One of the Democrats’ hostage demands is the repeal of fifty billion earmarked for improving rural healthcare. For all their focus on this stand being about healthcare, the media should be asking a lot more questions about why they oppose this.
The Big Beautiful bill cut funding for non-citizens and added funding to improve care in hard-to-reach areas (that would help everyone). Why are you trying to end the latter to fund the former?
New Hampshire has a rural health care crisis created by Democrats and sustained by the State Senate, whose benefactors in both parties receive large sums from the hospital cartel. Until recently, you couldn’t run any clinic or practice without the permission of the nearest hospital and some agreement to affiliate with it.
That local urgent care wasn’t independent. It’s tied to the local Hospital, which, as we saw during COVID, meant it had to align with its protocols or else. Things improved last session and were on the right track, but I just read a press release from the governor’s office about applying for some of that rural health care money in the big, beautiful bill. My cynicism may be getting the better of me, but it feels like the state is going to launder the grant through the usual suspects.
The way resources sent to third-world countries to provide food and clean water to the impoverished never get past the government officials tasked with managing them.
As an independent entity under the Governor’s office embedded in DHHS, GO-NORTH will leverage existing DHHS expertise and infrastructure to oversee implementation of the rural health transformation program and help deliver innovative solutions to improve rural health care.
New Hampshire’s Rural Health Transformation Grant application, with input from more than 300 stakeholders across hospitals, rural health care providers, community health centers, and the public, focuses on the following areas:
- Make rural New Hampshire healthier through prevention, chronic disease management, and improved behavioral and maternal health.
- Ensure sustainable access to care by strengthening rural hospitals, health centers, EMS, and telehealth services.
- Build and retain a skilled rural health workforce through education, training, and career pathways.
- Promote financial sustainability with innovative payment model and value-based care.
- Modernize care delivery by expanding technology, interoperability, and data security
It is unclear to me whether most of this “growth” or whatever you want to call it, will be happening outside the existing cartels or their interests. I sense that New Hampshire’s health care industrial complex will do its utmost to scoop up resources and control how they are used, with creating or allowing competition not on the list of priorities.
Truly beneficial improvement in rural care, or care in general, requires the ability to allow private interests to establish practices wherever there is a need. From doctors to clinics to pharmacies, working in underserved areas where margins need to be lower despite the likely decreased volume of patients. A few hundred million, managed by stakeholders, does not strike me as likely to address what would fix this without any tax dollars being laundered.
Doctors will establish a private practice wherever they are allowed to, if they can afford to. The problem is that they can’t afford it because of government barriers. Everything about being a country is predicated on the ability to help people without the state or its public health oligarchs making everything difficult or impossible or demanding control.
We still haven’t opened the insurance market enough to enable plans and pricing that work for regular people. The Affordable Care Act was sold as the path to this, but it did the opposite (as, of course, it would, being a government program). You can’t choose a buffet plan the way you might car insurance coverage and then send it to a dozen insurers so they can fight for the right to take your money.
Doctors are spending obscene amounts on managing the care system outside of actual care.
And while diagnostic services have shown signs of life by competing for customers for blood tests and imaging, the entire industry needs this sort of thing all around.
Sure, we’ve seen some cash-for-services offices pop up, but we need more of that and some amalgamation of this free-market thinking across the rest of what passes for the republic’s health infrastructure.
Much like public education, more money isn’t the answer because the more we throw at it, the more expensive it gets.
New Hampshire has a lot of rural areas in need of attention, but we’re a small state. Some corners of America have “middle of nowhere’s” the size of several New Hampshires. And I’m not convinced the best intentions of the 50 billion allocated to improve rural care will get there from here.
