People are like "Leonid is being a ghoul" but actually attempting to save rural hospitals given the budget constraint is going to negatively impact urban hospitals where there is a better lives/dollar ratio on care even despite the higher overhead of being in the city
I think the state should decline to bail out any of these rural hospitals.
I mean - if we want the state to be required to fund rural (or any) hospitals, then we should legislate it.
I mean let's be real, I'd 100% agree with him if that was actually what he actually said but that's not what he said, he was talking revenge fantasies designed to provoke people. That was the intent, not to start a dialogue on how to triage hospital funding.
People have a severe allergy, a physical repulsion, to understanding how anything operates in reality day to day. What a hospital operating cost is. How much their state Medicaid program receives in federal funding. What their state budget looks like. Just basic shit
We should deprioritize rural hospitals even if the lives/dollar ratio on care were favorable
Like these hospitals aren’t going to last three more years at the funding levels the OBBB did for Medicaid.
There isn’t going to be money to reopen those hospitals AND restore Medicaid funding
the thing about the people mad at LB is that Leonid did not create this problem, or generate false scarcity, he’s merely saying we shouldn’t gut our hospitals to support the people who voted for their own deaths. This is perfectly defensible morally and logistically!
Democracy is the theory that the common people know what they want, and deserve to get it good and hard.
My patience has worn thin with people being insulated from the consequences of their actions. The Democrats do the right thing in the short term and we've seen how that works out.
It’s not what he’s saying, it’s how he’s saying it that’s ghoulish.
Exactly. Funds aren’t infinite and bailing out/subsidizing rural hospitals to an even greater degree requires cuts somewhere else or higher taxes. Those peeps aren’t considering that.
Also if we continue to support them that’s the same as saying that there should never be any downsides to fascism.
“We must somehow stop fascism while making sure there are never any negative consequences to fascism.”
This sort of triage situation is how I've been taking it, too. It won't come down to a facially cruel help/don't help simply out of malice. It'll be triage, and the math of triage will dictate the cruelty and give it all the justification in the world.
a lot of the replies read the post as "in the face of ample funding and resources, i would close rural hospitals out of malice" instead of "lack of funding means we have to triage hospital closures; political support is a fine metric order the closures by"
📌
people in that thread are acting like he passed the medicaid cuts himself
the boat is sinking: who are you putting in the lifeboats? there aren’t enough for everyone.
that’s the calculus we’re in now. really fuckin wish it weren’t the case, but it is
Exactly. bsky.app/profile/clay...
“It’s simple: just raise taxes” as if rural areas/red states will be open to that and not call you an out of touch ghoul
Idk why people think there is an option to save everyone - there literally are fiscal limits that the GOP has imposed on states. This is a reality of GOP voters’ choosing.
i mean, what did they think touch the stove/accelerationism meant? vibes? essay? meetings? losers.
In Seattle we already carry a load given that the county hospital is the closest Level 1 trauma center for multiple smaller-population states. Cutting funding from that to bail out rural hospitals and clinics would be a poor use of limited funds.
They're not talking about closing rural hospitals because they're too busy, like people understand that part right
I don't think it's ghoulish. I think we (urban-based/blue state folks) have protected them (rural-based/red state folks) from experiencing the full consequences of their choices for so long they do not believe they will, or even can, be affected by them. Maybe that changing will change them.
It's also purely an academic exercise. It's the equivalent of the "kill baby Hitler" debate. Even if you think we should kill baby Hitler, it's too late!
The Medicaid cuts have already been signed. The bomb that will devastate hospitals has already detonated.
I mean, we're pretty much in standing-in-front-of-bulldozer territory to save a lot of them at this point, and I'm sorry but I have to work that day 😐
there’s a few reasons they are wrong. they don’t account for cascading hospital failures and the resulting financial contagion, and they don’t consider health or access equity. and in the end, this is a systems problem republicans created. bailouts can only do so much even if the best option
I just don’t see the point of helping people who refuse to help themselves. It’s not my job to save them. Psh.
leo's post is needlessly blun5 from a messaging perspective (though of course that's not his job) but I agree that its a really hard ask of a state to shift funds late in the game like this. States have limited resources and a lot of people are already counting on what they were promised
if your only priority is saving as many lives as possible with limited resources then closing rural hospitals first is the obvious course of action
literally it's just math
