4 ms·

People here seem to go straight to politics on US healthcare, but does anyone ever stop to consider that this really is a complicated problem? I’ll look at two

by HEmanZ 3y ago

People here seem to go straight to politics on US healthcare, but does anyone ever stop to consider that this really is a complicated problem? I’ll look at two political extremes: - in a pure-market healthcare situation, these hospitals likely wouldn’t exist in the first place. Health services would be worse than they are now in rural areas, to the point that many probably wouldn’t have “real” health services at all because there’s not enough of a market to support it. You can say “well that’s my choice to live somewhere I can’t pay for healthcare” and that’s a different discussion, but free market wouldn’t get good healthcare in rural places. - you could have a single payer system, at which point providing good healthcare to rural areas would be a “net drain” on everyone else. Basically people in dense areas would be subsidizing people in rural areas REGARDLESS of those people’s incomes or wealth (this is a similar problem to many ex-urbs in America where we basically subsidize the infrastructure of rich people who live there). Neither of these seems to work out well, and I worry neither I politically sustainable. It doesn’t strike me as an easy problem…

bombcar 3y ago
I'm not exactly sure what would drive rural hospitals to be a net drain unless they are "built too large" for the population, or are usually empty. Most of the rural hospitals I know will send you "to the big city" anyway for specialized procedures.
- tstrimple 3y ago
  The same reason rural areas are a net drain in other ways. They have no efficiencies of scale and since everything is spread apart, providing services becomes more expensive and difficult. https://www.brookings.edu/research/why-rural-america-needs-cities/ https://www.brookings.edu/research/why-rural-america-needs-c... > "This pattern holds for state government spending, too. Studies in Minnesota, Georgia, and Wisconsin reveal that metropolitan areas contribute more to state coffers than they receive in education, infrastructure, and other public services investments. In Georgia, for instance, metropolitan Atlanta provides 61 percent of state revenue but receives just 46 percent of state investment. State spending on roads, broadband networks, schools, and other public services in small town America is funded, in part, by the economic prosperity of cities." There's no way the majority of rural communities in this country could cover their own infrastructure costs. Those are heavily subsidized by the state. In the state I live in, Iowa, there are nearly 100k miles of rural roads to support a population of roughly 1 million rural residents. Meanwhile there are about 16k miles of road to support the other 2 million urban and suburban residents. Roughly 1/3rd of those rural roads are considered to be "farm to market" roads which facilitate delivery of farming goods to markets. The other 70k miles of roads are just to support rural residents. And while there's an argument that rural gravel roads are cheaper to build, that ignores the total cost of ownership as those roads need annual maintenance. Even things like electricity are heavily subsidized because residents pay a similar rate regardless of where they live, and rural residents require substantially more infrastructure to get the power to them in the first place. Those additional costs are borne by all residents. At least part of that "cheap rural lifestyle" is paid for by folks living in cities.
  - peteradio 3y ago
    Annual maintenance of gravel roads constitutes driving one pass with a road grader wholly owned by a local or municipal government.
  - bombcar 3y ago
    I wonder how much of this is the urban / rural divide (and where that divide is can be debated) and how much this is rich vs poor (obviously those who are poor produce a net drain on the government, but that’s not necessarily bad).
hotpotamus 3y ago
Serious people are aware that it's a really complicated problem - things with simple answers are not considered problems. Healthcare systems have been tinkered with in the developed world for about as long as what we'd call modern medicine has existed; in the US, the FDR administration looked into universal healthcare, but it was considered too big a reach back then, and it's been a thorny issue ever since. In a pure-market healthcare situation, we would treat people essentially the way we treat cars. Some would be worth much more than others and they would depreciate to approximately $0 as they age, and we would make repair calculations against that value. It would be considered morally heinous. The basic root of the problem is trying to put an economic value on human dignity and morbidity/mortality, and it will always involve tradeoffs.

by HEmanZ 3y ago

bombcar 3y ago

I'm not exactly sure what would drive rural hospitals to be a net drain unless they are "built too large" for the population, or are usually empty. Most of the rural hospitals I know will send you "to the big city" anyway for specialized procedures.

tstrimple 3y ago
The same reason rural areas are a net drain in other ways. They have no efficiencies of scale and since everything is spread apart, providing services becomes more expensive and difficult. https://www.brookings.edu/research/why-rural-america-needs-cities/ https://www.brookings.edu/research/why-rural-america-needs-c... > "This pattern holds for state government spending, too. Studies in Minnesota, Georgia, and Wisconsin reveal that metropolitan areas contribute more to state coffers than they receive in education, infrastructure, and other public services investments. In Georgia, for instance, metropolitan Atlanta provides 61 percent of state revenue but receives just 46 percent of state investment. State spending on roads, broadband networks, schools, and other public services in small town America is funded, in part, by the economic prosperity of cities." There's no way the majority of rural communities in this country could cover their own infrastructure costs. Those are heavily subsidized by the state. In the state I live in, Iowa, there are nearly 100k miles of rural roads to support a population of roughly 1 million rural residents. Meanwhile there are about 16k miles of road to support the other 2 million urban and suburban residents. Roughly 1/3rd of those rural roads are considered to be "farm to market" roads which facilitate delivery of farming goods to markets. The other 70k miles of roads are just to support rural residents. And while there's an argument that rural gravel roads are cheaper to build, that ignores the total cost of ownership as those roads need annual maintenance. Even things like electricity are heavily subsidized because residents pay a similar rate regardless of where they live, and rural residents require substantially more infrastructure to get the power to them in the first place. Those additional costs are borne by all residents. At least part of that "cheap rural lifestyle" is paid for by folks living in cities.
- peteradio 3y ago
  Annual maintenance of gravel roads constitutes driving one pass with a road grader wholly owned by a local or municipal government.
- bombcar 3y ago
  I wonder how much of this is the urban / rural divide (and where that divide is can be debated) and how much this is rich vs poor (obviously those who are poor produce a net drain on the government, but that’s not necessarily bad).

hotpotamus 3y ago

Serious people are aware that it's a really complicated problem - things with simple answers are not considered problems. Healthcare systems have been tinkered with in the developed world for about as long as what we'd call modern medicine has existed; in the US, the FDR administration looked into universal healthcare, but it was considered too big a reach back then, and it's been a thorny issue ever since. In a pure-market healthcare situation, we would treat people essentially the way we treat cars. Some would be worth much more than others and they would depreciate to approximately $0 as they age, and we would make repair calculations against that value. It would be considered morally heinous. The basic root of the problem is trying to put an economic value on human dignity and morbidity/mortality, and it will always involve tradeoffs.