Way out there, on your own. Fewer creature comforts, more getting stuff done on your own. No paying the connivence fee associated with cities, having everything nearby but paying double the rent.
Yes this sounds like an obscene edge case but it's part of the deal
Sure, most places never had a level 1 trauma center, but they did have hospitals, clinics, and pharmacies. Many of these medical institutions are leaving despite increasing population due to changing healthcare economics and policy choices.
A big reason you don't see family doctors in the sticks isn't because there aren't people that would love to be a small practice in the middle of nowhere. It's that nobody but a major medical institution can give them enough of a salary that they don't go broke under student debt.
EVERYONE should have healthcare. Just provide and tax to fund. It'd be cheaper than their medical bills, and WAY less headache if they don't have to deal with medical billing <<< THAT is the selling point.
Everyone should have retirement... wait that's what social security was supposed to be right? What's the problem *(other than funding it)... Medicine has developed 'old people jails' to turn the elderly into medicine consuming vegetables like some dystopian videogame or movie? Well... socialize that and have the experts figure something out. That's clearly a problem of improperly aligned incentives wound around a bunch of stuff I'd like people of various correct fields to address.
Why there aren't people in big cities: Costs too damned much to DO anything here; the rent is WAY too high. (we need to build a LOT, a WHOLE LOT more to catch up to years of not enough housing and slightly less not enough of the other stuff).
Why there aren't people in the rural areas: I suspect that though the rent is nicely low, the population density no longer supports the service. PART of that could be addressed by getting everyone on the same service (single payer healthcare), 3000 people sounds like enough for a basic family practice doctor to me. That's seeing ~10 people a day for 300 days out of 365 days a year. However that's about it.
Medical news during the decade after ACA passage was positively maddening. The ACA helped a lot of people. It didn't help a lot more people and those people did not exist - except for 5 min to bash their politicians.
And no one, anywhere poked around the ACA to scout out problems. For example: I did income comparisons and learned that coverage cost went down as income went up. Someone making 22k/yr paid 4x what someone making 32k/yr did.
ACA made that info a huge pain to find because you had to simulate enrollment over and over. But it wasn't particle physics.
I live in a relatively small town (~3000, though it's much bigger than other towns nearby). Most people here have never gone more than 100 miles from town. They have shit jobs (when they get them), live below the poverty line, have poor education. There is no transportation but rotted-out 20-year-old trucks or whatever $500 used car you could find in a nearby town. Their families have lived here their whole lives. They have no savings, no retirement, usually no health insurance.
This isn't "an appeal" or "a deal" they took, like they decided it would be cute to live a libertarian dream in the sticks. They have no other choice. This is what being poor is: a lack of options and no recourse.
Rural people who aren't poor still live there because... it's their home. You don't just decide move away from your family, friends, support structure, and entire way of life, because you want easier access to a pharmacy. Expecting people to just put up with pharmacy deserts or move, is a pretty hostile and careless position. It would be like expecting city people to get mugged every so often because that's the price you pay for wanting to have a pharmacy nearby.
These things shouldn't be expectations, they are problems to be solved, as in most other developed nations they largely are solved. We're the freaks for putting up with ridiculous amounts of crime, death, inconvenience, and needless expense.
It absolutely is all of that. It's also the money. $10k in flames is the low end of an interstate move. Supporting yourself and arranging all the pieces (ex:training) into a job that pays the bills - maybe quadruple that. Maybe more.
And all of that assumes luck.
Most counties are that kind of distance from job-rich areas.
That’s how those people got there a few generations ago in the first place.
Let me explain how the current residents ended up here:
- Indian tribes used this land as hunting grounds.
- English surveyors came and mapped out the area.
- The land was granted to a wealthy business owner by the King of England.
- A few wealthy families buy more land, form homesteads, moving away from NYC after the Revolutionary War.
- Over time those families develop more of the land and invest in property and business, and more families move in over time as the town grows.
- Factories and farms nearby provide a steady source of income and the town flourishes. The outer village is connected to the town after the county is officially formed.
- Eventually due to economic pressure from overseas, the factories and farms dwindle. Those who have enough money move away to find work; those who have lots of money, or none at all, stay.
- Most of the small businesses disappear as franchises move in. The small yet sizeable population is enough to keep a few big-name, low-cost stores in profit.
The story of America is rich people taking advantage of cheap land, and poor people struggling to survive.
What other option is there? They won’t vote for a government solution. Can’t have socialism forcing a pharmacy to exist where the market says it can’t.
The idea that moving into town, or the next town over, is going to mean giving up your family and friends seems overstated. Everyone I know in the sticks has some family that’s an hour away because they married or got a job.
And how does voting solve the problem? Who's putting what propositions forward? How does voting magically solve tax shortfalls, a lack of capital, deficits, state-wide or nation-wide political bullshit? How does voting create pharmacies, much less bring in people to staff them?
The point isn't that there's an easy solution. The point is, saying "just move" is as ridiculous and unrealistic as "just change our economic structure". There is no easy solution. But that also doesn't mean we should abandon our people because we don't want to deal with hard problems.
No, only the people who want to. The people who want rugged individualism stay rugged.
> And how does voting solve the problem?
They vote in representatives who will enact change through federal, state, and local governments.
There probably aren’t many candidates like that currently because the electorate demands candidates far to the right of that, but that could change.
> But that also doesn't mean we should abandon our people because we don't want to deal with hard problems.
Who’s abandoning them? They asked for small government and unchecked corporate power. Everyone on the left wants to deal with these hard problems, but you can’t force it on them.
Strange that small towns (500-5000) in Brazil are able to have a pharmacy, same in many countries in Europe, just found this one in Portugal in a town of 600 people: https://maps.app.goo.gl/fnFZMFtU3ZqbBAVk8
Perhaps the over-reliance on massive corporations like Walmart, CVS, Walgrens, etc. instead of small shops owned by private individuals is not really very good for society to fill in basic needs like groceries, medicine, etc. where "the market says it can't".
You need to do this once more if you do a specialization.
The town I lived in had a grocery store, full service station, restaurant, hardware store, and even a bowling alley. Those are all completely gone. This was in a town with about 300 people.
How the collapse happened is actually pretty simple. As suppliers slowly consolidated they started raising prices for smaller business as somewhat of a "go away, you're annoying to deal with" policy. It's simply far easier to sell 1000 items to walmart than it is to sell 10 items to 100 different stores. That in turn collapsed businesses in the town as you could literally go to the walmart a 45 minute drive away and get things for half the price.
Medicine is mostly due to privatization of education and consolidation of medical offices. There are simply limits to how many students medical schools can take and as a result they've simply continued to raise tuition prices to try and limit demand. That has put huge debt burdens on new doctors which makes working in rural locations particularly unappealing (they can't afford the salary a doctor needs to afford the debt they've taken on).
15 minutes from my hometown, there's a medical center that used to employ about 10 doctors when I was a kid. Now it's mostly staffed by 1 or 2 nurses with a doctor that comes in 3 times a week. Where they used to have to tools and equipment to handle most medical needs, now they are effectively just a stabilization location while patients wait for life flight to take them to one of the more major medical locations.
I personally blame weak anti-trust enforcement and mass privatization and deregulation for the current state of things in rural America. These communities are dying because they have no capital power. That causes them to be steam rolled by basically everyone. Big business has wrecked that part of america.
Why is this? Because a bunch of "get rich quick" scammers have purchased all the vacant homes and turned them into air-bnbs while they wait and hope to flip the properties to someone else.
My hometown is not some sort of "vacation destination". I highly doubt anyone is ever renting a single one of those homes. Yet here we are, with people sitting on property that used to be the homes of my childhood friends leaving them vacant or with a sale price that's double or triple what it should be for the location.
I visited 5 years back and it was weirder than I imagined. Most of the roads don't go in the same direction any more. A massive 100year old prison complex was erased.
The woods were cleared for roads, parks and housing. Meanwhile, the prison fields had grown into woods. Taken together, it was right out of my 7yo Kafka-dreams.
We spend a lot of time arguing on the phone.
My Aetna policy will deny all prescriptions for anything greater than 30 days supply or multiple refills unless you go through their mail pharmacy - it's the only way to get a 90 day supply.
And yup. Their online service often is "unable to determine status" of a prescription that they are filling, which means I can't even order a refill through them.
I've spent a lot of time in tiny poor Mexican towns that manage to have a pharmacy, sometimes several. Not only that, but you can get hundreds of prescriptions over the counter that would cost thousand dollar doctors visits in the US.
I can only imagine every small town in the US would also have an economically viable pharmacy if the regulatory environment here was the same.