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Over large parts of the United States, small farm towns are dying. Often it is a hospital that keeps them economically alive.

If you drive across America from east to west, and you have been doing this over a period of years, you can't help noticing that there are fewer and fewer places to stop. Small towns in rural areas once supported a cafe, a filling station or several filling stations to get gas, grocery stores, doctors, lawyers, banks, hairdressers and barbers, and maybe a diner or two. Many small towns once had manufacturing jobs but factories closed after NAFTA.

Walmart also has played a role in the decline of many little towns. Towns that were too small to get their own Walmart found themselves with no retailers at all. As Walmart put grocers and small retailers out of business, the cafes and service stations closed, too, and as jobs left, people left many small towns for good.

One institution that is helping many rural towns in the USA stay on the map is the local hospital. Hospitals provide well-paid jobs. Towns that manage to keep hospitals open often emerge as oases of economic stability in America's heartland. 

It is not necessarily easy, however, to keep a rural hospital open. Like every other commercial activity in America's small towns, hospitals have taken major hits of their own, and the pace of rural hospital closures has actually accelerated since Obamacare  became fully functional in 2014.

What Kills Rural Hospitals

A small-town hospital usually has to be everything for everyone in a small community. If you have heart attack, the local ambulance (which until the twenty-first century often doubled as a hearse), you will be taken to the local emergency room. The small-town hospital usually doesn't have a cath lab in which you could get a stent and certainly doesn't have facilities for open heart surgery if you needed a bypass or cavitation, so you are loaded into another ambulance, or a helicopter, for a thirty-minute to one-hour or sometimes two- or three-hour ride to a hospital in a major city.

Big city hospitals typically will release patients as soon as possible. You might get a cardiovascular stent only to be sent back to your little home town the very next day. However, it's not unusual for something to go wrong. Maybe you will have unusual bleeding from the incision site. Maybe you will have chest pain again. Maybe you will pass out because you are not used to your new high blood pressure medication.

If this happens, you go right back to your small-town hospital. However, under Obamacare, hospitals have to pay a financial penalty when patients are readmitted within 30 days. Even though your local hospital had no choice but to send you to the city, they pay a penalty for having to treat you again when the city hospital sends you back too soon. That happens a lot, because the big bucks in medical treatment are for surgery, not for letting you recover in your hospital room. City hospitals get the reimbursements, but rural hospitals pay the penalties.

How Bad Is The Problem Of Failed Rural Hospitals?

The United States has lost nearly 50 rural hospitals since 2010. Hundreds more are on the verge of financial collapse. On average, each of the hospitals served 10,000 people, so approximately half a million people are left without local medical care. This means that if they have a medical emergency, the nearest treatment will be 20, 30, 50, or even 100 or more miles away. All over the United States, rural areas are losing their hospitals, and patients are losing their lives.

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