NYT Shocked: Rural Means Not Big City

h/t Borepatch

Apparently the NYTimes has discovered that small-town means Small. Town.  And not Big City.

And that this has implications for medical care in Podunk.

"Hospitals are often thought of as the hubs of our health care system. But hospital closings are rising, particularly in some communities.

“Options are dwindling for many rural families, and remote communities are hardest hit,” said Katy Kozhimannil, an associate professor and health researcher at the University of Minnesota."

1) There is nothing wrong with the NYT story, per se.

2) They hit all the reasons.
 a) One-horse hospitals are being closed by ruinous malpractice premiums. Tort reform is long overdue.
 b) Indigent/uninsured care hits small potatoes hospitals a lot harder than conglomerates with multiple hospitals, because they have no way to spread that financial load.
 c) Care at small rural hospitals, compared to larger suburban and urban medical centers, is minimally adequate to borderline sub-standard. If anything "serious" needs Lifeflight to the city anyways, you aren't running a hospital, you're running a clinic, whether anyone told you or not.
 d) Expanding the Medicaid mandate costs states huge sums of money, which inevitably drives up taxes for everyone. If you kill jobs and tax people out of their homes, you won't just lose the hospitals, you'll lose the residents themselves.

What the NYT didn't tell you was that all of this was factored into ObozoCare, as it was intended to, in order to chain everyone to Big Daddy government, and push more people into cities, and out of more rural (and self-sufficient) living and lifestyles. That was known when they did it, but most of "flyover land" isn't having any, thankyouverymuch.

Good for them.

What you need in rural areas is primary care, not a mini-mart trying (poorly) to do Big City Care.
Trauma is even worse in rural areas because you never had trauma care there, and never will. One major case could break the hospital.

That's what medical evacuation is for.

Critical care (heart attacks & strokes) is essentially the same story: you can't have an ICU in Podunk, because it'll either be empty, or overflowing, and so even if you have it on paper, you don't in reality. So people will need transfer to Big City Hospital anyways. That's just how it goes.

More hospitals close than open because doing one right can no longer be done on a shoestring budget in Hooterville. Or even Pixley. You need the population of a city of a minimum of 100K people to do a small hospital, and 500K or more to do an actual decent primary facility that can offer everything.

By a strange coincidence, you don't have 97 dining choices in Ruraltopia either, or 3 mega-malls, or 5 multiplexes, and a professional sports team or 3.

But you also don't have multi-racial ghettoes, a gang problem, a crime problem, a homeless problem, and a host of other pestilential problems of the Big City.

Most folks who live there see that as a feature, not a bug.

So at the end of their pointless story, after paragraphs of pointless Chicken Little running around in circles, the lede is uncovered:

Not all closures are problematic. Some are in areas with sufficient hospital capacity. Moreover, in many cases hospitals that close offer relatively poorer quality care than nearby ones that remain open. This forces patients into higher-quality facilities and may offset negative effects associated with the additional distance they must travel. 

Perhaps for these reasons, one study published in Health Affairs found no effect of hospital closures on mortality for Medicare patients. Because it focused on older patients, the study may have missed adverse effects on those younger than 65. Nevertheless, the study found that hospital closings were associated with reduced readmission rates, which is regarded as a sign of increased quality. So it seems consolidating services at larger hospitals can sometimes help, not harm, patients.

No screaming eagle shirt, Cochise: Teeny Weeny Hospital is not your best choice for care, for the same reason Mr. Drucker's General Store is probably not the same retail experience that Mega-Mall or Amazon is going to be.

You want to b.s. over the stove about what's going on in Hooterville, hit up Mr. Drucker.
You want the Gee Whiz 2100, you go to MegaMall, or you have UPS or FedEx drop it off from Amazon.

In short, this is shocking to the NYTimes, but folks in the hinterboonies have been doing it for, oh, about 100 years.

They don't regard it as shocking.

But it does make me wonder something:

Do those ignorant boobs in NYFC get reruns of Green Acres and Petticoat Junction?
It would probably help to explain the facts of life to hipster yuppie millenials who think anything out of walking distance is Outer Mongolia.