Just before the election, I traveled by car from Utah to Pennsylvania and back, crossing 12 states, mostly in rural areas. I was struck by the apparently strong support for Donald Trump, judging by the signs I saw in the farming communities through which the interstate highway passed.
I did not vote for Trump, and I believe the country will be far better off without him in the White House. But I have seen how the 60 million Americans who live in rural communities do not share my opinion.
Now that Trump has lost the election, it is time for those of us who live urban or suburban to find something in common with the 20% of America who live rural. What do all Americans need? Can we share something together that makes all of us feel we have a stake in our country and its governance?
Let’s start by having those of us in urban/suburban America stop pretending that we know what’s best for rural Americans. So often I have heard comments to the effect that Trump voters don’t know what’s best for themselves, or that those voters are unknowingly voting against their own interests. This is condescending nonsense.
People who are choosing to live in rural communities clearly value things, lifestyles, careers and experiences that are very different from those to be found in urban or suburban settings. I don’t pretend to speak for rural America, but I am ready to listen to them.
I have heard a number of voices from rural America speak up recently about the loss of health care services in their communities. In the past decade, 176 rural hospitals have closed, with another 450 rural hospitals currently at risk for closure. Business as usual in U.S. health care does not adequately provide for the health care needs of rural citizens.
What works in urban health care delivery makes no sense in sparsely populated farm country. The notion that huge corporate health care interests can compete for health care business is nonsense in urban areas, but it is totally unconnected to the reality of rural health care delivery, where sole providers of care obviously can’t compete with themselves.
And let’s stop talking about “coverage” instead of “care." Health insurers don’t want to “cover” rural America. Patients don’t need “coverage” anyway; when people are sick or injured, they need care.
I suggest we start with the assumption that people all over this nation, including perhaps especially those living in rural America, know best what kind of health care arrangements are needed where they live.
Let’s stop trying to enact and fund whatever health policy comes out of the medical-industrial complex. We already have the most profitable health care system in the world, and therefore we have the least patient-centered and most expensive health care delivery among all developed nations.
The need for health care is universal. Health care delivery is administratively wasteful and poor quality everywhere in the United States, but it is often simply absent in rural communities. Changing how health care business is done in the U.S. will require finding a way to serve every American patient.
Let’s begin by listening to rural Americans. They will tell us how best to organize health care delivery in their communities. We can build a health care system that puts our patients first, no matter where they become sick or injured.
Urban Americans often vacation in rural settings. We all have a stake in building first-class care everywhere across America, including all along the interstate highway from Utah to Pennsylvania.
Joseph Jarvis
Joseph Q. Jarvis, M.D., MSPH, Salt Lake City, is a public health physician and author of “The Purple World: Healing the Harm in American Health Care.” Find more information at thepurpleworld.com.
