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Nearly a quarter of U.S. rural hospitals are on the brink of closure – report
- deleted 7y ago[deleted]
- bwb 7y agoInteresting, you have to wonder if this will help accelerate a push from rural voters for government-run health care where gov run hospitals have a mandate to stay open and the cost is spared across the system.
- brianpgordon 7y agoUnfortunately, I think it's more likely that no matter how bad private healthcare gets, people in the deep red states mentioned in the article will just assume that socialized healthcare would be even worse and dig in their heels all the more out of redoubled fear of losing what little they have left.
- vidanay 7y agoThey will demand that the government "do something" (aka, a bail-out) whilst simultaneously complaining about their taxes.
- Scoundreller 7y agoDon’t forget about subsidies and bailouts that are structured differently, but effectively that: - cheap loans to terrible creditors that nobody else in the world would loan to - not allowing governments to negotiate prices, even when they’re the buyer (drug prices) - extra taxes, errr, tariffs, on their competitors - exemptions from those same tariffs when its their input - access to cheaper labour pools that no small business could possibly do the paper work for (various visas)
- UncleEntity 7y agoOr... It could have been the plan all along to engineer a "market failure" so these people have no choice but to accept socialized healthcare even if they're vehemently opposed to it.
- slowmovintarget 7y agoThis shouldn't be downvoted, because this was was what the ACA was meant to do. Exacerbate the cost problem (which it has done), restrict doctor-run hospitals (which it does), and lead to a problem where the "solution" is a single-payer system so that 11% of the economy (back then), could be "captured". Many democrats thought (and said so) that there was a huge problem of all this money moving around without government control. The first attempt, which failed badly under Hillary Clinton's leadership during her time as First Lady, failed because it tried to do everything at once. It could therefore be seen as a massive power-grab. The ACA on the other hand, delivered an incremental approach that included lots of things people wanted: ignoring pre-existing conditions, broadening coverage. But it also did things like say there could be no new doctor-run hospitals, and existing ones could not add beds. Doctor-run hospitals, at the time, were actually a success of the free market in health care. Their outcomes in terms of patient recovery and survival rates were higher than state run hospitals. They were a direct threat to the idea that the government should run health care. The ACA also set the stage for the failure of private medical insurance. We're in limbo on that score, but the needle has moved toward that failure.
- guntars 7y agoAnd now you’re being downvoted because all of this is unsourced speculation and people here don’t really care for that.
- ryguytilidie 7y agoAlso because he is literally blaming Hillary Clinton for stuff that happened while she was first lady. I swear modern Republicanism is just agreeing with Donald Trump and blaming anything that goes wrong on Hillary or Obama.
- makomk 7y agoI'm not sure they'd be wrong. The politicians pushing to socalize US healthcare are doing so on a platform of cutting costs and are generally pretty hostile to the idea of subsidising rural folks. Both of those point in the direction of healthcare reforms that kill off rural hospitals.
- tjr225 7y ago> platform of cutting costs Costs should be cut, regardless of urban/rural, if we're being overcharged. Not sure what this has to do with killing off rural hospitals though. > generally pretty hostile to the idea of subsidising rural folks I have seen no evidence of this...do you care to elaborate or provide some links or something?
- deleted 7y ago[deleted]
- torpfactory 7y agoNah, rural politicians will most-likely find it more politically advantageous to claim that the hospitals are closing because of 'illegals', welfare-bound decadent city folks, or some hare-brained conspiracy theory. It will be too difficult to square their political convictions with economic realities. Providing healthcare in rural areas will always be economically difficult. There aren't enough consumers in rural areas to support modern hospital facilities. Admitting this isn't a problem markets will solve, and that government taxes and spending might be the answer, is something that will prove very difficult indeed.
- JPKab 7y agoThe hospital in the rural area I grew up in closed it's doors two years ago. The tribal politics in the comments here are obnoxious and myopic. Rural hospitals are receiving the majority of their money from Medicare and Medicaid. They don't pay enough. There was a great NPR show on this a few weeks ago. Hospitals in the US overcharge (cost shifting is the technical term) patients with private insurance to offset losses from offering services at below cost to Medicare/Medicaid patients. Too few private insurance patients means they close their doors.
- dd36 7y agoOr there’s just not enough volume in rural hospitals and reimbursement rates have to be higher than in denser areas to break even.
- 0xB31B1B 7y agoThat’s not the issue, the issue is that rural areas are also much older on average and have a much higher proportion of patients on Medicare.
- bwb 7y agoCould easily be both too, doesn't have to be just one. Not to mention many other things happening in rural issues that might be driving issues. Long live nuance.
- astronautjones 7y agoall of these points are irrelevant if the government is running the hospital. it shouldn't have to be profitable.
- dx87 7y agoI doubt it. My grandparents and inlaws both live in rural towns, and I think they'd rather have the hospital close down than have to pay more taxes. I know the news likes to show people from rural towns that want the government to provide urban ammenities in areas that can't financially support it, but in my experience, those people are in the minority. Most rural people I've met know the risks of living far from government services, and they think the benefits outweigh the risks.
- adamnemecek 7y agoIt might not increase taxes.
- Gusmann 7y agoStill even people living 'far from government services' should be able to get emergency help when they need to and the closure of the hospitals might just drop the general level of life in the area
- mymythisisthis 7y agoI've made a comment somewhere else in this thread, but I think it applies to your observation. We should have different laws for rural/urban about almost everything. Make flying cheaper in rural areas; less insurance, less safety standards. Rural people know what they are getting into and know the risk of living in rural areas. They are also more self-sufficient. The rural/urban divide is too great.
- sfkdjf9j3j 7y agoRural voters already have mostly government-run healthcare and broadly support medicare and medicaid. They just don't vote like they want to keep it.
- fucking_tragedy 7y agoThat depends on the state they're in. If they're in a state that didn't expand Medicaid with the ACA, like the states in orange on this map[1], then no, they do not have access to government-run healthcare unless they are retired or disabled. [1] https://www.kff.org/wp-content/uploads/2018/11/status-of-state-action-on-the-medicaid-expansionc2a0decision.png https://www.kff.org/wp-content/uploads/2018/11/status-of-sta...
- javagram 7y agoRural areas supported Trump who promised not to reform Medicare/Medicaid and was perceived by voters as a more moderate alternative to the rest of the GOP primary field (who did have plans to cut entitlements).
- asveikau 7y agoI have been told that once you go after increasing health care costs (one goal of government run health care) hospitals will have to accept lower payments, which will not be good for rural hospitals specifically. I am still in favor of doing that though. And ignoring that part, there are huge cost reductions to be had elsewhere, say, for example, an entire industry of medical billing and debt collection - though it'd sure be a shame to see all those nice folks out of work.
- a3n 7y agoNot in our lifetimes. For or against any form of publicly subsidized health service has become a bedrock part of people's identity.
- vidanay 7y agoJust more cracks in the facade on sick care here in the United States obscuring the fact that it is an unsustainable sham.
- MaupitiBlue 7y agoMakes sense. Why would anyone choose to be inpatient at Hickville Memorial Hospital when they could drive 45 minutes to go to State U Medical Center? These communities need smaller facilities with fewer beds, not mid 20th century style hospitals.
- giggles_giggles 7y agoI just think you should know that "hick" is an offensive slur.
- new2628 7y agoI agree with what you say, and I think it is wrong for the parent comment to use such derogatory terms. That being said, your comment also strikes me the wrong way, and I have received similar comments in real life where I had the same reaction, so I thought a bit about why I really feel that way. More precisely: 1. the patronizing "you should know", as if your goal was to educate the person, as if not offending others would be a matter to be solved by education, etc. 2. pointing out in a lukewarm and passive-aggressive way that something is offensive. What should the other person do? He clearly knows already, and his goal is to offend. There is no right "not to be offended". 3. that it is not directed at you, but you are offended on other people's behalf. All in all, while I am on your side, I would find it more heartfelt, if you said "you call me a hick? I'll kick your ass!" then this type of reaction.
- sudosteph 7y agoI agree that the wording isn't ideal, but I interpreted the commenter you replied to as explaining why the original comment was getting downvoted without real responses. That is a common occurrence on HN when someone steps outside the bounds of civility in non-immediately obvious ways. It serves to give context to both the original commenter, and readers who may wonder why it was downvoted. Also, why are you so sure that the responder is not offended on his or her own behalf? Hopefully you don't think that just because someone is commenting on HN that they would never be associated with "hicks". I find HN has people of more backgrounds than most folks realize, and as a person with a family who would certainly be categorized that way by many (southern, rural, working-class), I find your insinuation that it would be somehow more "authentic" to threaten violence as far more patronizing and stereotyping than the original comment even.
- fredgrott 7y agohmmm not sure..the rural hospitals near me combined to save costs.
- mrtweetyhack 7y agoJust means you have to pay more, much much more.
- dantheman 7y agoIt seems to make sense, as populations fall -- there would be less need for healthcare. The more we subsidize rural living the more we distort their long term viability. Towns and cities shouldn't be deploying infrastructure that they can't support, it adds up over time and makes their situation even more untenable in the future. A classic example of this small towns implementing city like water/sewer systems without the tax base to do the maintenance; the federal government provides a grant for the initial installation and the town slowly goes bankrupt trying to pay for it.
- jandrewrogers 7y agoThis is a longstanding problem of geography and demographics. It is not unexpected that many of the States with the worst problem are also the ones that are least urbanized i.e. much of the population is diffused across a vast region. The aging and decline of these populations makes the situation worse. The rural hospitals typically serve a population that otherwise would be several hours travel from the nearest "real" hospital, and typically have a catchment area of 1-2 hours travel. Many of these hospitals are located in towns with populations of a few thousand people. Even when heavily subsidized, the economics of maintaining these hospitals is very poor, especially as populations decline. Maintaining a fleet of doctors and facilities that are increasingly rarely used is expensive. And even with the current distribution of rural hospitals, it is not uncommon for people to live several hours from the nearest hospital. It is essentially a math problem. To ensure that virtually everyone lives within N hours of a hospital, you would need to build an enormous number of hospitals that each service a population of a few thousand people unless N is quite large. This has an extremely high cost per capita, most of which is wasted because they are often very underutilized, which does nothing to help reduce healthcare costs. And you can't force these people to move to more urbanized areas of the country either. The other challenge is finding enough doctors willing to work in a tiny remote town. Few people want to live in these areas and so many doctors that do work in these hospitals are effectively required to commute from a city that is hours away -- it is not a desirable assignment for most.
- 0xB31B1B 7y agoIt’s not just urban/rural divide, it’s young and old as well. The areas where hospitals are closing are disproportionately filled with retired folks who are on Medicare and will need more and more healthcare (Medicare pays out less than private insurance so these hospitals have less money coming in from patient care and need direct subsidy. I think the answer here is pretty clearly to close down the hospitals and highly encourage/enable older folks to move to urban areas where we can provide their care more cost effectively and they will be able to age safer (no driving, stronger social services etc). In the US, you have a right to live where you want but you don’t have an unlimited subsidy to age in place.
- 7y ago
- adrr 7y agoWhy shouldn't they close? If it is not cost effective to support rural communities why do we prop them up? Lot of these places have 20% unemployment rates(areas listed in the article) yet there is a severe job shortage in urban areas. How about we fund moving them to areas that have better economic conditions/jobs?
- saboot 7y agoThe question is how to provide healthcare for rural communities, these hospitals are it. The citizens often can't afford the healthcare, can't afford to go to a doctor until it's an emergency, and now with many of these closures they can't even get that. The easiest answer for many states is to expand Medicaid to cover a larger share of the low income population which can bring revenue to the hospitals with visits etc, but that seems to be very difficult politics for some individuals.
- ryguytilidie 7y ago>that seems to be very difficult politics for some individuals. Well, the frustrating thing is that those who are suffering essentially advocated for these policies that make them suffer and then just blame Obama and praise lord Trump for "getting things back on track" while their hospitals close.
- adrr 7y agoThe example given in the article was in New Mexico which is a state that expanded medicaid. The labor participation in that county is 30% with 14% of working age people on disability. There aren't jobs in the county. Sante Fe on the other hand has 70% labor participation. Moving people to areas that have higher economic advantages and jobs is a long term fix. On other solutions are just bandaids and doesn't solve the underlying economic issues.
- mymythisisthis 7y agoThis is the least mobile generation, few people more around. We need to make it easier for people to move around.
- screye 7y agoI honestly wonder if any form of sparsely populated settlement would be sustainable if it was not heavily subsidized by taxes from the urban regions. Ironically, the worst predicament for any form of infrastructure is under-use. In today's world where no town can be self-sufficient, low density can be the bane of its existence. It is sometimes irritating how heavily favored rural communities are (per capita) in the way Govt.is structured.
- namdnay 7y agoAnd heavily subsidised by not having to pay a fair carbon price!
- jostmey 7y agoTrue. Rural areas might also be the source of the next generation, having higher fertility rates. https://www.usnews.com/news/healthiest-communities/articles/2018-10-17/as-fertility-rates-fall-across-us-gap-widens-between-rural-and-urban-counties https://www.usnews.com/news/healthiest-communities/articles/...
- bilbo0s 7y agoMore likely immigrants will be.
- a3n 7y agoDoesn't the free market say that however many hospitals we have is exactly the right number? /s
- luckydata 7y agoWouldn't be better for pretty much everyone to just help the people in areas where services are unsustainably expensive to move to denser areas where they can be properly attended? At this point the less dense areas are a waste of energy and resources that are worsening our climate outlook, we should be starting to think about real solutions instead of some cockamamie telemedicine patch - seeing a doctor over the phone is only a solution for trivial problem, as soon as there's something serious the only option is a very long car ride or a very expensive helicopter ride.
- TulliusCicero 7y agoAlmost certainly yes. The main problem is that as a whole, we tend to romanticize and privilege rural living. It's generally bad for the environment and economy, and really the latter is why people have already been urbanizing for, well, centuries now. That as many people are able to live in rural areas now with a modern-ish standard of living is largely because of subsidies from more productive urban areas: just look at state government tax revenues vs spending by county and this is obvious. I don't hate rural areas, but there's really no reason we should be subsidizing a lifestyle choice that's bad for the environment. At the very least, zoning rules at city and county levels that prevent densification even from landowners who want it on their property should be illegal, there's no good reason for those to exist. Some regional housing and transportation authorities with teeth would also go a long way. There are all sorts of ramifications to the inefficiency of rural living that developed societies struggle to cope with. That providing, say, high speed internet out there may be too expensive for its own residents to afford may seem like an ignorable problem, until you remember there are kids out there too, and what if the local school wants the students to do things at home that depend on that internet access, which is a reasonable expectation in most of the country these days?
- wwweston 7y agoOnly if there's really no society-supporting activity that people who live in rural areas are engaged in.
- TulliusCicero 7y ago
- panzagl 7y agoDoes everyone here grow everything they eat in a windowbox? Dig their own ore? Not everyone in a rural area is just sitting in their trailer living off Social Security, and many of those that are were productive citizens in their youth. All the stuff NIMBY urbanites care not to do gets done elsewhere, and those people have just as much right to healthcare as anyone.
- lotsofpulp 7y agoThe voting record of most rural areas indicates they don't believe they have a right to healthcare.
- panzagl 7y agoYou're conflating a right to healthcare with a right to have someone else pay for it.
- wahern 7y agoIf they could pay for it then rural hospitals wouldn't be failing.
- eropple 7y agoNo, they're not, because implicit in a right to healthcare is access to subsidy. There's literally no other way for it to be systemically provided. Literally every other option results in provisioning failure. The former requires and cannot not require the latter. I have trouble understanding why social issues make nerds stop thinking systemically, but there you have it.
- panzagl 7y agoI'm not arguing against subsidy, everyone else is- most of the comments here are that rural citizens are 'getting what they deserve' because they don't vote correctly in national elections and burn too much carbon on the farm or whatever. I don't believe someone in SF has to subsidize a hospital in Alabama, but I do believe they have to subsidize a hospital in the Central Valley, either through taxation or through higher food prices.
- sho 7y agoHonestly I don't feel sorry for the USA any more. The rest of the world solved these problems 50 years ago. At some point you conclude that the USA wants these problems. China could not ask for a better boogeyman.
- toomuchtodo 7y agoIt’s certainly strange to observe rural voters make political decisions that hasten the demise of their way of life.
- namdnay 7y agoNot really, the same questions are common in many large European countries too. In France the “continuity of public service” is harder and harder to keep going, as taxpayers balk at the cost of subsidising telecoms, post, hospitals etc for sparsely populated areas
- TMWNN 7y ago>Honestly I don't feel sorry for the USA any more. The rest of the world solved these problems 50 years ago. What utter nonsense. The doctor shortage in the US has nothing on that in Canada. Not just the rural areas, either; in the biggest cities in the four Atlantic provinces, it is impossible to get a family doctor unless you are already a patient.[1] [1] https://www.thetelegram.com/in-depth/doctor-shortage/atlantic-canada-needs-more-doctors-where-are-they-278198/ https://www.thetelegram.com/in-depth/doctor-shortage/atlanti...
- mymythisisthis 7y agoThe urban/rural divide is so great we really need to sets of laws. Aviation laws should be different in rural areas; reducing cost by sacrificing safety. Make it cheaper to fly people to hospitals, in slightly less safe craft.
- pedasmith 7y agoWeirdly, the article didn't notice the very strong correlation between "states that didn't accept the Medicaid expansion" and "places with under-payed rural hospitals". This seems like an absolutely elementary analysis to do -- places with the Medicaid expansion are more likely to have people with health insurance; places without are less likely.