4 ms·

It’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

It’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.

wcunning 7y ago
That would cause an even greater housing price crunch in the cities than we currently have. Much of the retirement advice out there is that once you're on a fixed income, you need to move out of a high cost area into a lower cost, typically at a minimum less dense one. Also, in practice, quite a few older folks move to be close to family members who can support them, which requires living wherever your children and grandchildren live... Even strongly encouraging the urbanization of the elderly strikes me as the wrong answer here for so many reasons, even beyond the ones I've listed above.
- kiba 7y ago
  So we need to combine that with a plan of action that ameliorate urban problems we already have, such as building more medium and high density housing and creating more public transits instead of sprawling out.
- bilbo0s 7y ago
  But as the previous poster said, you don’t have a right to infinite subsidy for the purposes of moving to your “low cost” area. We’re entering an era where these places are low cost for elderly people precisely because everyone else is subsidizing a lot of that infrastructure for you. From the hospitals and clinics, to the roads. This is just a really hard problem. The best likely solution is to build more housing in the urbanized areas. But, yeah, how do you get that done profitably? It’s tough.
  - rayiner 7y ago
    Even if you build more housing, having older people live in urban areas still increases the price of housing. Crucially, older people don't need to be near urban jobs, so it's much more socially practical for them to live in rural areas. At the end of the day, the question is which subsidy is harder to deal with? Cash payments to keep rural hospitals open seems a lot easier than wading into enormously expensive and distortionary urban housing policies like rent control.
    - ProfessorLayton 7y ago
      There’s a bit of circular arguments going on here. Sure moving more people into an urbanized area may mean higher housing costs, but housing is not the only expense. Healthcare is a huge expense with over half of all healthcare expenses consumed by those 55 and older [1] Additionally, there are several approaches that can be taken to lower housing costs other than price control. Housing policies are a huge mess throughout the country as its regulated locally, and exclusionary housing policies limit high density developments necessary to keep construction and infrastructure costs down. https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population/ https://www.healthsystemtracker.org/chart-collection/health-...
    - bilbo0s 7y ago
      San Fran is not the only urban area in the US. Of course elderly people can’t move to Manhattan or San Fran. But there is lots of affordable housing in Omaha, Cleveland, Houston, Milwaukee, etc etc etc. Additionally, there is no reason we can’t build more housing in mid sized metros of that nature. (I guess Houston is not “mid sized”, but you get the idea.) No one is talking about the elderly moving to places that are too expensive. We’re putting forth the idea that maybe they should move away from areas that are too expensive.
      - rayiner 7y ago
        I think you don’t understand how cheap rural areas are. My Oregon family blanches at the prices even in Eugene, forget Portland or Seattle. It’s not at all clear to me that whatever subsidies (rent control, etc.) would be required to allow the elderly to live in Omaha would be less than the subsidies for keeping rural hospitals open.
- lotsofpulp 7y ago
  The rural area is only low cost in certain aspects. Other aspects, such as medical care, is far more costly due to having to pay substantially more to incentivize doctors to want to work in rural areas.
  - zdragnar 7y ago
    The certain aspects are important, though. Rental and ownership costs for housing are typically 2-4x or higher in an urban area versus a rural setting. When you're already on medicare and have a fixed income, that can make all the difference. More than anything, though, it really boils down to lifestyle. Often times, suburban senior living communities are reasonably affordable as well, avoid the major pain points of city life, and work out things like deliveries of everything from food to pharmacy goods.
- novok 7y ago
  If you can't drive anymore and you don't have to go up steps, transit is amazing for your mobility at that age. I know old people who got a house in SF, citing that as one of their reasons. I know it's not the best transit, but it's definitely better than the american no transit, drive everywhere default that they were living at.
tempsy 7y ago
I'm speaking as someone who has never lived in a rural area, but the thought of living in a rural area as a retiree seems very exhausting. Between the upkeep, driving everywhere to get anything, and the healthcare accessibility issue it doesn't seem practical for someone in their old age. Am I missing something here?
- rayiner 7y ago
  On the flip side, retired people don't need to live near jobs in the city, and their living in rural areas reduces the demand for housing in urban areas. Rural people are typically on fixed incomes, and cannot afford the skyrocketing rents or property taxes of urban areas. Now, of course, you can do things like rent controls, but those are also subsidies. So you're just trading one subsidy for another. At least subsidies to keep rural hospitals open doesn't distort the housing market for younger people looking for housing near where they work in the city. (Driving is also easy in rural areas. There is nothing to run into. Young adolescents routinely drive in rural areas. I'd imagine it's a lot easier for older people to do than to deal with being exposed to the elements/dealing with broken elevators and escalators to use public transit.)
  - tempsy 7y ago
    I'm not following your logic at all. I don't think it's a common phenomenon for retirees who once lived in urban or suburban areas to move to rural ones. I'm guessing the majority of these people have always lived in rural areas and just stayed put through retirement.
    - rayiner 7y ago
      That doesn't matter--the point is that because retired people don't need to be near urban jobs, we can reduce pressure for housing in urban areas by leaving retired rural people where they are. (Or, conversely, we can avoid increasing pressure for housing in urban areas by moving retired rural people into urban areas.)

wcunning 7y ago

That would cause an even greater housing price crunch in the cities than we currently have. Much of the retirement advice out there is that once you're on a fixed income, you need to move out of a high cost area into a lower cost, typically at a minimum less dense one. Also, in practice, quite a few older folks move to be close to family members who can support them, which requires living wherever your children and grandchildren live... Even strongly encouraging the urbanization of the elderly strikes me as the wrong answer here for so many reasons, even beyond the ones I've listed above.

kiba 7y ago
So we need to combine that with a plan of action that ameliorate urban problems we already have, such as building more medium and high density housing and creating more public transits instead of sprawling out.
bilbo0s 7y ago
But as the previous poster said, you don’t have a right to infinite subsidy for the purposes of moving to your “low cost” area. We’re entering an era where these places are low cost for elderly people precisely because everyone else is subsidizing a lot of that infrastructure for you. From the hospitals and clinics, to the roads. This is just a really hard problem. The best likely solution is to build more housing in the urbanized areas. But, yeah, how do you get that done profitably? It’s tough.
- rayiner 7y ago
  Even if you build more housing, having older people live in urban areas still increases the price of housing. Crucially, older people don't need to be near urban jobs, so it's much more socially practical for them to live in rural areas. At the end of the day, the question is which subsidy is harder to deal with? Cash payments to keep rural hospitals open seems a lot easier than wading into enormously expensive and distortionary urban housing policies like rent control.
  - ProfessorLayton 7y ago
    There’s a bit of circular arguments going on here. Sure moving more people into an urbanized area may mean higher housing costs, but housing is not the only expense. Healthcare is a huge expense with over half of all healthcare expenses consumed by those 55 and older [1] Additionally, there are several approaches that can be taken to lower housing costs other than price control. Housing policies are a huge mess throughout the country as its regulated locally, and exclusionary housing policies limit high density developments necessary to keep construction and infrastructure costs down. https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population/ https://www.healthsystemtracker.org/chart-collection/health-...
  - bilbo0s 7y ago
    San Fran is not the only urban area in the US. Of course elderly people can’t move to Manhattan or San Fran. But there is lots of affordable housing in Omaha, Cleveland, Houston, Milwaukee, etc etc etc. Additionally, there is no reason we can’t build more housing in mid sized metros of that nature. (I guess Houston is not “mid sized”, but you get the idea.) No one is talking about the elderly moving to places that are too expensive. We’re putting forth the idea that maybe they should move away from areas that are too expensive.
    - rayiner 7y ago
      I think you don’t understand how cheap rural areas are. My Oregon family blanches at the prices even in Eugene, forget Portland or Seattle. It’s not at all clear to me that whatever subsidies (rent control, etc.) would be required to allow the elderly to live in Omaha would be less than the subsidies for keeping rural hospitals open.
lotsofpulp 7y ago
The rural area is only low cost in certain aspects. Other aspects, such as medical care, is far more costly due to having to pay substantially more to incentivize doctors to want to work in rural areas.
- zdragnar 7y ago
  The certain aspects are important, though. Rental and ownership costs for housing are typically 2-4x or higher in an urban area versus a rural setting. When you're already on medicare and have a fixed income, that can make all the difference. More than anything, though, it really boils down to lifestyle. Often times, suburban senior living communities are reasonably affordable as well, avoid the major pain points of city life, and work out things like deliveries of everything from food to pharmacy goods.
novok 7y ago
If you can't drive anymore and you don't have to go up steps, transit is amazing for your mobility at that age. I know old people who got a house in SF, citing that as one of their reasons. I know it's not the best transit, but it's definitely better than the american no transit, drive everywhere default that they were living at.

tempsy 7y ago

I'm speaking as someone who has never lived in a rural area, but the thought of living in a rural area as a retiree seems very exhausting. Between the upkeep, driving everywhere to get anything, and the healthcare accessibility issue it doesn't seem practical for someone in their old age. Am I missing something here?

rayiner 7y ago
On the flip side, retired people don't need to live near jobs in the city, and their living in rural areas reduces the demand for housing in urban areas. Rural people are typically on fixed incomes, and cannot afford the skyrocketing rents or property taxes of urban areas. Now, of course, you can do things like rent controls, but those are also subsidies. So you're just trading one subsidy for another. At least subsidies to keep rural hospitals open doesn't distort the housing market for younger people looking for housing near where they work in the city. (Driving is also easy in rural areas. There is nothing to run into. Young adolescents routinely drive in rural areas. I'd imagine it's a lot easier for older people to do than to deal with being exposed to the elements/dealing with broken elevators and escalators to use public transit.)
- tempsy 7y ago
  I'm not following your logic at all. I don't think it's a common phenomenon for retirees who once lived in urban or suburban areas to move to rural ones. I'm guessing the majority of these people have always lived in rural areas and just stayed put through retirement.
  - rayiner 7y ago
    That doesn't matter--the point is that because retired people don't need to be near urban jobs, we can reduce pressure for housing in urban areas by leaving retired rural people where they are. (Or, conversely, we can avoid increasing pressure for housing in urban areas by moving retired rural people into urban areas.)