Wendell Berry
Kentucky author Wendell Berry at the 2014 Festival of Faiths. "Since the election, liberal commentators have made 'rural America' a term of denigration, the same as 'boondocks' and 'nowhere,' " says Berry in a New Yorker interview. (Photo: Festival of Faiths via flickr)

What would “Medicare for all” do to rural hospitals? It’s worth asking, since this is a campaign theme for several Democratic presidential contenders.

WBUR radio in Boston reports that “(a)dopting a single-payer government health care program that covers all Americans would force more rural hospitals to close, according to hospital administrators from Texas to Maine.”

There are those who think this may be overstating the case. The Boston radio station quotes Craig Garthwaite, a health care economist at Kellogg School of Management at Northwestern University, as saying some of this alarm is “hyperbole.” Garthwaite tells the station, however, that “Medicare for all” would more likely force hospitals to scale back services, amenities and staff.

The Congressional Budget Office finds that universal coverage would help rural hospitals. “They (rural hospitals) treat a greater share of uninsured patients than some more urban and suburban hospitals do,” a CBO official told Congress this summer. “They could actually get more revenue under a single-payer if Medicare payment rates were provided for every patient.”

Rural hospital administrators interviewed by WBUR aren’t buying that argument.


The Washington Post has a truly horrifying story on health care billing in Butler County, Missouri. Residents in the southeast Missouri county talk to reporter Eli Saslow about the “follow-up appointment” — the summons from the court about unpaid medical bills.

This year alone, the local hospital has filed over 1,100 civil court cases seeking payments for bills that often don’t make a lot of sense.

Nobody was complaining about the quality of care, but people with insurance are often finding themselves thousands of dollars in debt after visits to the emergency room.

Meanwhile, bad debts are killing local hospitals.


Every month economists at Creighton University poll bankers in 10 Great Plains states about their local economies. Recent reports have been dismal.

The latest report just came out and three quarters of the local banks say their economies continue to weaken and that President Trump’s trade policies are having a detrimental impact. The index concocted by Creighton shows a shrinking rural economy in Nebraska, Iowa, Colorado, Illinois, Kansas, Minnesota, Missouri, North Dakota, South Dakota and Wyoming.

One might think this would indicate displeasure with the Trump trade war, but that’s not the case. Seven out of 10 bank CEOs said they were in favor of continuing the trade conflict or even increasing tariffs.

If that seems weird to you, you’re not alone.


We recommend an interview in The New Yorker with Kentucky writer/farmer/philosopher Wendell Berry.

Berry talks about his decision to leave New York City for the family farm in Kentucky. He discusses the need for “limits” in life and what it takes to be a good farmer. When we looked for good parts of the interview to print here, we found so many that we realized we had to stick with just one.

So here it is. Read the rest of the interview. You won’t be disappointed:

What do you think people—journalists, commentators, citizens—mean when they use the term “rural America”?

(Berry) Since the election, liberal commentators have made “rural America” a term of denigration, the same as “boondocks” and “nowhere.” It is noticed now, by people who never noticed it before, only because of its support for Donald Trump. Rural America could have supported Trump, these people conclude, only because it is full of bigoted “non-college” white people who hate everybody but themselves. These liberals apparently don’t know that, with their consent, urban America has been freely plundering rural America of agricultural products since about the middle of the last century—and of coal for half a century longer. Conservation groups have accepted this abuse of non-wilderness land about as readily as the corporate shareholders. Benson gave permission to urban America to accept that industrial technology could solve all the problems of food production. And so urban America could just forget about rural America. What a relief! And then Mr. Trump arrived. A century ago Robert Frost spoke of “the need of being versed in country things,” and that need has now been reinforced, at least politically.

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