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Depends where you live. If you live in Cheapsville, just like anywhere else there are no services because there are no taxes to help pay for them. Doctors do not want to live where manufactured and trailer parks reign. A lot of folks that live there have no way to get to the Health Services.
Fast forward to Middle and Upper middle class areas, where docs and surgeons actually want to live, and HC is top notch. Do you think that Palm Beach has poor HealthCare, think again? Where we live we trip over doctors, good ones, and we have an abundance of specialists. A lot of them live in our area. So this is no different from any other state where the local governments put nothing into infrastructure, there only people with limited means can afford to live.
In the USA you get what you pay for. If you live in cheapsville you are typically SOL. Newsflash, Taxes pay for Amenities, Schools and a better quality of life.
There are a lot of economic reasons why rural and small town healthcare is struggling. It's not simply a matter of "docs not wanting to live there."
There are a lot of economic reasons why rural and small town healthcare is struggling. It's not simply a matter of "docs not wanting to live there."
Yeah, but that is a very big part of it. It’s really hard to attract talent to rural areas. Those places tend to get the bottom of the med school class.
There’s also the issue that hospitals in poor rural areas have been failing at an alarming rate, particularly in red states. Medicaid in those places doesn’t even cover costs. It has payout caps in states like Alabama. Alabama caps the hospital benefit at $3,500 per year. The hospital either wheels Medicaid patients out into the street after a day in the hospital or eats the huge loss. There aren’t enough private health insurance patients to subsidize that so the hospitals go bankrupt. The ones that stay open do it on a bare bones budget and can’t provide the level of care typical in an affluent urban hospital.
Yeah, but that is a very big part of it. It’s really hard to attract talent to rural areas. Those places tend to get the bottom of the med school class.
There’s also the issue that hospitals in poor rural areas have been failing at an alarming rate, particularly in red states. Medicaid in those places doesn’t even cover costs. It has payout caps in states like Alabama. Alabama caps the hospital benefit at $3,500 per year. The hospital either wheels Medicaid patients out into the street after a day in the hospital or eats the huge loss. There aren’t enough private health insurance patients to subsidize that so the hospitals go bankrupt. The ones that stay open do it on a bare bones budget and can’t provide the level of care typical in an affluent urban hospital.
This is so true, especially in the poor Red States you mention. They consider lower taxes and LCOL to be more important than their citizen's well being. But some people just do not get it. Again, you ONLY get what you pay for. Taxes are important for Schools, infrastructure and amenities.
What you say is also VERY true regarding Medicaid expansion. However in Rich counties like ours they do cover the costs (Florida). Our hospitals and docs are top notch. BUT 50 miles East, it is a completely different story, no busses, no hospitals, No real grocery stores. People are very poor and their mortality rates are on the increase, and yes Taxes are very low, not my ideal place to live.
Yeah, but that is a very big part of it. It’s really hard to attract talent to rural areas. Those places tend to get the bottom of the med school class.
There’s also the issue that hospitals in poor rural areas have been failing at an alarming rate, particularly in red states. Medicaid in those places doesn’t even cover costs. It has payout caps in states like Alabama. Alabama caps the hospital benefit at $3,500 per year. The hospital either wheels Medicaid patients out into the street after a day in the hospital or eats the huge loss. There aren’t enough private health insurance patients to subsidize that so the hospitals go bankrupt. The ones that stay open do it on a bare bones budget and can’t provide the level of care typical in an affluent urban hospital.
We joke around here that most of the community hospitals are just big urgent cares. I had someone from NYC message me privately that they were looking at my area and wanted to know various things. It's darn sure not NYC.
This is so true, especially in the poor Red States you mention. They consider lower taxes and LCOL to be more important than their citizen's well being. But some people just do not get it. Again, you ONLY get what you pay for. Taxes are important for Schools, infrastructure and amenities.
What you say is also VERY true regarding Medicaid expansion. However in Rich counties like ours they do cover the costs (Florida). Our hospitals and docs are top notch. BUT 50 miles East, it is a completely different story, no busses, no hospitals, No real grocery stores. People are very poor and their mortality rates are on the increase, and yes Taxes are very low, not my ideal place to live.
Yep. Florida is certainly a good example. In the affluent places, people have good health insurance. If they're 65+, they tend to have premium supplemental plans on top of Medicare. A physician can earn a good living there and hospitals can cover their costs. The big property tax base and all the retirees with no children in the school system fund good services. Go inland 50 miles and it's no longer affluent.
Tennessee is similar. No income tax. Everything is funded through property taxes and sales taxes. Prosperous Nashville is full service. The rest of the state, not so much.
Upthread, I also made the point that the big cities with the premier medical schools and teaching hospitals offer a level of health care you don't necessarily find in other affluent places. In NYC, you can find a world class specialist in just about anything. The A+ guy. In other affluent places, you can maybe find the A guy or the A- guy. Most of us don't ever hit the point where we'd need that A+ guy but it's an advantage. The only places south of the Mason-Dixon line with top-20 medical schools are Duke and Vanderbilt. If I have a big health problem, I can book myself in with the specialist at the Wang building at Mass General who is on the Harvard med school faculty.
Yeah, but that is a very big part of it. It’s really hard to attract talent to rural areas. Those places tend to get the bottom of the med school class.
There’s also the issue that hospitals in poor rural areas have been failing at an alarming rate, particularly in red states. Medicaid in those places doesn’t even cover costs. It has payout caps in states like Alabama. Alabama caps the hospital benefit at $3,500 per year. The hospital either wheels Medicaid patients out into the street after a day in the hospital or eats the huge loss. There aren’t enough private health insurance patients to subsidize that so the hospitals go bankrupt. The ones that stay open do it on a bare bones budget and can’t provide the level of care typical in an affluent urban hospital.
Ok, so how is it that those in rural areas make more than docs in desirable urban areas?
I agree that it’s generally the bottom of the barrel that goes to places like Alabama. Why do we keep hearing that they make more to go there, when they are the bottom of the barrel and Medicaid reimburses so poorly?
Tennessee is similar. No income tax. Everything is funded through property taxes and sales taxes. Prosperous Nashville is full service. The rest of the state, not so much.
You don't know what you're talking about. There is nothing here in Knoxville that I can't get in Nashville other than a fancier mall, of which malls I hate and never go to anyway. I would say there are more sports there but we have the Vols here. I can't begin to describe the space we are losing due to the countless McMansion neighborhoods popping up. People have to have money to afford these $3-600+k homes. To infer that a city with a metro of 1 million isn't "full service" is pretty dumb. From where my house is it's plenty prosperous here, maybe not insanity on Nashville's level, but yeah.
Healthcare here is great, one of my just-retired doctors is/was nationally recognized has published works all over the place. For the very very very worst they'll send you to Nashville but yeah.
Yeah, but that is a very big part of it. It’s really hard to attract talent to rural areas. Those places tend to get the bottom of the med school class.
There’s also the issue that hospitals in poor rural areas have been failing at an alarming rate, particularly in red states. Medicaid in those places doesn’t even cover costs. It has payout caps in states like Alabama. Alabama caps the hospital benefit at $3,500 per year. The hospital either wheels Medicaid patients out into the street after a day in the hospital or eats the huge loss. There aren’t enough private health insurance patients to subsidize that so the hospitals go bankrupt. The ones that stay open do it on a bare bones budget and can’t provide the level of care typical in an affluent urban hospital.
What you say is true. Any state with a lot of Medicare/ Medicaid patients are in trouble. I have private insurance thru Hubbie's job, plus since I'm 66, Medicare.
Medicare pays peanuts on the dollar, and much of the blood work or tests order by my doctors are not even covered at all by Medicare.
That's why old ppl are sicker- even seniors that are my age. (My father had Medicare and altho he lost 100# and couldn't keep food down, they kept saying he was as healthy as a horse. When he started vomiting blood, they did exploratory surgery and found he had cancer of the stomach, intestines, esophagus, and interstitial fluid between the organs.)
An MRI that was billed at $1125, is approved at $225. (they actually paid $19.21 because the BC/BS paid first). X-rays charged at $137 (for 4 of them), was approved at $46.42, again paid only $19.21 because of my insurance.
Also, my husband was a state hospital inspector. (Still works for the state but now in a different program). Hospitals HAVE to treat anyone who comes into the hospital/ ER even if they have NO INSURANCE of any kind. You can not be turned away. Just think how many ppl have no insurance....and the hospital treats...
So you get lots of sick elderly or poor ppl with no insurance, or Medicaid or Medicare as the main source of payment and hospitals can get into trouble real quick.
That is also 1 reason why some inpatient stays ends even when the patient is not ready to go home, but then is readmitted within 24- 48 hrs. First it is an emergency admission, and the payment clock starts over. The hospitals do that because if the patient stay longer, they won't get paid.
Also, because insurance tells the hospital how long a stay you can have. Called DRGs (diagnosis related group) is when an insurance company says how long a hospitalization SHOULD take for any group of illnesses. That is why a doctor has to do a "song and dance" to get the insurance to pay for a longer stay if needed. BTW- insurance companies also have DRGs.
I was down in south Florida last week. The weather was beautiful. However, crowded is an understatement. Many areas have grown significantly in the past 30 years. I'd imagine that just like infrastructure healthcare institutions are having a difficult time keeping up with the rapid growth. The weather is a definite plus and I would enjoy being able to be outside walking, swimming and enjoying the sun in the winter, but a big concern of mine is crime and traffic. There was a large number of police officers in the area and heavy traffic at nearly all hours of the day. Oddly, pedestrian cross walks give you a walk sign but cars turning right and left have green lights when the crosswalk sign is on and drive right through when people are crossing. It was unnerving. I am also concerned about the extreme contrasts in wealth. I saw a $250k exotic car pulling into a parking space where someone had been sleeping in the bushes. It seems to me like the area is overwhelmed and not only trying to manage the people who live there, but the massive number of tourists constantly coming and going as well.
I was down in south Florida last week. The weather was beautiful. However, crowded is an understatement. Many areas have grown significantly in the past 30 years. I'd imagine that just like infrastructure healthcare institutions are having a difficult time keeping up with the rapid growth. The weather is a definite plus and I would enjoy being able to be outside walking, swimming and enjoying the sun in the winter, but a big concern of mine is crime and traffic. There was a large number of police officers in the area .....
One way to measure how FL is changing is to do the newish internet pastime: google "Florida Man" & any random date, say the month & day of your birthday, & see what result you come up with.
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