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Comment by peepeepoopoo5 | Hacker News Reader

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>Combine this with a large influx of uninsured, undocumented migrant workers in rural areas

I'm sorry to be that guy, but extraordinary claims require extraordinary proof. Claiming that the failure of rural hospitals is due to illegal immigration, even in part, is an extraordinary claim.

Do you have anything at all other than anecdotes to back that claim up?

It's hardly extraordinary. This has been a major problem for decades, and it's only gotten worse. I'm sorry it disagrees with your politics, but illegal immigration is bankrupting hospitals. Here is a previous attempt to shore up some of the financial losses:

https://www.cms.gov/newsroom/fact-sheets/emergency-health-se...

That's an 18 year old article and the OP's PDF shows hospital's closing in Montana, the Dakotas, Idaho, Michigan, etc that aren't near the border.

If I had posted a recent article you would have said that wasn't evidence of a long term trend. The problem has gotten worse and it's impacting the entire country now. My family members work at hospitals in rural eastern WA, and not only has the local hospital system there already collapsed, but the entire Providence medical system for all of the Pacific Northwest is at risk of going under too. This is a direct result of uninsured migrant workers and medicaid underpayment.

Government payer reimbursements must go up, but cost controls are necessary as well to drive out a profit motive. Yes, I'm aware that the limited quota on residency slots is also a problem that needs solving for.

https://www.commonwealthfund.org/publications/fund-reports/2...

https://www.commonwealthfund.org/publications/explainer/2019...

https://www.politico.com/agenda/story/2017/10/25/doctors-sal...

https://www.vox.com/22989930/residency-match-day-physician-d...

What about menu prices and the ability to comparison shop?

I think there is mixed evidence this is beneficial vs fixed prices. I'm not outright against the idea, but there has to be robust pricing and metadata available so you can be a high information consumer when shopping for non emergency services.

https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1471

https://www.ncbi.nlm.nih.gov/books/NBK53921/

Yeah, Medicaid payments aren't great but wouldn't it be better to be reimbursed for at least those pennies instead of no reimbursement at all?

It's not like it's Medicaid that caused those people to appear. Not expanding the coverage isn't reducing the rate of people needing care it's just reducing what will be paid for.

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