Striking, unsettling piece. A while back, my wife suggested that we think about resettling in a particular oceanfront town. I wrote out 20 reasons why we shouldn’t. The first two were (1) 3-hour drive to nearest commercial airport and (2) 3-hour drive to nearest sizable hospital.
You are fortunate to have found such a place. They are there but anyone wanting to 'leave California' for a quiet place should carefully research health care access.
Once again, you describe the demise of rural healthcare to a T. Unfortunately, the care provided in urban areas is often less than it should be. What we really have is a healthcare system that has been taken over by big business medicine peddling specialists to replace the general practitioner. With healthcare services from labs to prescriptions available online, I think what we are really seeing is the shift of healthcare to internet providers. Check out Maven. There's plenty of criticism of this by employed physicians, but patients really have few other options. Your advice to summer vacationers is right on. As for choosing to live in rural areas, many of us have no intention of spending our last days in a hospital.
So true, even in urban areas the quality of healthcare can be inadequate. Managed care, reduced Medicare and the influx of immigrants are stressing all public services, including Medicaid
While it might be easy to blame “Big Health” for all the reasons rural health is suffering, it wouldn’t be totally correct. If you were a talented neurosurgeon, would you choose to practice in an area that might have a half dozen patients a year? How. Would you maintain your skill in a low volume environment? Everyone agrees that when you are the patient in need, the only important thing is access to care, but it’s not logistically possible to have every possible specialist in every one of 5,400 counties in the US. Subsidies can only go so far.
Aye, that’s the rub. This is a problem without a ‘silver bullet’ solution. We have tried a number of ways to serve ‘have nots’ without solving the problem totally. There were networks of faith based non profit hospitals that no longer exist, and there are (too few) cases of hospitals whose donors allow them to take all patients, and we have massively spent tax money attempting to solve that problem, and all seem to have limitations.
All of this is very true. I have two homes, one in a small town in TN where I lived and worked for most of 40 years, and one in an Atlanta suburb, close to where I grew up. 4 years ago we moved our permanent residence to the Atlanta area from TN due primarily to healthcare. Over the past 10-15 years the healthcare in the TN location has declined significantly while the care at our GA home is excellent. We also maintain an annual subscription to an emergency evacuation service which will take us back to GA as long as we are at least 150 miles from home.
When I finally was able to retire, there were some beautiful homes on the Oregon coast. We had talked about getting out of the San Francisco Bay Area for a long time. Unfortunately those small coastal towns were hours away from any major medical centers and there was no way I was going to be that far from definitive care, especially in this era of closures and consolidations. (Oh, and the PCPs at the clinic I used to work at have 2000 patients on their panels. My current PCP works for a large medical facility and probably has close to the same number. We talk a lot about the toll it takes to work in healthcare these days.)
Striking, unsettling piece. A while back, my wife suggested that we think about resettling in a particular oceanfront town. I wrote out 20 reasons why we shouldn’t. The first two were (1) 3-hour drive to nearest commercial airport and (2) 3-hour drive to nearest sizable hospital.
I have CHF and other heart problems. I made a decision seven years ago to move to the outskirts of a large city with two teaching hospitals.
You are fortunate to have found such a place. They are there but anyone wanting to 'leave California' for a quiet place should carefully research health care access.
Once again, you describe the demise of rural healthcare to a T. Unfortunately, the care provided in urban areas is often less than it should be. What we really have is a healthcare system that has been taken over by big business medicine peddling specialists to replace the general practitioner. With healthcare services from labs to prescriptions available online, I think what we are really seeing is the shift of healthcare to internet providers. Check out Maven. There's plenty of criticism of this by employed physicians, but patients really have few other options. Your advice to summer vacationers is right on. As for choosing to live in rural areas, many of us have no intention of spending our last days in a hospital.
So true, even in urban areas the quality of healthcare can be inadequate. Managed care, reduced Medicare and the influx of immigrants are stressing all public services, including Medicaid
While it might be easy to blame “Big Health” for all the reasons rural health is suffering, it wouldn’t be totally correct. If you were a talented neurosurgeon, would you choose to practice in an area that might have a half dozen patients a year? How. Would you maintain your skill in a low volume environment? Everyone agrees that when you are the patient in need, the only important thing is access to care, but it’s not logistically possible to have every possible specialist in every one of 5,400 counties in the US. Subsidies can only go so far.
True, so what do we do about the have-nots, and how many patients don't make it to the "big city" specialists?
Aye, that’s the rub. This is a problem without a ‘silver bullet’ solution. We have tried a number of ways to serve ‘have nots’ without solving the problem totally. There were networks of faith based non profit hospitals that no longer exist, and there are (too few) cases of hospitals whose donors allow them to take all patients, and we have massively spent tax money attempting to solve that problem, and all seem to have limitations.
Wonderful article, Ed. I took the liberty of copying parts of it to my substack.
All of this is very true. I have two homes, one in a small town in TN where I lived and worked for most of 40 years, and one in an Atlanta suburb, close to where I grew up. 4 years ago we moved our permanent residence to the Atlanta area from TN due primarily to healthcare. Over the past 10-15 years the healthcare in the TN location has declined significantly while the care at our GA home is excellent. We also maintain an annual subscription to an emergency evacuation service which will take us back to GA as long as we are at least 150 miles from home.
When I finally was able to retire, there were some beautiful homes on the Oregon coast. We had talked about getting out of the San Francisco Bay Area for a long time. Unfortunately those small coastal towns were hours away from any major medical centers and there was no way I was going to be that far from definitive care, especially in this era of closures and consolidations. (Oh, and the PCPs at the clinic I used to work at have 2000 patients on their panels. My current PCP works for a large medical facility and probably has close to the same number. We talk a lot about the toll it takes to work in healthcare these days.)