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Health care reform legislation is pitting city hospitals against rural hospitals, the Boston Globe’s Susan Milligan reports. “Big hospitals affiliated with medical schools around the country receive heftier reimbursements for treating elderly patients covered by Medicare, part of a government policy that rewards them for maintaining things such as trauma centers and burn units, as well as for training future generations of doctors,” Milligan writes. “Rural members of Congress, however, angry at what they see as an unfair advantage to glitzier facilities in cities, are demanding a bigger share of the pie for smaller hospitals, which serve remote populations and often struggle to survive.”

“This is a very urban bill,’’ fumed Representative Earl Pomeroy, a North Dakota Democrat on the House Ways and Means Committee, which passed the healthcare overhaul bill Friday. “Could it be improved? Could it be more rational? Of course.’’ Rational to rural legislators (Republican and Democratic alike) is a system that changes the status quo on how hospitals are reimbursed by Medicare. For urban legislators, Milligan writes, “any attempt to strip a portion of Medicare money from teaching hospitals would be a deal-breaker for House members from cities.”

This tussle between rural and urban hospitals “exposes the often deep regional differences in Congress, with lawmakers of like political ideology squaring off on discreet local issues,” Milligan writes. “The hospital Medicare reimbursement dispute is just one of many such issues that could upset the coalition required to pass the healthcare overhaul bill before the August recess, as House Speaker Nancy Pelosi, Democrat of California, has promised to do.”

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