‘It’s gone haywire’: When Covid-19 arrived in rural America | Hacker News Reader

‘It’s gone haywire’: When Covid-19 arrived in rural America

detroitnews.com

70 pointsrmason42 comments

Trying to convince medical students to practice in rural/underserved communities by trying to appeal to altruism is clearly not working when many of them may be half a million dollars in debt. It's such a big problem but it seems like there are no easy solutions in sight. Even debt relief programs are clearly not enough. Or perhaps there just aren't enough doctors to begin with.

Why should we convince them on altruism and not by paying them more? I thought USA was all about the market deciding where resources should go?

That would be if we didn't let them successfully lobby to restrict residencies and therefore doctors. Americans with the skill and will exist but we will shut them out because we want to maintain price floors.

This is false, or at least no longer true.

Since you didn't provide evidence, I don't feel the need to do so either. But debunkings can be found on this site, as well as elsewhere

Edit: OK, here's one from me https://news.ycombinator.com/item?id=21127853

1986, 1997, 2005, 2018. Not only is there a hysteresis effect here but the AMA didn't stop being evil villains in 1900. https://news.ycombinator.com/item?id=22940320

Doctors are protectionist evil people.

Your 2018 link is the same opinion piece that I rejected in the comment I linked.

Your 2005 link includes the following quotes:

> Congress controls the supply of physicians by how much federal funding it provides for medical residencies — the graduate training required of all doctors.

and

> Even the American Medical Association (AMA), the influential lobbying group for physicians, has abandoned its long-standing position that an "oversupply exists or is immediately expected."

That second quote precludes me from having to respond to the 1986 or 1995 links since my original comment said "no longer true"

It's the usual hysteresis that results in what they did. The Nazis haven't gassed anyone in fifty years. They're still evil.

Ultimately, the AMA blocked residencies through lobbying and now maintains the position through small expense of effort because the status quo is a strong position. Change needs justification and you only have to block at the point of change. Things are the way they are because they put in the effort at the crucial moment.

And they certainly haven't undone their crimes. Just stopped being criminal. It's like a bank robber who stopped robbing banks and invested in the S&P500.

Because when people don't have money to "pay doctors more", if there's no altruism then there's death.

Because rural life is fundamentally economically inefficient, so they can't pay more. Transportation and overhead is too expensive. It only works if its subsidized by altruism of the urban economy, or a huge portion of locals learn the skills for themselves.

The way I see it is, a rural economy has to be propped up by at least one "export" of some kind. This usually isn't informational; the information economy gravitates toward urban centers. Whether or not the information economy has to stay in urban centers is unclear, but it seems to be the case right now.

Traditionally that export has been mining, manufacturing, and/or farming. Things that require lots of cheap space and labor and not much else. The first two have taken deep dives in the past few decades. This makes rural life, in many places, simply uneconomical. Without something bringing money into the town, people don't have money to spend on local services. Healthcare is an expensive local service. If we leave it up to the market, the answer is often simply "don't live in a rural area". I'm not saying we should just leave it up to the market, though many would, but I think these are the base facts.

Edit: I hadn't actually read the article yet and I hope the above doesn't come off as insensitive in relation to the OP's tone. But I still think it's the truth. Rural America right now is the most broken part of our country's broken system. Something fundamental has to change.

The crux of the rural decay problem is that we've left it up to the global free market, and China/India/other developing countries have sucked up all the manufacturing jobs (national labor cannot realistically compete with Chinese labor).

Sure, but that's still the free market. Free-market purists (many of whom live in rural areas) have to realize that this is what comes from taking a hardline stance against government action when it comes to the economy. Stuff just shifts to maximize efficiency, with no regard to the lives that break in the process. This is the unregulated force that they so blindly worship.

Many conservative people in rural areas are not pure free market people. Hence the wide support for Trump. He's a populist and nationalist. Ask anyone in rural America and I guarantee you will be hard-pressed to find anyone that thinks the US should do nothing to stop jobs and production from moving overseas because they believe in the free market.

I'm more pointing out that when they talk about that sort of thing, they're often being hypocritical after using "small government" and "free market" arguments five minutes before to denounce everything from social services, to capital gains taxes, to environmental regulation. There's a deep-cutting double-standard. I'd have more respect for it if they just admitted to self-interest, instead of preaching against deregulation except when it negatively impacts them.

"The country" means rural for anyone curious.

Edited for clarity. Didn't think about the ambiguity.

I can get on board with the urban centers being altruistic and subsidizing rural America as long as there is some return value unlike the current times where they turn around and gives us Mitch McConnell.

Also let’s pay nurses and doctors well even if someone has to bring healthcare to rural America.

Or if we bring the inflated costs of medical school down.

Sounds like the modern day definition of socialism, which is largely rejected by rural populations, as evidenced by voting patterns.

It seems logical to allow people who reject a the system that provides them care to endure the consequences of that decision.

Actually it’s unclear how the people in the article would vote as that section of Georgia was subject to de facto voting restrictions in the last two elections.

'New bill would forgive medical-school debt for Covid-19 health workers'

https://abcnews.go.com/US/bill-forgive-medical-school-debt-c...

It's called the 'The Student Loan Forgiveness for Frontline Health Workers Act.' Introduced by Rep. Carolyn Maloney (D-N.Y.) on Tuesday

there are no easy solutions but there are straight-forward solutions. In the short term, have the state incentivize doctors to move through loan forgiveness programs.

In the middle and long term, incentivize people to move to urban areas, build more housing, and culturally stop glorifying suburban and rural life. (And stop supporting it by subsidizing single home ownership and so forth).

In response to a post about a pandemic where the "approved response" is to self-quarantine, you are suggesting that people should be incentivized to live in high-density areas?

Putting aside the benefits of living in a city for the moment, I have to say that such a response appears to be somewhat tone-deaf.

[shrug]

Anyway, it seems that the State paying off medical student debt in return for a certain amount of service to a particular population (a.k.a. the Joel Fleischmann experience) is an efficient use of tax dollars. I admit to only knowing of one person in this situation, but she enjoyed working in the area where she was assigned so much that after her commitment was fulfilled, she stayed on. And even if she hadn't, the community was still well served for the time she was there.

I don't know how widespread this practice is, though.

> I have to say that such a response appears to be somewhat tone-deaf.

You can self quarantine in a city as well as in a rural area. I think we shouldn't blame urban life for what was botched policy. Taiwan, Singapore, Beijing, they all did just fine.

Short of a zombie apocalypse I'd always rather be in a city and in close proximity to quality care (in particular relevant for the elederly) than somewhere else. After all, other diseases haven't stopped existing. If you are in a rural remote area, if you have a heart attack you're pretty much done for. Not to mention even getting good dental care can be difficult.

Also shifting the mindset in the US is a decades long endeavour, fascination with pastoral or bucolic lifestyles is deeply ingrained.

We have a serious and growing shortage of primary care physicians, mostly due to insufficient federal funding for residency programs. Every year some students who graduate from medical school are unable to practice because they can't get matched to a residency slot. Ask Congress to increase funding for those programs.

It would also help to expand the ranks of physician assistants and nurse practitioners. It doesn't take a full physician to diagnose a middle ear infection or wrap up a sprained ankle.

Perhaps delegating authority to issue immigrant work visas to counties in such cases. Get skilled staff from overseas. Sure, there are ways it could be done badly and go wrong, but it could be done right.

While in principle that makes sense, I think in reality it wouldn’t work.

First, rural counties are not prepared to run their own immigration systems. That kind of work is centralized for several good reasons.

Second, they’d still have to compete with richer counties, who would also love to reduce their health care costs. The price overall might drop a bit, but ultimately I think more urbanized counties would tend to win out over rural counties in such a system.

Where are the unemployed foreign doctors?

Don't need the unemployed. Go for the best. Brain drain the world like America did right after WW2. Suck the best up and put them here. Don't even have to do very much, just liberalize skilled immigration and pull everyone who wants to come who has degrees in nations with equivalent systems.

Canadian medical staff, for instance, should be able to instant-transfer. Forget the small ball with licence reciprocity between states. Licence reciprocity between nations. They will come. Just let them.

Why the heck would "the best" people from overseas want to work in the US?

Well, if they don't want to, then the liberalization won't do anything. So it looks like a Pareto-optimal move.

Because, contrary to the constant anti-America sentiments shared across social media, the US remains one of the best places to live in the world.

You're not going to see a massive influx of doctors leaving Switzerland, Germany or the UK to come to the US because those countries are all very similar quality of life.

However, the world is bigger than handful of Western European nations which are gleefully looking down their noses at Trump-era America, and there are literally billions of intelligent, hard working, educated people across Africa, Asia, South America and Eastern Europe who would see their lives improve in every way by moving to the US.

> Because, contrary to the constant anti-America sentiments shared across social media, the US remains one of the best places to live in the world.

Evidence please? :)

They don't need to be unemployed, just be paid much higher than what they make in their home country

Visas for skilled immigrants rarely are given to the unemployed, largely because skilled workers very rarely go without work in most countries. Usually these immigrants are looking for a safer or better life in America for themselves or their families.

We are just getting started in dealing with covid-19 health and economic issues.

There are no quick fixes and we need to hope that almost everyone does the right thing (wearing masks, social distancing, keep shopping at local businesses) because we can’t really get the economy going until almost everyone gets on board.

Whoa, you have local businesses?

Our leaders have deemed that even curbside pickup is far too dangerous, so Amazon is the only shop in town.

Here in the Midwest, everything except 1) franchise stores and 2) single-proprietor stores have gone to curbside pickup. They invented a whole pickup process at our grocery store, with shipping containers in the parking lot containing staged carts with numbers, masked-and-gloved young people filling and shuttling carts to the container. They text you when your cart is ready. Drive over and park in a numbered space and reply with your space number. Somebody comes out of the container with your cart and you pop your trunk.

Cars coming and going all day. Works well for everybody (with a car).

And there is the challenge that many of the most vulnerable are even more devastated financially by this situation, they have to keep working, and many low pay (now essential jobs) haven't done a good job on ppe. People in those jobs have less access to good medical care and they have to keep working.

I agree, and the blame falls mostly in the federal government for that. They could have mandated many companies to make PPE starting in February. Getting protective gear to workers should be a high priority.

Just today morning, I saw an article in NYT about how US should not be happy that it's COVID numbers are tapering.

They show the total numbers split between NY city and whole of US, and it clearly shows that apart from NY, Boston and a couple of other cities, there is a rapid growth in cases across the country.

That's a devastating story.

Reply on news.ycombinator.com