it is definitionally a cost/benefit thing; you’re just highlighting a certain (important!) type of benefit that can be included in the analysis

Its complicated. Many rural folks still need to come to larger urban hospitals for specialty care. You could give whatever money is now left to the rural hospital, something that is key for access, or the urban hospital serving more people and providing care just not possible at the rural hospital.

Its absolutely the most bleak conversation to have and one that will end with people losing life saving care either way.

look man, my wife works at a rural hospital lol. trust me, I don't love it personally!

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