Rural America's working-age adults die at wildly higher rates than their counterparts in cities. Why?

[ShazzieB]

22. You're right, especially about access to specialists.

My sister (now deceased) lived in a rural town. There's a hospital there, but it can only do so much. This past January, she got covid (not an antivaxxer, but had been living in a nursing home). She was admitted to the local hospital, but when a nephrolology consult was needed, they had to put her in an ambulance and send her to a bigger hospital in a city that was 50 miles away. In her case, Medicaid paid for everything, but without that, she would have have been up the proverbial creek without a paddle.

(Before anyone asks, she was diabetic and her kidneys had been gradually failing. That bout of covid pushed her over the edge into what is called end-stage kidney failure, treatable only by dialysis or by a transplant. She wasn't a good candidate for either, for reasons that would take too long to go into here. She was past being able to make any decisions, so as the person who held her medical power of attorney, I had to make the call to change her code status to dnr (do not resuscitate) and call in hospice services. She was transported 50 miles back to the nursing home in her little town, where she died about a week later. The hospice folks were fantastic, and I am fine now.)

I mention this just as an example of the extra hassles that can occur in a small rural town with a lack of local access to specialized medical care, even when payment is not a barrier.