a nice way of saying "exurbs & farm/oil regions have been free-riding on urban hospital capacity for decades because they'd have to actually tax land barons to build their own & god knows they'd never let that happen" https://twitter.com/SouthernHomo/status/1245323096120320000

also, local rural elites HATE having good hospitals around bc you know what happens when you have a good hospital?

doctors, nurses, & techs move in

creepy, gross, white-collar ppl who do weird shit like "vote for local services & infrastructure & property taxes to pay for them"

that's why so many rural areas' doctors are recent med school grads from overseas who are basically just there bc of programs that forgive med school debt and/or help with visas in exchange for working in underserved areas

it's not JUST a deal to help out MDs with otherwise precarious lives.

it's also a deal to keep rural good ol boys in power.

Those MDs stay just long enough to fill out their end of the debt/visa bargain & then leave for greener pastures.

That's not a bug. That's THE POINT.

How do I know this?

Because this is exactly how land barons destroyed farm workers as a political force, too.

Make sure they're mostly foreigners & keep them moving. It's a divide-and-conquer tactic & it WORKS.

I happen to have a lot of personal experience with how small-town local elites burn their own counties to the ground for personal gain.

Read this whole thread if you want a good laugh. https://twitter.com/SarahTaber_bww/status/1236049176443654149

The last thing rural elites want is any significant concentration of white-collar workers in voting distance of "their" county & state-level offices.

THAT'S why rural areas have shitty healthcare infrastructure.

It's not because of cities.

In real life, brain drain & poor infrastructure are almost never just because of an irresistible suction force from the place that brains drain TO.

There's a lot more push than pull involved.

But the only explanation most folks ever seem to hear for poor rural healthcare is "The cities steal money & skilled workers from us!!!"

That explanation is bogus.

It's a political talking point. It's an excuse.

It's how good ol boys manage to both terraform rural areas to be their own personal low-tax fiefdoms, AND get to play victim when, god forbid, there are consequences.

they're all about personal responsibility until they need a bed at a hospital someone else built & paid for

We absolutely, 100% have a problem with healthcare infrastructure in rural areas.

And the only way we're actually going to fix it is by being honest about how it happened.

Not scapegoating cities, not pre-wrapped excuses from the local powers that be. Real accountability.

You simply cannot have this level of rural decay without somebody knowingly, deliberately running a place into the ground.

DO NOT let rural leadership keep passing the buck. They're grown-ass men and they own this as much as anyone else.