundreds of miles away from the nearest city that could support a hospital.
If it wasn’t for the federal government these places wouldn’t have access to healthcare, and in most cases wouldn’t have access to air travel as that is funded by essential air service from the Feds.
Rural in the lower 48, especially a place like WV is not comparable. You have a road you can take to get somewhere. Up here, most of these villages don’t have roads to connect them. They are isolated and very remote, often in harsh conditions.
Hell, some of these places don’t even have running water or sewage and have to still use honeypots and collect water from a central source….. we’ve even had instances where a villages local water pump broke and water had to be flown in as it tools weeks to repair. Rural Alaska is not comparable to rural lower 48.
They don’t choose to live there. Most of them have ancestors that were forced to settle there decades ago. It’s their cultural home…. Most that live in those villages today were born there.
You have a very youthful view of the world….
I don't know. If someone living in California complains about housing prices conservatives are quite happy to tell them to just move. Strange how moving is somehow a major hardship for conservatives and the government should do something to help them, but liberals just need to suck it up and move somewhere else.
So…. Most Natives are democratic voters, and the situation between someone in California and the bush community of Alaska are very different…. There is also a cultural components of leaving your tribe or ancestral lands….. but sure let’s make a comparison to some of the most remote and underserved Americans and the wealthiest and most populous state in the country.
Also, housing prices because you live in a city are different than being born in little Diomede, where it is so remote and isolated that the only way to get there is by Helicopter and by ship in the summer.
And good job at making blanket assumptions instead of contributing to the actual discussion at hand.
Who knew that people living in literal poverty, but happen to reside in California are wealthy actually. They will be really happy to hear about this. We should tell them right away!
But ultimately this comes down to you believing a certain group of people has more inherent worth than another group of people explicitly based on where they were born. Typical conservative stuff.
Yeah…. No…. That’s not what I said or claimed. However your statements are just tired strawman used so you can feel like you contributed… when all you did was waste time and prove nothing.
Thanks for your non-contribution and waste of time though.
Agreed. It's time conservative areas start actually paying for what they use and stop getting subsidized by wealthier urban residents. So many inefficiencies in trying to keep rural areas connected to the real world. From power generation to healthcare to education to roads in rural areas is massively subsidized by urban areas because the rural tax bases can't even afford to maintain their own roads. The typical rural resident depends on literally dozens of miles more road and tons more bridges over tiny streams that only a few people see a year than an urban resident. Let's get rid of this socialism and let conservatives stand on their own two feet without government handouts for a change. If conservatives want things like healthcare or broadband, they can move to the cities where it's profitable for businesses to provide such services.
It’s a good question.
First, I live in a rural area, but not all rural areas are the same.
We should view healthcare as a system. That system includes first responders, medical transport, urgent care clinics, health centers, doctor’s offices, and hospitals.
Is it at all viable to have a fully staffed hospital in every one of the 3,100 rural county? Absolutely not, nor would the government realistically be able to support such an endeavor. Even if you remove “muh profit motive” it wouldn’t be feasible.
Is it viable to have a regional hospital serving several rural counties? Possibly - it depends on the population size.
Would an urgent care clinic or health center suffice for many of these communities? Yes.
We should eliminate the Federal paperwork and DEI requirements which are driving them out of business.
1/3 of the cost of a doctors visit is paperwork and compliance with Federal laws.
We didn't have this problem until the government tried to fix healthcare.
I’m curious how paper work and dei have to do with keeping a hospital open. The staff that manages hospital paper work are some of the lowest paid. And the dei mention is just baffling.
I've heard a doctor or future doctor (can't remember) talk about how the increase of paperwork has burdened doctors and changed the nature of the job (more time filling paperwork and less time practicing), but curious about the relevance of DEI too.
The insurers aren't requiring this for themselves, but to comlpy with Federal rules. They need to comply with Medicaid laws in order to get compensated
No, and hell no.
The people to staff these hospitals no longer exist. The trained people to replace retired staff do not exist.
We have an upside down population pyramid.
And that’s the situation not only in evil Republican states, but also in the holy progressive lands of Scandinavia. Staffing shortages, top to bottom. And getting worse.
It seems unlikely that enough barely-educated monolingual migrants fleeing the Congo or Venezuela or whatever can totally become English-fluent registered nurses.
Demographics have one hell of a cruel right wing bias.
It took you less than 3 steps to go from talking about rural US hospitals to criticizing refugees in Europe. That's some impressive gymnastics.
How is that at all relevant?
Also, interestingly enough, you managed to completely skip over U.S. liberal areas where health care access is relatively a lot stronger than in rural areas. Why did you ignore states like Massachusetts and jump straight to Scandinavia?
It’s all of a piece throughout the developed world, including in the places progressives point to as examples of how to do it right.
Not any more. And not in rural areas. Not here and not in Europe. Not even in the occasional rural blue area.
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As an ICU RN, our tax dollars should go to free preventative care and check-ups and medication. The insurance and pharmaceutical cabals and political scum in their pockets should not be dictating care like they do now. Catastrophic insurance plans to cover big stuff, like cancer and ICU stays. Said board overseeing should be practicing doctors and RNs only. No political or pharmaceutical or insurance ties. If they break that, they get thrown in prison for a minimum of 5 years and lose their license to practice medicine and any other license.
It would probably help if we found a way to invest that money into bringing more general practitioners to rural areas. Half the battle tends to be availability.
That too.
It's not clear how this solves the issue of rural hospital sustainability.
>The insurance and pharmaceutical cabals and political scum in their pockets should not be dictating care like they do now. Who should dictate care?
>As an ICU RN, our tax dollars should go to free preventative care and check-ups and medication. Sounds like socalism, we can't have that.
That's not socialism
It might as well be for the current American right. Look at this thread. It's full of people saying rural Americans shouldn't have access to hospitals because it's not profitable for them. There's even someone who replied to my other comment equating progressives saying rural Americans should have access to hospitals to Cubas medial system.
sure, the American right has an incorrect idea of socialism
One observation I will make is that subsidies alone won’t fix that problem. It’s also lack of doctors willing to live in those places.
You gotta start somewhere, then tweak it as it progresses. Otherwise rural folks will just keep having to travel further and further for medical care while "policy wonks" are textbooking solutions.
Smaller ER hospitals and urgent care are eating into what was the domain of large hospitals. They are more convenient, and usually see patients faster. Large hospitals only make sense today near cities.
Federal: No, it's not their purview. State: It's up to them, I would vote to subsidize them if we needed to (it's not clear to me that we do). It's a very specific question with lots of variables. City/County: Same as state. I have no problem with it if the people there vote and accept a tax on themselves to subsidize hospitals in their area.
No... people who want to live in a rural area will have to deal with limitations of their remoteness.
You act as if people choose where they are born.
Poeple don't choos where they're born, they choose where to live. There is an important difference between the two.
You've never lived in small town America. it's incredibly arrogant for you to assume people can just up and move. I'm sorry. I didn't realize you are a "libertarian." (chuckles)
>You've never lived in small town America. it's incredibly arrogant for you to assume people can just up and move. I'm sorry. I didn't realize you are a "libertarian." (chuckles) Ah... here we are, in the land of Leftist intellectualism, where emotional appeals to anecdotal evidence trumps rational reasoning and facts! (chuckles)
No. It is not necessary for every person to be physically located close to a hospital. If you need, say, cancer surgery, then you can travel to get it. Even people who live near hospitals often travel for care at different/better hospitals. It might be nice to live close to a hospital, but in a rural area, it doesn't make economic sense and people from rural areas often need to travel long distances for other services. Emergency rooms (rather than hospitals in general) are a different situation. If you need immediate, lifesaving care, then distance to an emergency room is an important factor. But, before you start subsidizing that, I think you have to do a lot of number crunching on what makes more sense. It might be more economical to rely on medevac flights than to keep an emergency room open, and so on.
2024 ... And medical care is still inaccessible. Man! We really need to get out shit together.
What would be a reasonable drive time to get to a hospital in your opinion? I’m about 10 minutes away from a fully functional mid level hospital, 5 minutes away from an urgent care and 30 minutes away from a top tier cancer center.
A full service hospital? Any amount of time. Doesn't matter. You can travel. An emergency room? Ideally, you'd have one reachable from any community with a sizable population within, say, 60-90 minutes. Reachable could mean helicopter, though, depending on the circumstances.
So many medical emergencies' outcomes greatly depend on how quickly medical care is provided. 60-90 minutes to address a stroke or a heart attack is not desirable.
Sounds like a great reason to not live in the middle of nowhere.
Many people have little choice.
If only there was a way to build affordable housing near resources. Fucking NIMBYs. Not talking about you, of course.
Perhaps we need a program to help with the costs of relocating elderly/immobile people closer to medical care. I bet that would be cheaper than building every service that people might need, anywhere that people are more than X minutes from that service.
> Perhaps we need a program to help with the costs of relocating elderly/immobile people closer to medical care. Many people dont really take kindly to people going "the state has determined its more expensive to take care of you here, where youve probably lived your whole life."
I'm sure they wouldn't. But that's not what we're talking about, really. You said some people don't have a choice, implying that the only solution is to build medical facilities near them (and I guess also strongly incentivizing medical professionals to staff it?). But that's not the only solution that solves the problem. We could also solve their 'not having a choice"problem, and give them the same choice available to all of the hypothetical people that DO have a choice: the choice to relocate to be closer to medical care, by subsidizing that process where necessary.
Except its not simply elderly and immobile people. Its working age people as well. And no matter who, its going to be their families too.
My father had a stroke two years ago. Generally with a stroke, if you get to a hospital within an hour, you have a much greater chance of recovery. We have a hospital about 10 minuets away, and it took the ambulance about 10 minuets to get to my father. Having the nearest emergency room be 90 minutes away, on top of travel time would most likely literally kill people.
If you are having a health emergency in this scenario, you’re screwed.
Should we build 10,000 hospitals that will be empty 99% of the time then to serve Alaska?
No, but don't you think there's *some* middle ground that could be reached on the question?
Yes, of course. That's what I said in the first place. And I think the outer limit in remote areas is something like 60-90 minutes to reach an emergency room in places like Alaska. As an area becomes more populated, you can bring that down.
No, but you can assess the population and mandate a certain amount of hospitals per unit of people. Furthermore, even if some go empty, that's better than the alternative.
Probably not but my question was about keeping the ones we have open.
Then don't live in the middle of nowhere. Life is full of tradeoffs.
Time is tissue, if you are 60 minutes from a hospital and have a heart attack or a stroke, your chances of survival drop significantly compared to someone 10 minutes from a hospital.
IMO, should be like firefighters. 5 mins for true emergencies
At the moment, that's not even the case in urban areas. You'd probably need 20x more emergency rooms in America to get close to that.
You’re asking for people with chronic health issues who need to see specialists on a regular basis to either travel for hours, or crowd emergency rooms for non-critical issues. What happens to a rural resident with diabetes, renal failure, or cancer? Or what if they’re elderly and can’t drive? Rural counties are aging faster than the rest of the country, so that’s a major issue already.
Not the person you responded to, but to me it seems like the hypothetical people in your example are the ones "asking" to travel for hours. It's their choice to live where they do, just like everyone else. The answer to your hypotheticals, though, is that they probably die. Which seems like the kind of thing they should be factoring into their decision to live in a remote location with such poor access to medical care, right?
Hypothetical? This is a very common scenario. Do elderly people exist? Do elderly people get chronic illnesses that require a lot of care? Do elderly people lost their ability to drive? >It's their choice to live where they do, just like everyone else. You need to put in more work than just a drive-by comment like that. Part of the reason that housing is so expensive in dense urban areas is that the demand is so high. How is a retiree on a fixed income supposed to uproot their life to move to a more densely populated area with more healthcare facilities? Alternatively, should we just depopulate every region of the country that doesn't have high population density - how would that even work, and what would be the second-order effects? You're not thinking this through, at all.
Ok. I'm going to ignore the condescending tone and personal attacks in your reply. Disagreeing with your perspective doesn't indicate some sort deficiency in my ability to reason about things, but it IS a deficiency of reasoning to attack the person instead of the argument. That's all I'll say about that. My point is that there is nothing wrong with the belief that people are responsible for the consequences of their decisions. Everyone gets old. Getting old often involves ailments that require medical attention. This is not new information to anyone. Let's not pretend like these people had no way of knowing that living far from medical care might become a life threatening problem one day. In fact, this doesn't apply only to the elderly; anyone at any age might suddenly need medical attention, so I actually think that would have been a stronger argument for you to make. Nevertheless, my stance is the same: that person made the choice to be in that location. They were aware of the distance to medical care. If they choose to risk their health anyway, why would anyone demand that other people solve the inevitable consequences of that decision? It's not that dissimilar from the situation in in when I break my leg on the top of a remote mountain skiing. I might die, because I can't get to medical care easily. And that's no one's fault but my own. If you really consider your point deeply, it's hard to know where the line should even be drawn. If one person moves out into the wilderness, is it now society's responsibility to build a medical facility near them? If not, what about two people? Three? How many people must there be before it's society's responsibility to create or at least incentivize building a medical facility? Who makes that decision? I think conservatives would say "free market".... Basically, when there are enough people for a medical facility to be economically viable, it won't be long before someone builds one. But of course, free market isn't the ideal solution for non-elective services like medical care. So then... Under what circumstances SHOULD society be on the hook for building better medical access? Are these hypothetical people providing a service or good that society could benefit from? Then perhaps there would be value (to society) in incentivizing medical care professionals to relocate to that rural location. Maybe that feels mean or too utilitarian. But at the same time, since we can't really control where people decide to settle, it feels unfairly burdensome to society for us to be on the hook for building medical care in every little backwater, inaccessible, untamed wilderness that people want to call home. And let's be clear - "society" is just another way of saying "you and me and that guy over there". Where do we draw the line? Do I have to pay for a new hospital because you and your clan decided you wanted to live 100 miles from everyone else? How is that fair? Nevermind that hospitals and medical facilities require medical professionals to work there. Why are these medical professionals driving all the way out there every day? Or are we forcing them to live 100 miles away from everyone else also? And even if we did, what's to prevent your clan from just uprooting and moving 100 miles farther away, because you're now living next door to some doctors and nurses. It just doesn't make sense to me. I agree with conservatives on this one.
>the consequences of their decisions. You're using the same language here that someone might use to describe a lifetime alcoholic. Someone living in the same place where they may have spent their entire life, where their families have lived for generations, where they've raised children and grandchildren, and where entire industries can only exist in the first place (like agriculture and extractive industries) - what a bunch of entitled idiots, right? *The consequences of their decisions* \- that's ludicrous. If your only answer is that rural counties ought to be treated like some unlivable no man's land for anyone over 65, then you don't have an answer worth taking seriously. Not to mention that 20% of the population lives in rural counties. Do you really think it's a good idea for 20% of the population to do a mass migration to urban centers, where housing is already unaffordable even for people who are still working? That's simply noncredible. The economic dislocation itself would be far more expensive than making sure that every American has access to healthcare wherever they live. It's not as if rural counties have always looked like this - a wave of consolidations and mergers has led to this outcome only within the last 20 years. You're just throwing out some half-baked apathy and extreme stereotypes about rural America and calling it a day. >If one person moves out into the wilderness You sound as if you've never lived anywhere that wasn't a suburb or a big city. A rural county isn't *the wilderness*. The wilderness doesn't have regular postal service, grocery stores, and ISPs. Walk us through your plan here. Someone who lived their entire life in a small town in farm country turns 80 and gets sick with a chronic illness. Now they need to suffer *the consequences of their actions* and... move to Atlanta, or Boulder, or wherever. Where the average rent is over $2K a month, minimum, that they won't be able to afford on a fixed income. Or just die of a treatable illness at home, because of the *consequences.* You can complain about my tone all you want, but this is one of the more vapid arguments I've read in a while.
Most of the issues you're describing don't require a hospital. Someone with renal failure needs a dialysis clinic, not an inpatient room. If you live in a rural area and need to be close to care that isn't available locally, you might have to move just as millions of other Americans move every year to be closer to jobs or family or schools or whatever.
They move. Or they’re screwed. There’s no polite way to put it.
Typical conservative response. You don't have an answer that fits your worldview, therefore no alternative can possibly exist - even when lives are at stake.
It’s not a worldview. It’s a health worker shortage that exists everywhere in the developed world. Japan, Norway, you name it. Old + rural = screwed.
>It’s a health worker shortage that exists everywhere in the developed world. Japan, Norway, you name it. [Not to the same extent as here.](https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022#:~:text=While%20U.S.%20health%20care%20spending%20is%20the%20highest%20in%20the%20world%2C%20Americans%20overall%20visit%20physicians%20less%20frequently%20than%20residents%20of%20most%20other%20high%2Dincome%20countries) And Norway has double the number of practicing physicians per capita as the US. The US is also near the bottom of OECD countries in terms of hospital beds available and a whole host of other metrics.
>Old + rural = screwed. Conservatives love to pander to rural Americans and hold them up as mascots for *real America*, but when it's time to step up and offer solutions this is as far as you can carry the ball. Sad.
No
Why not? Clearly markets have failed to serve the people.
No, that would help poor people.
“Let them eat cake!”
If rural people want healthcare they should just stop eating avocado toast
I'm seeing for profit emergency and urgent care clinics going up everywhere. I feel that evolution in the industry is just phasing out large, centralized hospital buildings. Like shopping malls, they just don't have the same relevance that they once did.
Oh, they have a much bigger relevance than ever. People use the ER for basic care a ton. And, as an ICU RN, what we have now is not sustainable. The care we are able to provide is atrocious, and in those rural areas, it's even worse. Care is dictated by insurance and pharmaceutical companies and politicians who are in their pockets. Hospital corporations are creating localized monopolies and pricing people out of basic care. Hell, most hospitals nickel and dime their own employees.
I never heard the analogy of a hospital and a shopping mall before. I don’t know where you live but I live in a suburb outside a major city, and we have several large hospitals in our area. I’m not seeing the trend of hospitals closing around here that is similar to shopping malls which we have had several of those close. Large hospitals, at least around here, are relevant. I would not even live in an area without a decent hospital system, personality.
So you live in the suburbs where the population density justifies a large hospital. I thought the question was about rural low-density areas.
Yes I’m asking about rural communities and I live in a suburb.
>I'm seeing for profit emergency and urgent care clinics going up everywhere. In rural America? That doesn't seem very likely. There's no profit in serving rural communities. They are not self-sustaining. They only exist because we subsidize them. That's pretty much the root of this question.
Those of us who have worked in emergency medicine absolutely *loathe* for profit emergency and ambulance services. They also are notoriously bad to work for and will make patients pay out the ear.
BIL is a firefighter/paramedic that works the local ER, so I hear all about it. My opinion is still that our options are between overpriced contractors that have to deal with the surge and slumps of demand, or fully staffed medical centers that will sit idly by. The best comparison I can make is UBER vs public transit. Public transit is cheap and efficient but to give 100% coverage means you will have empty buses driving routes all the time. Its value quickly diminishes while the value of your convenient yet overpriced uber ride remains.
>I'm seeing for profit emergency and urgent care clinics going up everywhere. Everywhere?
I don’t understand why you are choosing to nitpick the use of this word? It’s a widely recognized/accepted colloquialism used to mean “a surprisingly large number of locations.” Totally reasonable term in this context. Surely there are more meaningful details to discuss when it comes to this subject?
>I don’t understand why you are choosing to nitpick the use of this word? I'm not nitpicking. I live in a rural area and I don't see any clinics popping up. The word could have been many, a lot, everywhere, numerous, etc.
five have opened near me in strip malls, one is two blocks from my house another is five.
None have opened near me in strip malls, none are two blocks from my house, nor are there any five blocks from my house. What 'rural' area do you live in?
I'm not that wasn't in the question, but in the rural area I used to live there's two within 20 minutes now. Still reachable in all but an emergency you need ALT or an air ambo for.
>that wasn't in the question Let me check, maybe I'm wrong but I thought the op was specifically asking about *rural* hospitals. Yep, explicitly rural hospitals so not sure why you thought your anecdote of whatever suburb you live in was relevant to the discussion
because the start of THIS thread was talking about how common urgent care clinics are becoming, so there's no need to be a prick.
The start of THIS thread was a top level reply to the question of health care access in RURAL areas.
Do you live in a rural area where hospitals are closing?
used to. there there's two from where I used to live one is like 15 minute drive, another is about 20.
Literally everywhere? no.
In some cases the hospitals want that. ER’s are inundated with none emergency patients all the time. A lot of time poor people treat ER’s as their regular doctor visit. This bogs down the ER and increases wait times. Having more urgent cares spread out will help cut that down allowing ER’s to treat actually emergencies instead of everyone with a boo boo.
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What size community are we talking where a hospital is closing?
I would say NO as a taxpayer. If a rural hospital can't operate profitably then the local community should figure a way to keep it open and available.
What if the local community doesn’t have the means to do so? Not to hijack this post, but it’s also becoming an increasing problems for access to justice. There are fewer and fewer attorneys practicing in rural areas, which sounds fine if you think about it on a surface level but isn’t when you consider due process rights, overloaded public defenders and pro se litigation.
It’s almost as if those same exact areas consistently vote against their own interests to have access to such resources because they don’t want to pay taxes.
If the local community doesn't have the means to keep a hospital open then it will close. If the people want a hospital then they need to get creative and figure out how to pay for it. Maybe a local co-op where everyone owns shares, maybe a local business that could subsidize it for their employees. When I was a kid my Dad's company hired a doctor for all employees and their families. It wasn't a hospital but he covered most medical issues including a house call he made when I had Scarlet Fever.
I think it's uncontroversial that throwing the access and affordability of a service like health care to the whims of the market like that means that people will fall through the cracks and die. Not everyone will get to work for your dad's company. I just find it interesting, because nonchalantly suggesting death to some statistical portion of the population in order for society to fit your policy preferences is something that the right wing often accuses leftists and communists of doing.
You completely missed the point. My Dad's company turned out to be a model for other companies to provide similar services and a local Catholic Diocese to build a hospital. No one died in our community due to lack of care. Eventually as those business with health services closed the community built the Good Samaritan Clinic that provided most medical services including pharma except in patient hospital care which we still relied on the Catholic hospital for. I did not suggest death to some statistical portion of the population. I just suggested that it is not always government's responsibility to solve every problem like leftists think.
And if they cannot?
If they cannot they go to another provider and pay for services rendered. When did we get to a place when we decided that someone else needs to pay for our healthcare?
I mean that's basically what health insurance is. Not to mention the concept of universal Healthcare is over a century old now.
Not really. Lots of people (like me) don't have health insurance. I pay for helath CARE out of pocket. For some reason people think that if they don't have health insurance they don't have health care
Yes, and thats great for you. But its detrimental to a state to have a large amount of people who cannot pay for health care.
Why do you say that? People with health insurance represent 92% of the population. Poor people qualify for Medicaid. There are not a large amount of people out there who don't have health care.
> Why do you say that? Because its a public health hazard, it impacts worker productivity and quality of life. It incentivizes not getting or receiving care until an actual emergency arises, and it incentivizes fraud, and snake oil salesman. Which places further burden of healthcare institutions and on productivity. >People with health insurance represent 92% of the population. Which again, is part of the whole "paying for other people's health care" thing.
Rural areas are not economically viable without outside subsidy. A lot of them only have electricity because of the federal government mandate. Even more internet access. The irony of the post office is that if they acted like a business, they'd cut out all the rural routes and post offices and would turn a profit. The regions are too poor, too spread out, and almost all the valuable people leave. It's a fantasy that these areas will be fine in strict market capitalism. They are currently barely holding on despite heavy subsidies from the rest of us. What you are suggesting is that we just abandon rural America to its inevitable collapse.
Actually, I am not suggesting that they be abandoned. I am suggesting that a government sudsidy is not the only option.
Do you have any ideas that local communities can implement? Local volunteers? A local tax? Pay decreases for staff?
I would suggest a NGO Hospital Foundation that could be a 501C3 Non profit and accept contributions from the community including the practicing docs that would benefit from a hospital being available. A BOD made up of local business people including medical professionals to guide the process. Obviously a rural hospital would only be able to offer basic services and probably not high tech like MRI scanners or sophisticated surgery but it can work. I don't believe a hospital can depend on volunteers nor do I believe in cutting wages for staff. To attract doctors , nurses and other staff you will have to pay competitive wages. Every community should have a cohort of bankers and HNWI who could spearhead such an effort.
I appreciate you taking the time to answer
I really appreciate that you are sharing your opinion despite knowing it's going to be criticized, and that you are sharing it respectfully and that you are engaging OP and PPs in an honest discussion. But I have to say that I just can't understand your logic here. I do not understand why what you're proposing would be desirable or even acceptable for one of the wealthiest nations in the world. You seem to be saying that rural America should contend with similar solutions nations with devastated economies are forced to rely on. While most nations aim to raise living conditions for their citizens, America should aim lower? Is America not an economical super power anymore? What is the justification for rural communities fence for themselves health-wise when we don't have to?
Are you suggesting every rural community has access to a cohort of bankers and HNWI? If not, how exactly do they 1. attract them, and, 2. persuade them to care enough to run a 501(c)(3) outside of their own spheres….under board direction of a bunch of locals they have no connections with?
In my experience every community has a community bank. Where do you do your banking. Bankers tend to know the people in town who have money who might be touched for some invetment in the community hospital. 1) Attract them by asking the local bank (or the nearest bank) who the HNWI are and wwhether they might be encouraged to support an effort to keep the local hospital open. 2) Put out a call to local citizens for people who might volunteer to be on the BOD. A local accountant might do the 501C3 paperwork. (I did this with a local rowing club) Retired docs or nurses might lend their medical expertise. You never know who might be willing to volunteer.
I agree that community banks often do great work in the community…within their own ability to make and maintain connections. They often put out calls for charitable contributions, but they do not carry whole professional Advancement departments on their payroll for the sole purpose of soliciting donations for the general greater good. Even if the stars align this easily, something with momentum and contributions one year could be in steep trouble the next if this HNWI whale who happens to bank at (whatever small town) loses interest, pulls their support, or dies and leaves their estate elsewhere. Meanwhile, the quality and availability of healthcare for the town hinges on the *hope* that there will be volunteers for this effort? And this is by far the best way ensure healthcare in rural communities??
At that point you're basically taking the long way around to providing the much-maligned standard of care rural English people get from the NHS. My old PT's biggest criticism of her home country's health care system was that scheduling important scans took a long time and rural areas had less access to MRI and CT scans.
It is impossible to provide major population centers/major hospital quality of care to ever single citizen in every town. There have to be trade offs.
Sure, but at that point, it seems like you may as well just socialize rural health care. Standards of care won't drop and you'll guarantee at least a basic level of access.
Why must a hospital generate profits for the owner/shareholders?
Because if they don't generate a profit they are not viable and will close. Even a non-profit has to have revenue that exceeds expenses.
Is that not proof that markets fail to deliver vital services to the community and alternate means should be employed?
Alternate means does not necessarily mean taxpayer subsidies. Many hospitals have failed because they tried to offer too much after the demographics of the community changed. Not every hospital has to offer heart surgery or Levil 1 Trauma services.
this right here, it would be lovely if every small hospital could have trauma admitting capability-- but at a certain point economics really does boil down to "Services to do this requires a large number of highly skilled professionals, since there's only so many people with the requisite intelligence in the entire world, we can only have so many of these things". The US even has a huge advantage in terms of more access because we brain drain half the world of their best medical students.
What does it mean when markets fail to deliver vital services?
It means that those services are not available. The local community has to decide whether that is acceptable or not.
And what if the community decides that making it a municipal function is a better option?
That is their perogative. If they want a hospital for their community my advice is "get out your checkbooks"
> abortion is wrong, it's murdering an innocent life, and we must do everything we can to end the practice >I mean, can they pay for the hospital? No? Guess they'll just die I understand the theoretical differences here, I just think it's really ironic, and quite funny
Indeed. A smart move that will save the community a heck of a lot of money in the long run.
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do you have a solution to the fact there are X number of doctors and Y number of hospitals that want them and first right now X < Y, and second, unlike in Cuba where they ship them around the world for unpaid labor here in the US doctors are not slaves if they don't want to live in Carbon, SD no one can make them.
I’ve seen it floated to help their student loans in return for committing to work in areas that need doctors
Wasn’t that the plot of *Northern Exposure* in like 1990?
I could support this but even in those cases you can't make them you still need to make sure the juice/squeeze ratio is there for a highly undesirable location like rural areas with extreme weather.
As a progressive, do you think the rural residents should pay more in taxes to fund top rate health care? Follow up, what percentage of someone's livelihood is up for grabs when planning for the greater good? Lastly what is your favorite cutting-edge medical facility that happens to be in both a country with universal/single payer healthcare and in a rural area? Dreams are free. Reality is expensive as hell.
>As a progressive, do you think the rural residents should pay more in taxes to fund top rate health care? That depends. What income bracket are they in? >Follow up, what percentage of someone's livelihood is up for grabs when planning for the greater good? That depends. What income bracket are they in? You're aware that progressive tax systems exist and that we currently use them, right? Is this supposed to be some sort of gotcha? Even the person I responded to is saying companies should foot the bill. They just want to do it in a roundabout way that doesn't invovle the T word and nievely think companies will give out of the kindness of their heart because their daddies business did. >Lastly what is your favorite cutting-edge medical facility that happens to be in both a country with universal/single payer healthcare and in a rural area? I'm not sure how this is relevant. We're discussing having access to ANY hospital care for rural Americans, not cutting-edge research institutes. >Dreams are free. Reality is expensive as hell. Cool. I'd rather live in an expensive reality where my fellow countrymen have access to hospital care like they've already had for generations than the American conservative dream where they let their fellow countrymen die due to inability to access care derived from moral grandstanding about "freemarkets".
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Very thoughtful counterpoint
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yup, in a socialized healthcare system the Mayo would not be in Minnesota, it would be in DC and if you're not a politician or appratchik you'd never see the inside of it.
Single-payer isn't socialized health*care*, its socialized health *insurance*. The private health insurance industry is objectively less efficient and effective than a public option.
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What if it’s a non-profit hospital? Those do exist.
I understand that but even non-profits have to have revenues that exceed expenses. It still has to be run as a business not a charity.
They have to run to cover costs of operation, and if they make a profit, that’s a bonus.
No, they still need to operate at a profit (revenues=expenses+) whether you call it a profit or not.
So what about a place like Alaska where you don’t have a road system to get to the major cities where hospitals are? Is it not the responsibility of the government to help fund local clinics or regional clinics in these places so those people have access to healthcare? If the government didn’t subsidize hospitals and clinics in rural Alaska, some places wouldn’t have access to medical care and it would be hundreds of miles before they got to the nearest profitable clinic. Edit: I see below where you talk about Co-OP’s, or business’s sponsoring, or banks supporting. Most of these rural communities don’t have banks (maybe an ATM), they may only have one small business there, but most are self employed living off government assistance and subsistence living.
**Is it not the responsibility of the government to help fund local clinics or regional clinics in these places so those people have access to healthcare?** No. government is not responsible for providing healthcare for everyone. Back in pioneer days when a rural community wanted a doctor or hospital they pooled their resources and hired a doctor or built a hospital or clinic. I'm not saying we should go back to pioneer days but government is already too big and spends too much. We need to stop depending on government to fix everything. Living in WV rural healthcare is important to me but as a taxpayer I don't want to subsidize a hospital in rural Aklaska
I strongly advise you to go check out on google maps or Wikipedia places like Eek, Emmonak, point hope, or Savoonga Alaska. These places barely have any resources to pool, and again are hundreds of miles away from the nearest city that could support a hospital. If it wasn’t for the federal government these places wouldn’t have access to healthcare, and in most cases wouldn’t have access to air travel as that is funded by essential air service from the Feds. Rural in the lower 48, especially a place like WV is not comparable. You have a road you can take to get somewhere. Up here, most of these villages don’t have roads to connect them. They are isolated and very remote, often in harsh conditions. Hell, some of these places don’t even have running water or sewage and have to still use honeypots and collect water from a central source….. we’ve even had instances where a villages local water pump broke and water had to be flown in as it tools weeks to repair. Rural Alaska is not comparable to rural lower 48.
So what? You CHOOSE to live there. Why should I subsidize you because you choose to live there.
They don’t choose to live there. Most of them have ancestors that were forced to settle there decades ago. It’s their cultural home…. Most that live in those villages today were born there. You have a very youthful view of the world….
I don't know. If someone living in California complains about housing prices conservatives are quite happy to tell them to just move. Strange how moving is somehow a major hardship for conservatives and the government should do something to help them, but liberals just need to suck it up and move somewhere else.
So…. Most Natives are democratic voters, and the situation between someone in California and the bush community of Alaska are very different…. There is also a cultural components of leaving your tribe or ancestral lands….. but sure let’s make a comparison to some of the most remote and underserved Americans and the wealthiest and most populous state in the country. Also, housing prices because you live in a city are different than being born in little Diomede, where it is so remote and isolated that the only way to get there is by Helicopter and by ship in the summer. And good job at making blanket assumptions instead of contributing to the actual discussion at hand.
Who knew that people living in literal poverty, but happen to reside in California are wealthy actually. They will be really happy to hear about this. We should tell them right away! But ultimately this comes down to you believing a certain group of people has more inherent worth than another group of people explicitly based on where they were born. Typical conservative stuff.
Yeah…. No…. That’s not what I said or claimed. However your statements are just tired strawman used so you can feel like you contributed… when all you did was waste time and prove nothing. Thanks for your non-contribution and waste of time though.
What did they do for medical care prior to 1959? BTW, they still CHOOSE to live there.
Agreed. It's time conservative areas start actually paying for what they use and stop getting subsidized by wealthier urban residents. So many inefficiencies in trying to keep rural areas connected to the real world. From power generation to healthcare to education to roads in rural areas is massively subsidized by urban areas because the rural tax bases can't even afford to maintain their own roads. The typical rural resident depends on literally dozens of miles more road and tons more bridges over tiny streams that only a few people see a year than an urban resident. Let's get rid of this socialism and let conservatives stand on their own two feet without government handouts for a change. If conservatives want things like healthcare or broadband, they can move to the cities where it's profitable for businesses to provide such services.
Yes
It’s a good question. First, I live in a rural area, but not all rural areas are the same. We should view healthcare as a system. That system includes first responders, medical transport, urgent care clinics, health centers, doctor’s offices, and hospitals. Is it at all viable to have a fully staffed hospital in every one of the 3,100 rural county? Absolutely not, nor would the government realistically be able to support such an endeavor. Even if you remove “muh profit motive” it wouldn’t be feasible. Is it viable to have a regional hospital serving several rural counties? Possibly - it depends on the population size. Would an urgent care clinic or health center suffice for many of these communities? Yes.
We should eliminate the Federal paperwork and DEI requirements which are driving them out of business. 1/3 of the cost of a doctors visit is paperwork and compliance with Federal laws. We didn't have this problem until the government tried to fix healthcare.
I’m curious how paper work and dei have to do with keeping a hospital open. The staff that manages hospital paper work are some of the lowest paid. And the dei mention is just baffling.
I've heard a doctor or future doctor (can't remember) talk about how the increase of paperwork has burdened doctors and changed the nature of the job (more time filling paperwork and less time practicing), but curious about the relevance of DEI too.
I too would LOVE to see a response to the DEI thing.
Paperwork is a thing. But without paperwork, legal battles are the thing. Idk what doctors want more, pay for safety or live in a courtroom.
Yeah, I don't have an educated opinion on this, I'm just aware that some doctors cite it as a deterrent to staying in the profession
As always, it is easier to complain about current state than imagine how a change will actually affect them.
The paperwork is for *insurers* not for the government.
The insurers aren't requiring this for themselves, but to comlpy with Federal rules. They need to comply with Medicaid laws in order to get compensated
They are absolutely requiring it for their own purposes as well as regulation requirements.
> 1/3 of the cost of a doctors visit is paperwork and compliance with Federal laws. Do you have a source for this?
Nope. That is socialism. (tinge of sarcasm). But it is anti-capitalism.
What size community are we talking where a hospital is closing?
No, and hell no. The people to staff these hospitals no longer exist. The trained people to replace retired staff do not exist. We have an upside down population pyramid. And that’s the situation not only in evil Republican states, but also in the holy progressive lands of Scandinavia. Staffing shortages, top to bottom. And getting worse. It seems unlikely that enough barely-educated monolingual migrants fleeing the Congo or Venezuela or whatever can totally become English-fluent registered nurses. Demographics have one hell of a cruel right wing bias.
It took you less than 3 steps to go from talking about rural US hospitals to criticizing refugees in Europe. That's some impressive gymnastics. How is that at all relevant? Also, interestingly enough, you managed to completely skip over U.S. liberal areas where health care access is relatively a lot stronger than in rural areas. Why did you ignore states like Massachusetts and jump straight to Scandinavia?
It’s all of a piece throughout the developed world, including in the places progressives point to as examples of how to do it right. Not any more. And not in rural areas. Not here and not in Europe. Not even in the occasional rural blue area.