I’m not saying we shouldn’t reform - I’m saying we should be careful about what that reform is, and what its goals are. I would generally suggest that CMMI and provider groups is/are more heavily involved than big city voters who know very little about a very, very complicated issue.

Lastly, rural healthcare is in trouble because reimbursements are bad (especially Medicare reimbursements), FFS (fee-for-service) is a failed model, there’s a massive credential shortage, and given those, the credentials that exist would prefer to work in desirable places, not Pine Ridge, SD. If you’re serious about fixing healthcare, you should start by fixing education. State politics, specifically around Medicaid, are, generally, not driving the hospital closures and OB/GYN deserts.