I think the next time we have any power we should triage whatever is left of the health care system as best we can and then rebuild, but states are going to have to make some really hard decisions in the meantime and cost/benefit favors preserving urban systems over rural.
Meanwhile, state level Republicans are doing their best to blame Democrats for the cuts. For example:
WA GOP reminds me of the leftists who would rather critique power than ever have it. They are so extreme that this last election cycle ended with no Republican winning any statewide office.
Rural voters are like a teen who's mad at their parents and so call their work trying to get them fired. Buddy who the hell did you think was paying for your lifestyle?
I knew a couple, kids, separated, and out of a sense of obligation – and because he could – he still paid for her to have everything. Then she got mad and got him fired from his second job. Both were very high-paying, but with just one he could no longer afford her lifestyle. Seems a better analogy.
If nothing alters the current course, rural areas are mostly fucked. The combination of no vaccines and no hospitals is no bueno.
Jane Jacobs reminded us that cities were created by agrarians as a place to sell and trade and build wealth. Farmers, especially mono-crop commodity farmers, need cities more than cities need them.
rural places aren’t even farm driven really any more, they’re transfer economies. social security, Medicaid.
My dream is to retire to a small town full of urban social security transplants.
with a restaurant run by a Top Chef finalist.
And good old farming the mailbox
If I were a blue or purple state gov...I would put the pain right on the people who voted Trump. You think your life sucked before, rural dudes, well when there's no hospital for 50 miles and outbreaks in disease start killing you...well you have Found Out then I guess.
Uh, no. You just made the same mistake that got us here using "cost benefit analysis" to apply to a human right. It should not matter the cost, other countries cover everyone, rural and urban, at far less the cost. Once insurance companies are eliminated and pharma is regulated, poof, on our way.
giving certain people a lot of benefit of the doubt when you say these will be tough decisions for state governments to make
I believe every human deserves access to healthcare, but if people keep voting against their own interests then there's nothing you can really do but give them what they asked for.
Perhaps we should consider that they believe voting for racial hierarchy IS in their best interests
Its astounding that you have to use the word triage on health care in a country that could absolutely do universal health care everyone else does even Russia and North Korea does that tell you anything about life in America where the adage is no money you die its disgusting
Yeah, we should really look into what makes…uh…North Korea’s healthcare system so great?!? I do hear they have great TB treatment in Russian prisons. Sorry, meant to say they have a great amount of TB in Russian prisons. I don’t think they bother treating it at all.
By the way your profile picture suits your way of thinking
Canadian here free Healthcare you can make up any bullshit excuses you want they are not believable universal Healthcare is affordable and should be the right of every citizen save your brainwashed bullshit if you have never had it one bad sickness your bankrupt or dead
Dude, if you’d stuck with Canada I wouldn’t have replied. It’s the accepting/repeating of Russian & North Korean propaganda that caught my attention.
Yup but at least they dont charge you to die right
I have no idea what this is referring to
Ooooh i found the infighting now. Yep, this is pretty boring. It's truly fucked up but I can't force people to help themselves and so I try to elevate sane rural voices but there's not much you can do to beat out decades of propaganda. Breaks my heart but I'm, sadly, not a super hero.
And besides those rural assholes got us in this mess
Urban health systems, especially inner city ones, are as vulnerable and dependent on federal funds as rural ones. One of the most startling findings I’ve ever ran across was an analysis of healthcare for rural and urban poor that found basically the same things.
📌
Uh, yea. My wife works in Wilmington and they are freaking out about the potential Medicaid/Medicare cuts
I just used the triage metaphor elsewhere and I think it's a valuable one for thinking about the situation. The Republican desire to slash and burn everything means we are in a triage situation, which means tons of people are going to be hurt. Triage is horrible, but you can't wish it away.
I honestly think that's some white Trump voters& goals. There seems to be an idea they have that if they break 'the system' enough their (also white) neighbors will help them directly instead of paying taxes. An idea that we liberals will take care of them instead of black/trans/Latino people.
They think we will fracture into racial groups and they will be with Bill Gates and Elon Musk and will be better off. Because they've fucked their lives up already
And it's more than cost benefit. It's also supporting communities that will, in the future, rebuild capacity. If we spend our very limited power trying to preserve the society that keeps slashing and burning, then we are harming everyone AND never getting out of this mess.
Meanwhile in Mexico, my health insurance is $300/year with no copay and I'm not even a citizen. America is shitholeville
That good old CURP card.
we have our problems, to be sure
Sadly they're the same problems we've had for decades.
This is how you get rationing, but really there is no choice when resources are this constrained. Enjoy those 20 month waiting lists and 1 day a month appointments because we have a traveling medical team that can only do that much.
This would be far less of a problem if MediCaid and Medicare were not handled by counties
In case you didn't notice. President Biden rebuilt Affordable Care Act into a more manageable system, saving lives all across the board.
Funnily enough that also aligns with short and long term political incentives. Sucks for my family in rural areas
We always have power. 51% isn’t 100% - maybe believing so got y’all what you got.
Right like I understand viscerally recoiling from people who immediately go "fuck the hicks" but there is no situation in which we will be able to save everyone
honestly I could see the country implementing universal healthcare as a “temporary emergency measure” post-2028
Really? I was alive in 2020. I can't.
We'll have to go beyond universal healthcare to socialized medicine, ie the UK's National Health System or the VA hospitals.
that’s never going to happen in the US, esp in a post-Trump world where i severely doubt the state capacity to do that will even exist, much less it being worthwhile to pay the upfront costs of it while in the middle of an active health crisis
the american medical system, from doctors to the massive insurance bureaucracy, would never get behind that, and they’re large enough and well-connected enough to utterly kill it dead politically, and there are much more valuable things to use political capital for post-Trump
On the contrary I’d argue it’s inevitable in the US, there is literally no adequate alternative. It’s either universal healthcare or things get exponentially worse forever. I don’t know how long it will take, but voters won’t tolerate that forever.
universal healthcare and the UK socialized system are two very different things, and very few countries have a British-style state-owned system—not to mention that there’s little reason to believe the British healthcare system is a particularly-good model of UHC compared to other countries
Same for all infrastructure spending
And we can use deficit spending on items like that and then tax the rich to continue funding it
like, you are going to have to cut specialists and you are going to have longer travel distances and longer wait times. this is what happens when you pull a trillion dollars out of the baseline
“Take money out of rural healthcare and use it to build more cheap housing near cities so people don’t have to live in rural areas with bad healthcare anymore” is not a ridiculous position
I agree. I think there’s a huge difference between “we have no option, we’re losing capacity, it is out of our hands” and “we could stop this, but fuck ‘em”. We can’t get out of this by going “beatings will continue until morale improves” and we sure as hell shouldn’t pretend we’re doing the beating
Because we *aren’t* the ones with power here. We *don’t* have control over funding. It’s bad on a basic moral level to vicariously live dreams of explodinating farmers through Trump destroying the rural areas and everyone in them, but at the very least we shouldn’t *actively take credit for it.*
It's human to have bad thoughts and bad dreams but we're also human and can choose to not state and live those things. So you're right on the money. We don't have power and part of that is the fact that the people hurt the worst are those furthest from most people. It's heartbreaking really.
Yup. From a practical perspective the conversation is less about "saving" and more about "rebuilding." To a certain extent it's like climate change: there is a lot we can, should, and MUST do, but even if we stopped all future carbon emissions there's a certain level of disaster baked in now.
rural hospitals were going out of business anyway and I doubt there's going to be much effort to protect them from these cuts
really need to build up housing capacity in the cities
TBH I'd say first ring suburbs. Nobody fleeing rural care deserts wants to live in a city neighborhood, but a lot of the older suburbs already have a lot of infra for newcomers, but don't have a ton of extra housing capacity anymore.
Like, a little apt building like this isn't foreign or alarming to somebody from a rural county (in the way that an urban rowhouse would be, let alone midrise apts), but it's near lots of care, & many are near transit. But we need many more of them (+ more density where suitable).
honestly I think *some* people fleeing rural health care deserts would be fine in cities, on the theory that some of the people still there are there because they can't leave but that nitpick aside, I agree
Yeah, not "nobody", but if we're imagining a large influx, it's going to be people who basically like it out there (or have never known anything else).
and also business districts in those inner-ring suburbs
I'll never understand how councils in these towns don't see the virtuous circle of more housing=>more residents=>more customers. I mean, the answer is basically that they're hopelessly suburb-pilled and view people as a scary urban thing.
Building up capacity in cities also reduces the number of people heading out to the burbs and competing with rural influx
Good point.
I do not like the idea that meemaw will have to travel farther for chemo which is one of the many reasons I voted for not-that. but here we are.
"Oh but we should do both" we don't have the money now, the people of Fucksburg made sure of that when they elected Trump. Because we are about to have to make intensely hard choices about the distribution of resources. Why take food out of the mouths of people who didn't vote for this shit?"
might be the right time to invest in long-stay motels.
chemo trailers. gonna be great.
Had a flashback to the penultimate episode of Breaking Bad
We have something like this in NYC run by the American Cancer Society but, you know, in Manhattan. Where there's a concentration of doctors and real estate. Meemaw can take the bus right to its door.
The State Employees' Credit Union in NC operates one near the university medical centers in the Research Triangle.
A local university hospital that is a major cancer center put in a whole new building that is partially long stay apartments for people undergoing treatment. Really makes a difference. www.ohsu.edu/health/rood-...
That's fucking cool.
Maybe it's time for meemaw to move into the big city.
Start a TV show called "Meemas Moves to the Big City" and it's about how the city is cool and awesome for older people. Might save lives.
Thankfully, American urban development is famously responsive to increases in demand.
The greater DC area just nodded grimly in unison.
Being from Canada, I can confirm that what you just described is the dilemma at the heart of publicly-funded health care systems.
There is no dilemma im 72 probably used the system most in the last 10 yrs old age being what it is i have been taken care of wonderfully and this made up bullshit of our system being broken is that bullshit could it be improved absolutely but its far from broken
One of the last things I worked on was an insurance product where, if the wait was too long or you couldn’t get a particular treatment within 200km of your home, you would get flown to and put up in a US city where you could get treatment immediately. Look for similar products to appear in the USA.
OHIP was going to fly us to Cincinnati and put us up for the duration when it looked like there wasn’t an opening in paediatric cardiology; it didn’t happen but it was nice to have the option.
Mine was for cataract surgery because of how specialized it is; not every town can have someone who knows how.
I think this is actually a good way to handle the scarcity of healthcare send skeet
did I like having to choose 1 of 2 coastal cities to travel to for the cancer care that saved my life? no was I mad when I learned my "insurance" didn't have to pay because there was no doctor in NM, AZ or TX who would work on me? you bet do I like living in a low cost low population place? yes
There's no queue if people just plain can't pay for something. Those are two opposite problems.
I invite you to learn about a process called “reasoning by analogies”.
Opposites are not analogous
mmmm kinda. you don’t pay for it, supply doesn’t get built, which means bottlenecks when for whatever reason demand spikes high
we definitely have _charities_ of that nature, but I have not seen insurance products! Interesting.
It won't happen. The wealthy in the US already do this, so there's no need to offer the same to the poor in a for-profit healthcare system.
Bingo.
It's not the poor you're targeting, it's group health plans for large employers whose employees are mostly middle class.
Correct. If there’s money to be made, insurers will be on it.
for example, some group plans in Alaska will fly members out and put them up in hotels to get major surgeries in Seattle - which is a lot cheaper for the insurance than paying for care in Alaska. we’re seeing this now with group plans for some gender affirming care too
Yeah, my work insurance has something like this already. The devil is in the details on stuff like this—how hard is it to get approved, what if there’s someone who offers the treatment but you have good reason to not want to go to them, is care actually available “immediately” somewhere else…
But it does exist in at least some large employers’ health plans already. Honestly, a flight and a hotel is pocket change compared to some of the charges involved with specialty care.
(thinks about costs of specialty care our family has received) ….this is extremely true
Having greater unity in the payment scheme should be a goal of any reform. What will happen is all kinds of alternative care models will start to sprout up (e.g., APRN clinics, etc). Having cash and carry providers in the mix isn't good unless they are legit offering something at low $$.
A problem we have now is that these entities sprout up and then start demanding payment from existing coverage networks. We're going to have to say 'no' to a lot of that, if we want a system to operate from any kind of intended design.
But, as with anything, that's hard. If some guy creates a strip mall chemo outfit and it starts out looking affordable because they're losing money, they could snow their way into network.
BUT: A thing we also need to do is encourage state lawmakers to crack down on alt medicine. Encouraging the creation of 2 million more chiropractors won't be good for society.
This is both entirely correct and will result in a level of absolute, screaming, frothing, destructive anger you and I can barely even imagine. But, as the song says, we did it before and we can do it again: We had to fight charismatic purity cult of alternative medicine a century ago:
Related: we need to start encouraging a focus on women’s healthcare. I saw an interesting comment suggesting that the anti-vaccine and woo health stuff may derive from women having to figure out their own remedies because doctors and pharma companies didn’t think their pain was real post-partum.
I don’t know that I agree with that, but I think it’s worth considering whether excluding women’s health issues from Western medicine has had some negative outcomes.
This is one of the most popular wait time reduction measures in publicly funded systems globally. Portugal and Norway do this as well. In the Portuguese case, the procedure provided by the private provider is billed to the national payer, but with a tariff as an incentive to keep wait times minimal
Canada was a bit weird back then because offering a private method to get health care that was covered under the Canada Health Act was a criminal offense. It isn’t anymore.
IIRC that's only ever been prohibited within the province you're insured by, so going private inter-provincially was fine --- except that until relatively recently, it wasn't a large enough market to develop much supply.
Fair. It was more that other provinces wouldn't take you because they couldn't charge you, and you couldn't have a private system parallel to a public system until M Chaoulli brought his suit.
You were in Quebec, right? I hear they’re notorious for poor inter-provincial chargebacks. If someone from NS gets care at an Ontario hospital, NS will pay the docs at the OHIP rates. But if a QC resident goes to a doc in Ontario, QC will pay them RAMQ rates.
I was, and I’m not sure if this is still true but it absolutely was when I lived there.
Not only that, but the ON doc couldn't bill QC; you'd have to pay upfront and get reimbursed at QC rates.
20 years ago I ran into a weird exception to this: I got a hernia repair at the Shouldice clinic which is semi-private and was grandfathered into OHIP because it predates it. But NS has different rules, and for whatever reason the anesthesia wasn’t covered. $2500 in local anesthetic.
Can't wait 'til a Democratic congress someday restores rural hospital funding over the "no" votes of every single GOP legislator, only to have Katie Britt (etc.) show up at the hospital re-openings and be like, "you're welcome."
I don't actually think it's a completely planned conspiracy or anything, but the movement toward woo-woo "health" scams that happen to be both affordable (and available in any grocery store) seems directly conversant with the upcoming collapse of the rural healthcare system.
(Maybe it's a conspiracy in the "let it happen on purpose" way we saw in 9/11 truther discourse.)
Supplements were Alex Jones’s cash cow for a very long time, the whole industry is effectively grifters top to bottom Less of a conspiracy and more grifters gonna grift combined with an already established market (Limbaugh to jones is a straight line) that turned med distrust up to 11 post Covid
We can, and should, enable and encourage people to move out of rural areas and into urban areas. We can save rural lives without saving rural areas.
We are already short of housing in urban areas. There are going to be shanty towns in the suburbs.
That's why we need the YIMBY movement! Also, the post that inspired the rural hospital debate was about hospitals in rural Michigan. Cities in the rust belt, like Detroit, would actually benefit from population growth.
Detroit is not representative & the people that voted for this also destroyed programs that would have facilitated the construction of more housing. It will be years before we can build enough housing for the people who voted to make it harder.
We voted to keep their hospitals open. They voted to put a boot on our necks.
My wife has said if we ever leave this area we’re going to have to move to somewhere with a similar density of healthcare services, which … definitely limits options. But with her health situation, I definitely get it.
Rochester, MN is great 😊
I mean most likely New Haven CT - the pizza is 💯
I still, to this day, cannot get over how REAL RURAL AMERICA *did this to themselves out of pure spite*. Literally the guy putting a stick in his spokes meme.
I'm going to have to listen to this shit from these people for the next two decades of my life
I'm just a simple caveman, but I was under the impression that you should be responsible for your political choices *particularly* when those choices are animated by bottomless, intense hatred of "dirty, evil, scum sucking city lowlifes that should be exterminated by COVID or whatever is convenient"
Put me in charge of the reconstruction caucus’ efforts to re establish systems of care in rural areas. I dream of that opportunity.
But in the meantime? Triage, as you say.
Why not aim for ridding the healthcare system of corporate insurer grift? It would be a better start than planning based upon a scarcity assumption. All those sadistic profits of stolen premiums, co-pays and denial of care could be reinvested in sound strategic planning and development.
Yep, let rural areas live with what they voted for. We have to stop letting "conservatives" drag us back to the Dark Ages because they don't like "woke" equality.
We must not abandon rural citizens. That's what they say we ALWAYS do. Even though 🌊 never did. Now, they're discovering what Republicans really think of them.
“The next time we have any power” pretty well sums the situation up. Given the trache of actions this administration has unloaded, the likelihood of this is extremely slim.
sir, you appear to be Australian
EVERY time these days they just have a lot of feelings
I’ve just looked and, by God, you’re right. Very clever of you.
Aussie doomers out in full force today for some reason. Must be looking for a respite from living in a post-apocalyptic Mad Mad hellscape.
If you don’t subscribe to the “doomsday scenario” how do you see the next decade progressing in America?
Without the research looking into it , how can you say theres no successful model for rural healthcare??
I double checked and that’s not what I said
We're going to need an NHS at the other end of this fucking thing.
Or a WHO. The opposition thinks globally, and so must we.
Whatever comes next, a strong NHS will be essential. We can’t afford to let it be run down any further.
Exactly—no matter what, we need a strong NHS to protect people. Letting Big Pharma dictate terms puts everyone at risk.
great play on words
Those rural areas might be almost entirely depopulated by then as a result of all the cuts and mismanagement.
I say blue states keep their federal taxes and fund their own state's healthcare, ignore rfk, and fund clean energy projects...we do not have to go down with the ship....
The majority of poor PoC live in states with GOP trifectas …
You don’t pay your federal taxes to your state to then pass on to the feds, you pay the feds. Blue states don’t have federal taxes to keep. They have more productive individuals and businesses living in them who have higher federal tax bills. Separately, states collect state taxes.
The absolutely key thing is for Dem pols to flood the zone explaining why these changes are happening. People will literally not believe it no matter what, but it needs to be said over and over.
I kinda disagree: next time we get power, the country won’t be remotely wealthy enough to afford anything but single payer
💯
