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I don't know how you can realistically look at this without thinking of the "I never thought leopards would eat MY face!!" meme. Politics matters. Voters in ru

• swader999 3y ago
  Yet in Canada we have this same issue.
  • notho 3y ago
    [dead]
  • bombcar 3y ago
    Canada did not vote for Obamacare, so they get what they deserve. (Sarcasm, of course, every single problem in the USA comes neatly down on political lines and one side is perfectly good and the other objectively evil).
  • rayiner 3y ago
    And in blue states in America that voted for Medicaid expansion we have the same issue. It’s almost as if the problem is escalating costs for skilled workers, lack of economies of scale in rural areas, and wealth/job flight to urban areas.
• kevingadd 3y ago
  Yeah, but it's not as if all the people who live in these areas voted to shut down the hospitals. There's still a sizable portion of the electorate that wants good things and they get to suffer now. Not great.
  • bwb 3y ago
    It can be good as pain motivates, and hopefully they vote better or cause change vis different policies.
    • notho 3y ago
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  • wwweston 3y ago
    Rural voters as a bloc seem determined to vote in support of laissez-faire socioeconomic approaches which incentivize this result. I suppose it’s possible that they don’t intend this and merely are thoughtless about it from a policy standpoint, but if we’re being generous it also seems plausible to assume they’re not being stupid and this is either acceptable or part of the intended result.
• jbm 3y ago
  I do not understand how Obamacare would resolve this issue. This seems to be related to the lack of income; how would Obamacare or Medicaid fix this?
  • ceejayoz 3y ago
    Medicaid expansion was a key Obamacare pillar, one a number of red states opted out of. https://www.kff.org/health-costs/issue-brief/rural-hospitals-face-renewed-financial-challenges-especially-in-states-that-have-not-expanded-medicaid/ https://www.kff.org/health-costs/issue-brief/rural-hospitals... > Among rural hospitals in non-expansion states, median operating margins were 2.1 percent during the July 2021-June 2022 period and were -0.7 percent when excluding documented relief funds. In Medicaid expansion states, median operating margins dropped, but remained positive even after excluding documented relief funds.
  • hn_throwaway_99 3y ago
    A huge reason hospitals lose money is due to the amount of charity care they provide. There is a saying that "Reagan instituted universal healthcare in the US, he just didn't institute a way to pay for it." That is, during Reagan's time, laws were passed that required hospitals to provide emergency care regardless of an individual's ability to pay. But no laws were passed then that actually funded that mandate. So in rural areas where you have more people in poverty, if they had health insurance hospitals would be better able to actually collect payment for the legally required services they provide.
    • ROTMetro 3y ago
      This. The USA HAS socialized healthcare, just at the worst point of the system to have it and in the worst way for improving outcomes.
    • maxerickson 3y ago
      Even hospitals disagree with this. https://www.aha.org/fact-sheets/2020-01-06-fact-sheet-uncompensated-hospital-care-cost https://www.aha.org/fact-sheets/2020-01-06-fact-sheet-uncomp...
• wernercd 3y ago
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  • burnished 3y ago
    Are you one of those people that love the ACA but hate obamacare?
    • wernercd 3y ago
      Are you one of those that can't read where I explicitly stated "Obamacare (unACA)"? reading comprehension is important if you're going to try to dunk... because an IQ above single digits would show you that the unaffordable care act was directly referenced by me. To be clear: the unACA helped a handful of people and made it more expensive for everyone else with lies (keep your doctor) and lies (keep your plan) and more lies (save $2500). I have extreme distain for the unACA because it's government solutions to government that is built on lies and doesn't solve the problems - instead it's goal is to exacerbate the problem so the "public option" becomes "desirable" by those who think big government solves problems (if you need time to go look up works like exacerbate? I'll be here when you get back)
  • Eisenstein 3y ago
    You need to do more than just claim 'government caused this', when the hospitals are private and the governments are the ones with the least regulation, while the states with 'more government' are going quantitatively better on all margins. If 'more government' was such the bane as you claim it is, why are the places with 'more government' (that isn't fixated on only enforcing christian norms) doing so much better?
• peepeepoopoo5 3y ago
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  • Loughla 3y ago
    >Combine this with a large influx of uninsured, undocumented migrant workers in rural areas I'm sorry to be that guy, but extraordinary claims require extraordinary proof. Claiming that the failure of rural hospitals is due to illegal immigration, even in part, is an extraordinary claim. Do you have anything at all other than anecdotes to back that claim up?
    • peepeepoopoo5 3y ago
      It's hardly extraordinary. This has been a major problem for decades, and it's only gotten worse. I'm sorry it disagrees with your politics, but illegal immigration is bankrupting hospitals. Here is a previous attempt to shore up some of the financial losses: https://www.cms.gov/newsroom/fact-sheets/emergency-health-services-undocumented-aliens https://www.cms.gov/newsroom/fact-sheets/emergency-health-se...
      • WoahNoun 3y ago
        That's an 18 year old article and the OP's PDF shows hospital's closing in Montana, the Dakotas, Idaho, Michigan, etc that aren't near the border.
        • peepeepoopoo5 3y ago
          If I had posted a recent article you would have said that wasn't evidence of a long term trend. The problem has gotten worse and it's impacting the entire country now. My family members work at hospitals in rural eastern WA, and not only has the local hospital system there already collapsed, but the entire Providence medical system for all of the Pacific Northwest is at risk of going under too. This is a direct result of uninsured migrant workers and medicaid underpayment.
  • toomuchtodo 3y ago
• lifeisstillgood 3y ago
  FYI https://knowyourmeme.com/memes/leopards-eating-peoples-faces-party https://knowyourmeme.com/memes/leopards-eating-peoples-faces...
• notaustinpowers 3y ago
  I have so many rural family members that are like this. And so much of it is because they just actively and brazenly do not want to help anyone. Their individualistic ideology runs so deep that they view people homeless, struggling, or unable to afford healthcare as a moral failing. To them, the system is working as intended. They're cleaning out the moochers and welfare queens. But by the time they notice they need those services as they get older, it's already too late to do anything about it. Everyone they know then ostracizes them and they end up being the new moral failure of the community.
  • notacoward 3y ago
    > they view people homeless, struggling, or unable to afford healthcare as a moral failing ...until it's them. If you really want to rile up an old white rural dude with a Trump placard on their lawn, threaten to take away their healthcare subsidies. Or really any other kind, and for most farmers that's a long list. Then the sparks will really start to fly. They believe that government assistance is a God-given right for "salt of the earth" like themselves, but an absolute crime for those "other people" in the cities. It's not hard to see the subtext, even when they're not consciously aware of it themselves.
  • lowercased 3y ago
    Pfftt.. they'll just have a church fundraiser! Then maybe a gofundme to top it off! I had some family members similar to this, and that was their actual thinking. "God will handle it. Our church always helps its folks". 30 years later... well.. pastor's changed, the focus is always on the younger families with kids and... my relatives, now in their 70s... just don't go to their church of 30+ years because "we don't feel all that welcome any more". So... their plans for church fundraisers is essentially off the table now. But it took them 30 years to realize this, and they'd consistently voted against their future selves all that time. And I won't even say they "realize" anything profound or deep here. They've not switched party allegiance. Trump will still save them. ugh...
    • notaustinpowers 3y ago
      What's so sad is that is what happened to a grandma of mine. I had come out of the closet (she supported me 100%) and she spoke about it to her church friends and talking about how much she's learned in supporting me. Well, I guess one of those friends didn't share the same beliefs. And the pastor met with her and my grandpa and said that they were no longer welcome at the church. The church they've both attended since they were children. Thankfully they're fine and don't rely on the church. But it, again, reiterates how much so much of it is viewed as a moral failure. And how much our nation loves punishment more than we love support.
• cheeseomlit 3y ago
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  • sidr 3y ago
    Obamacare won't fix it because it's a gutted compromise. Universal healthcare (which is the only way to get around private insurers not paying out, and not tying healthcare spending to income) is a non starter in this country and it's entirely due to one political faction. It's accurate to blame them for this.
    • i2cmaster 3y ago
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  • hn_throwaway_99 3y ago
    > So vote for my party or you don't deserve healthcare? What an enlightened liberal world view. What a silly mischaracterization of my point. That point being that actions have consequences, and sometimes unintended consequences. Since you seem to be taking a "tribal" approach to this, I'll flip things on their head. Voters (again, generally of course) in some urban areas have decided addressing inequalities in criminal prosecutions are more important than reducing crime. For example, if you elect a prosecutor who broadcasts that they won't prosecute shoplifting below $1000, you shouldn't be surprised if then many people take it as the green light to take $999 worth of stuff whenever they feel like it. In the Idaho example I gave, voters got exactly what they wanted, which was a forced birth legal system. But they shouldn't be surprised that most obgyns, even very conservative ones, are not willing to work in a state that puts them in severe legal jeopardy for providing health care.
    • lelanthran 3y ago
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      • text0404 3y ago
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• oaktrout 3y ago
  The article is arguing that private payers don't reimburse rural hospitals enough, not that lack of medicaid or obamacare is an issue. Perhaps your premise is correct but it is at odds with the article, I would be interested in hearing more about why you disagree with the article. From the article "The biggest problem facing small rural hospitals is inadequate payments from private health plans. Most “solutions” for rural hospitals have focused on increasing Medicare or Medicaid payments or expanding Medicaid eligibility due to a mistaken belief that most rural patients are insured by Medicare and Medicaid or are uninsured. In reality, about half of the services at the average rural hospital are delivered to patients with private insurance (both employer-sponsored insurance and Medicare Advantage plans). In most cases, the amounts these private plans pay, not Medicare or Medicaid payments, determine whether a rural hospital will have to close".
  • nradov 3y ago
    That part of the article makes no sense at all and appears to be pushing a biased political narrative. Private commercial insurers already pay more than Medicare / Medicaid for the same treatments. Patients with private insurance are effectively already subsidizing those on public plans. Why should the burden of keeping small rural hospitals open fall entirely on private health plans? Perhaps hospitals should advocate for higher Medicare reimbursement rates.
    • oaktrout 3y ago
      I found it odd also, I was under the impression that hospitals made their money on private insurance and lost on medicare/Medicaid. I do recall hearing that rural hospitals are reimbursed at a higher rate from the government, perhaps that explains the discrepancy.
    • hotpotamus 3y ago
      > Why should the burden of keeping small rural hospitals open fall entirely on private health plans? Because that's how the majority of Americans get their healthcare? I assume that's the case, but I don't actually know - as mentioned there are multiple single-payer health plans (lol) that cover those we have deemed worthy of them. The paper linked says that rural hospitals need to bill higher because their unit costs to deliver healthcare are higher (which makes basic economic sense). Therefore it would seem like the market solution would be to charge people who live in rural areas more for healthcare/insurance. I can never tell whether the US is a nation or an economy.
• throwaway43642 3y ago
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• rayiner 3y ago
  Except rural hospitals in blue states that expanded Medicaid, etc., are also at risk of closure: https://www.beckershospitalreview.com/finance/631-rural-hospitals-at-risk-of-closure-by-state.html https://www.beckershospitalreview.com/finance/631-rural-hosp.... For example, 41% of rural hospitals in New York are at risk of closing, similar to the 38% in Florida, and a lot more than the 18% in Kentucky. Solid blue Washington is at 33%, worse than Iowa or Indians at 24 and 21%. Idaho, which you call out specifically, is only at 7%. It’s quite interesting that your first reaction was to demonize rural voters for political choices, in the absence of any data supporting that assumption.
  • text0404 3y ago
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  • positron6000 3y ago
    Based on the data here (which your source is based on) four out of the five rural hospital closures in NY are in counties that voted for Trump in 2016: Irving, NY - Chautauqua County - Trump Fulton, NY - Oswego County - Trump Ticonderoga, NY - Essex County - Clinton Amsterdam, NY - Montgomery County - Trump Sidney, NY - Delaware County - Trump - https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/#citem_fe3f-61e3 https://www.shepscenter.unc.edu/programs-projects/rural-heal... - https://www.nytimes.com/elections/2016/results/president https://www.nytimes.com/elections/2016/results/president Voting against Medicare or Obamacare aren't the only ways to vote against healthcare reform, as OP states: > Politics matters. Voters in rural areas (generally, of course) have consistently voted against policies that would help support health care in these rural locations
    • rayiner 3y ago
      You’re begging the question. 90% of rural counties voted for Trump. The phrase “rural hospitals” is pretty much synonymous with “hospitals in counties that voted for Trump. That doesn’t prove that the policies people voted for caused the problems with rural hospitals. Healthcare is handled at the federal and state levels, not the county level. Thus, rural areas in blue states like New York should be doing better than ones in red states like Florida. They all voted against these policies that supposedly would have helped them—but in Florida they were successful in opposing them while in New York they were overruled by urban areas and got those policies anyway.
• deleted 3y ago
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• rhaway84773 3y ago
  I think it’s a little more nuanced than that. There is no group of people in the US more subsidized by the government than the rural dweller. Both through direct and indirect subsidies. Rural voters receive massive agricultural subsidies, they receive significant tax breaks, almost all their infrastructure, from roads, to internet, to the mail, is nearly entirely paid by the federal government with little support from local federal taxes because their tax base is so weak. But then there’s also the indirect subsidies, such as the U.S. preventing the import of a whole lot of fruits, eve tables and meats altogether, and the ones they do, they do with high import taxes, or the US promoting the sale of rural products both domestically (USDA’s primary goal) and through international trade deals. But rural voters actually believe, despite all the evidence to the contrary, that they are not the recipients but rather the donors of wealth to the rest of the country, particularly the urban parts. Most other Western countries’ rural areas have no such misgivings, so I suspect it’s a result of them looking at themselves as the archetype US cowboy who pulled himself up by his bootstraps, with no help, etc etc. So you have this strange situation where the rural voter votes for the party that promises to reduce taxes thinking that they will benefit, since they believe they pay more than they receive, but in reality they are shortchanging themselves. This worked for a while. The richest enjoyed the real tax cuts, while the rural folks got minor cuts, but nonetheless they didn’t see any downsides, because the roads, hospitals, internet had already been built. Maybe it had a few more potholes than before, and you needed to wait 2 days instead of 1, but you never connected this to the reduction of federal tax money (to be fair, the impact would have been convoluted…tax money being pulled out somewhere else, so the state having to reduce district level funds in one area to plug that hole, which was then possibly pulled out from the hospital maintenance fee by the local administrators). However, at one point these started accumulating, and what it took was 1 major stress event to go from slowly increasing the temperature of the water the frog was in, to picking them up from the lukewarm water and dropping them in a fire.
• peteradio 3y ago
  I doubt you had much empathy to begin with if you can cast it aside based on a passing reading of the title.
• timbo1642 3y ago
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