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Comment by ghaff | Hacker News Reader

At some point, many people start thinking about things like access to good healthcare, various types of trades, ability to travel without it being a huge hassle, etc. Doesn't mean you need to live right around a big city but I doubt I would want every task or appointment to be a big undertaking.

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Healthcare is huge. It's amazing how terrible access to good care is in many rural areas. It's something people often overlook but it's just so important.

Here in Australia people retire ‘down the coast’. For us that’s the stunning south of NSW. Look up Eden (yes, really, Eden).

And then … they come back to the city. Because the older you are the more medical care you need, and there just aren’t enough doctors down there, or in any other regional area.

My parents are going to retire on the Gold coast for this reason. Quieter life but several big hospitals and Brisbane nearby

All the doctors want to live in LA and NY. This problem only gets worse as medical school, etc becomes more competitive and costly.

The problem is a mix of people leaving rural areas which increases per patient overhead at facilities, plus mergers and private equity takeovers.

Hospital chains and healthcare systems have been consolidating like crazy for decades and it's still going strong - 80 or so hospitals merge every year. PE has also been snapping up private practices like crazy, too.

https://www.kff.org/health-costs/issue-brief/ten-things-to-k...

Though the consolidation is something of a mixed bag. My community hospital network had some pretty good docs but lab work, appointments, and so forth was pretty much faxes and phone calls which sometimes worked. Now they're on Mass General Brigham's electronic records system and it's a lot better.

It's not quite that bad. For example, the Boston area is arguably as good or better than those two cities. And some higher-income relatively small town/rural areas are pretty decent. But it definitely becomes a bigger consideration as you get older--although you can of course get unlucky at any time.

(desirable coastal cities with young people and vibrant entertainment)

It's a lot more than that but, as you get away from at least medium-sized cities, things get scantier especially if you need specialized care.

It’s a problem in the medium sized cities too? Because many of the smaller rural facilities are being closed down (often in the wake of for-profit buyouts), and then all those displaced patients overrun the remaining facilities in surrounding towns.

Are we saying anything different?

Have you seen the medical offices in Scottsdale?

This is actually a very good point. The family I visited travel 1hr+ to get healthcare services because the local ones are pretty bad. They're not elderly per se, only a few years into retirement but they definitely have health issues that come with old age. They're relatively well-off and live in the nicer section of Cumberland where doctors and lawyers lived. I can't imagine how bad it is for people who are just getting by.

Telemedicine / remote surgery should solve this.

I doubt it. Physicians (and nurse practitioners, etc. at urgent care clinics) could arguably do more remotely but I'm not convinced that reducing the involvement of trained humans would be a positive move.

Think you missed the implied /s here :-)

I think a lot of people actually believe that kind of thing.

I was rather impressed with the nurse practitioner at a CVS Instant Clinic a couple of months back. I could have tried to get an appointment with my primary care when I got home. But when I actually saw her a few weeks later for a scheduled appointment, she basically shrugged and said she'd have done exactly the same thing the nurse practitioner did. (Keep taking Tussin and there's a prescription for an inhaler at the pharmacy counter.)

Pre-COVID (and the test I took was negative for what little that was worth), it would have been eh you have a virus. Which ended up basically the diagnosis.

If you’d suggested LLMs in some way I probably would have caught it.

No sarcasm implied. There needs to be programs at medical schools (or ideally, new schools in the first place) that teach robotic surgery only.

Why would you think this is sarcasm? The availability of capable surgeons is already limited; when looking geographically, they are extremely limited.

You would have surgical assistants and nurses on the ground, but the actual expertise for surgery shouldn't be location dependent.

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