Lastly, rural healthcare is in trouble because reimbursements are bad (especially Medicare reimbursements), FFS (fee-for-service) is a failed model, there’s a massive credential shortage, and given those, the credentials that exist would prefer to work in desirable places, not Pine Ridge, SD. If you’re serious about fixing healthcare, you should start by fixing education. State politics, specifically around Medicaid, are, generally, not driving the hospital closures and OB/GYN deserts.
I don't dispute the rest of your arguments about healthcare, but you cannot fix education and/or brain drain without fixing state politics.
Hospitals are not closing because of shitty prenatal laws. They’re closing because reimbursement rates are insufficient, in part, because we’ve allowed too much consolidation, in part, and because there aren’t doctors/nurses who want to live in the sticks and make peanuts.
That sounds workable.
"If you choose to live on an obscure island or corner of alaska unreachable by land, should the government be obligated to keep a doctor living and working nearby you?"
To which I'd then imagine the thought process is more sometimes you'll just have to move to a more urban / developed area if you have a really severe disease, or deal with long drives or getting plane flights.
This is a sort of disingenuous way to talk about rural America. Pine Ridge is two hours from Rapid City, not the middle of nowhere, Alaska, and the discussion isn’t about specialty care, but normal primary care, hospital and Ob/Gyn services.
Saying “suck it you stupid rubes, move to a city” is going to make it difficult to get anyone to agree with your version of healthcare reform, assuming it was even going to work.