Tag: Problems in Rural America

Rural Hospitals Are No Longer Providing Maternity Care

The Daily Escape:

Perseid meteor shower, from Mt. Evans, CO – August 13, 2023 photo by Paul Blais Photography

Welcome to our Saturday Soother, but first, Wrongo intends to spin you up before eventually letting you slow down.

There’s a crisis in rural healthcare in America. Rural hospitals are closing at a rapid rate. Our county (Litchfield) in Connecticut has one of three remaining hospitals that are designated as rural in the state (Sharon Hospital).

A problem for rural hospitals is that many are closing down their labor and delivery services in order to try and remain economically viable. WSHU, a CT-based NPR affiliate, has covered the impact of these closures to Connecticut. They quote Peiyin Hung, a researcher on maternal and rural health at the University of South Carolina:

“My team has been tracking nationwide, hospital-based obstetric unit closures since 2008 up to 2022,…. Almost 300 hospitals closed their OB units.”

WSHU points out that more than 60% of those closures were in rural areas. Why are so many hospital groups moving away from delivering babies in rural locations?

WSHU quotes Dr. Robert Roose, chief medical officer at Johnson Memorial, a hospital in rural Stafford Springs, CT that closed its obstetric unit. He said that it’s a safety issue. Hospitals with fewer than 200 deliveries a year, like Johnson Memorial, are considered low-volume birthing centers:

“There is a clear and critically important correlation between volume and quality of services provided when it pertains to labor and delivery and maternity care…”.

Three years ago, Hartford HealthCare’s Windham Hospital in Willimantic, CT stopped delivering babies, citing the same concern.

Also, malpractice insurance rates go up for low birth-volume hospitals because insurers feel the risk is higher if doctors aren’t getting sufficient practice with birthing. Hung says another problem is the level of reimbursement:

“Medicaid…pays half as much on average [as] private insurance pays for labor and delivery across the country”.

That’s important because about four in 10 of all Connecticut deliveries are covered by Medicaid. Simply put, delivering babies doesn’t pencil out for many rural hospitals.

There are other factors: Rural America’s demographics skew older. Young families in general prefer living in the suburbs or exurban areas. Couple that with America’s lower birth rate and rural hospitals really can’t maintain the birthing volume they need to remain economically viable.

The Center for Healthcare Quality and Payment Reform, (CHQPR) a Pittsburg-based health policy group published “A Crisis in Rural Maternity Care in the United States” which shows the problem:

“Fewer than half (45%) of the rural hospitals in the US currently offer labor and delivery services, and in 9 states, less than one-third do. Over the past decade, more than 200 rural hospitals across the country have stopped delivering babies”.

More:

“Hundreds of additional communities are at risk of losing maternity care because of the financial challenges rural hospitals are facing….More than 1/3 of the rural hospitals that still have labor & delivery services have been losing money on patient services, so their ability to continue delivering maternity care is at risk.”

CHQPR reports that more than half of small rural maternity care hospitals lost money in 2021-22.

They suggest that a primary reason rural hospitals are losing money is that private insurance plans pay them less than what it costs to deliver many of the services they offer patients, not only maternity care. They point out that while rural hospitals are losing money on uninsured patients and Medicaid patients, the losses from private payers have the biggest impact on their overall profit margins.

CHQPR suggests that a potential solution is to require that health insurance payments actually cover the cost of rural maternity care. With more than 40% of births (on average) in rural communities paid for by private health plans, having the private insurers pay more would help keep rural maternity care viable:

“Payment amounts must be higher in communities that have difficulty attracting staff, and payments must also be higher in communities with smaller numbers of births to ensure that revenues cover the fixed costs.”

This means that the fee-for-service model isn’t working in low-volume hospitals. Rural hospitals are only paid when they actually provide a service, but a small hospital has proportionally higher overheads than larger hospitals, since they must be staffed and ready to deliver a baby at all times, even if there are no deliveries at all. Read CHQPR’s report “A Better Way to Pay Rural Hospitals”.

Back to Connecticut, Sharon Hospital has proposed closing its labor and delivery unit. There will be a public hearing to consider the closure later this year. But Sharon is about an hour from its affiliated hospital (Danbury Hospital) that has a fully-staffed labor and delivery facility. Sharon may actually be closer to two other unaffiliated hospitals in New York state than it is to its own parent facility.

It’s now time for our Saturday Soother. Litchfield County is having beautiful weather this weekend. We’re taking advantage of it by going to a live Baroque music concert, and possibly heading off to the annual fair in a local town.

To help you relax and zone out from all of the Trump indictment analysis, grab a chair outside in the shade and watch and listen to “Gortoz a Ran” (I’m Waiting) sung by Denez Prigent and Lisa Gerrard. The language in the song is Breton, spoken in Brittany, France. It is closely related to Cornish and Welsh, and all three are Celtic tongues. When the Angles, Saxons and Jutes invaded Britain in the fifth century (400-500 AD), many of the Britons in Cornwall, Devon, and the West Country fled across the English Channel to France. Because of the influx of Britons, the region became known as Brittany.

Most of the images in the video are of Scotland, England, Wales, and Brittany. Lisa Gerrard isn’t singing in any language; she’s just vocalizing. The Uilleann pipes, an Irish instrument, are heard at 3:50:

Lyrics: English Translation

I was waiting, waiting for a long time
In the dark shadow of grey towers
In the dark shadow of grey towers

In the dark shadow of rain towers
You will see me waiting forever
You will see me waiting forever

One day it will come back
Over the lands, over the seas

The blue wind will return
And take back with it my wounded heart

I will be pulled away by its breath
Far away in the stream, wherever it wishes

Wherever it wishes, far away from this world
Between the sea and the stars

The song describes waiting, possibly forever: Aren’t we all waiting? What are we waiting for? For whom are we waiting? Happy Saturday!

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Monday Wake Up Call – June 20, 2022

The Daily Escape:

Field of Valerian at Indian Henry’s Crossing with Mt. Rainier in background, WA – June 2022 photo by Edwin Buske Photography. Oh, and a deer.

For more than 100 years, there have been attempts to improve telephone, cable, and internet services in the rural areas of America. Most of them have failed because it isn’t profitable for private firms to string wire to a small group of users who live at great distance from the nearest phone, or cable company.

This is a problem that requires government help, in particular, from the federal government. And there’s an abundance of government grant and loan money available to help rural America build broadband connections in unserved areas.

Recently the bipartisan infrastructure bill created the Broadband Equity, Access and Deployment Program (BEAD) and the State Digital Equity Act to provide money to underserved areas through the National Telecommunications and Information Administration.

The $42.5 billion BEAD Program automatically gives each state $100 million to start, but to receive additional broadband funding, local governments must apply for grants that are due by July 18. The State Digital Equity Act has $1.5 billion to allocate, and state’s letters of intent are due July 12. Not much time left.

The American Rescue Plan Act (ARPA) also has a pool of $10 billion to expand broadband through the Coronavirus Capital Projects Fund, supervised by the Treasury Department. States had until Dec. 2021 to apply for the fund program, and until Sept. 24, 2022, to submit a grant plan to the Treasury.

But as always, distributing government money efficiently is an issue. Early in June the Government Accountability Office (GAO) issued a report “National Strategy Needed to Guide Federal Efforts to Reduce Digital Divide,” that found many flaws with these programs:

“Federal broadband efforts are fragmented and overlapping, with more than 100 programs administered by 15 agencies. Many programs have broadband as their main purpose, and several overlap…”

More:

“Despite numerous programs and federal investment of $44 billion from 2015 through 2020, millions of Americans still lack broadband, and communities with limited resources may be most affected…”

Here’s the GAO’s chart of the overlapping jurisdictions:

Looks impossible to navigate. The WSJ weighed in focusing on the FCC’s role. They concluded:

“…many residents are still stuck with service that isn’t fast enough to do video calls or stream movies—speeds that most take for granted. Many communities have been targeted for broadband upgrades at least twice already, but flaws in the programs’ design have left residents wanting.

The WSJ found that areas with a combined population of 5.3 million people had previously been fully or partially covered by at least one federal broadband funding program. But the FCC’s rules didn’t require ISPs or Telecoms to serve all customers equally, as long as they served a minimum number of locations statewide.

That allowed internet providers to pick only the profitable customers to upgrade. This meant they could take public money while leaving pockets of homes and businesses without access.

Wrongo detests that public monies are lining the pockets of private firms who won’t solve their own problems. He detests that our government can’t get out of its own way, even after Congress rouses from its slumber and allocates funds that can help out rural Americans.

Republicans blame big government inefficiency, and they have a point. They also laud Elon Musk’s Starlink low-earth orbit satellite internet service. They say it proves that private industry can solve this problem. Except that there’s a 2+ year wait for Starlink services in much of rural America. And it’s estimated that the Starlink ground antenna costs $2500 to build, but is sold for $600. Who’s paying the difference?

And Starlink satellites have to connect to ground stations (NOCs) that connect to the web. Starlink’s speeds have slowed recently because they haven’t built NOCs fast enough.

It will never be profitable for private firms to connect the last mile to very rural homes. So there’s a role for government, properly managed. We subsidize the farms, roads, postal service, telephones and now, the broadband needs of rural people. Apart from factory farms, these are among the least economically productive areas in our economy.

And the best part? They hate the people who foot the bill!

Time to wake up America! Our public-private “partnerships” that are trying to get internet services to the toughest to reach parts of the country aren’t working. They need more red-tape cutting and more corporate CEO feet held to the fire if they are to work.

This can be done. America went to the moon before we put wheels on luggage.

To help you wake up, let’s spend a few minutes with Paul McCartney, who turned 80 recently. Take this opportunity to cherish his presence. Here’s McCartney doing “Jet” live at Glastonbury in 2004 when he was 62:

Don’t worry, nobody knows what the song is about.

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Saturday Soother – December 5, 2020

The Daily Escape:

Trump barn, Ohio –  photo by Dan Keck via

The Democrats are soul-searching about why they can’t win the US rural vote. Many believe the Democrats underperformed in fly-over America, and they’re asking (again) if rural America is lost to them forever.

According to the Economic Innovation Group, the rural Midwest counties Biden won had population growth that averaged 1.8% over the past 10 years, while counties Trump won saw an average population decline of 2.5%:

“…16 rural counties flipped from Trump in 2016 to Biden in 2020…12 flipped from Clinton in 2016 to Trump in 2020.”

So, not much change. Over the past 50 years, the Midwest has seen out-migration, economic stagnation, young people leaving and small towns withering. They turned rightward and have largely stayed there. Is rural America worth fighting for?

Estimates of rural populations across the US suggest roughly 20% of Americans live in them. Rural areas are not exclusive to states that gave all their electors to Trump. New York and California have plenty of rural spaces and voters. Wrongo’s county in Democratic Connecticut is largely rural, and voted for Trump in 2016 and by a lower margin in 2020.

Yet, given the Electoral College, it is difficult to fashion a durable political majority if Democrats write off most of exurban and rural America. Let’s briefly look at Iowa and Wisconsin.

In Iowa, Trump won the state by 8.3 percentage points this year. GW Bush won in 2004 by 0.7 percentage points. He was the first GOP presidential candidate to carry Iowa in 20 years. Obama won with 54% in 2008 and 52% in 2012. Trump won with 51.7% in 2016, and with 53% in 2020.

Trump carried 93 rural counties, while Biden carried all six of Iowa’s urban counties. Republicans now represent all or parts of 97 of Iowa’s 99 counties.

Wisconsin flipped to blue by six-tenths of a percentage point. Biden won in 14 counties. From Martin Longman at Progress Pond:

“Wisconsin’s Dunn County is in the central part of the state, over 96% white, and represented by Democrat Ron Kind in Congress. Not far from Eau Claire, the rural area voted for Barack Obama twice, but in 2016 Donald Trump won it with 52% to 41%, a 2,000-vote advantage over Hillary Clinton. In 2020, running against Joe Biden, Trump carried Dunn County 56-42, giving him a 3,300-vote edge.”

Bill Hogseth, the chair of the county’s Democratic Party, wrote a piece for Politico Magazine, explaining that the national Democratic Party doesn’t take rural issues seriously enough to get support from rural Wisconsinites. From Hogseth:

“For Democrats to start telling a story that resonates, they need to show a willingness to fight for rural people, and not just by proposing a “rural plan” or showing up on a farm for a photo op…A big step forward for Democrats would be to champion antitrust enforcement and challenge the anticompetitive practices of the gigantic agribusiness firms that squeeze our communities. In his rural plan, Biden pledged to “strengthen antitrust enforcement,” but the term doesn’t appear until the 35th bullet point. For rural voters, antitrust enforcement is a top priority…”

Hogseth is talking about Democratic neglect. Elizabeth Warren made anti-trust and the breakup of big companies’ part of her primary campaign. That’s good policy, and if it helps win some rural votes, even better.

Republicans aren’t talking about anti-monopoly anywhere in America. A generous Farm Bill channeled money into rural areas and the Trump administration’s trade relief payments to farmers have helped maintain rural Republican support. Hogseth says Democratic neglect leaves:

“…an opening for other stories to be told to fill the vacuum—stories that villainize and divide us along racial, geographic and partisan lines.”

People don’t make decisions based solely on a rational analysis, or on self-interest. They don’t believe in the Democrats’ promises to improve things, because Dems haven’t delivered on them in the past 40 years. They need a villain to blame. Trump, and the GOP (and every other nationalist movement in history) gives them just that.

The center-left should be rejoicing, but their down-ballot results are a cause for concern. Today, Democrats are fighting about whether they should be more progressive, or remain moderate going forward.

One reason that Trump got 74+ million votes was because Democrats never mobilized the working class against him. Instead, they mobilized to win suburbia. That gave Biden the presidency, but it also keeps our enduring governmental gridlock in place.

Time to relax a bit on this December Saturday. Today, Connecticut is waiting on a snow storm that in typical nor’easter fashion, could dump 10+ inches, or miss us entirely.

Still, we have time to take a few minutes, turn away from our email, and listen to Harpist Silke Aichhorn play Tchaikovsky’s “Waltz of the Flowers” from his Nutcracker Suite. It was written as a ballet in 1892, and has been enjoyed around the holidays ever since:

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Current and Future Job Growth Will Be In Cities

The Daily Escape:

Breezewood, PA – 2008 photo by Edward Burtynsky. Each year, 3.5 million passenger vehicles and 1.5 million trucks drive the half-mile Breezewood strip on Route 30. That’s because a law in the 1950s prohibited spending federal funds to connect a free road to a toll road. So, highway planners designed an interchange that routes drivers onto Route 30 for a half-mile.

An interesting article from Market Watch shows how nearly all job growth is in big cities, while rural America is being left behind:

“Since the economy began adding jobs after the Great Recession nine years ago, about 21.5 million jobs have been created in the United States, the second-best stretch of hiring in the nation’s history, second only to the 1990s. But….Most of the new jobs have been located in a just a few dozen large and dynamic cities, leaving slower-growing cities, small towns and rural areas — where about half of Americans live — far behind.”

MarketWatch cites a July 2019 study by McKinsey forecasting that 25 cities that are home to about 30% of Americans will capture about 60% of the job growth between 2017 and 2030, just as they did between 2007 and 2017. In typical McKinsey fashion, they break cities and towns into many categories. Please read the report for full details. Here are their top-line findings about where the largest growth is happening:

  • Twelve mega-cities (and their extended suburbs) top the list: Atlanta, Boston, Chicago, Dallas, Houston, Los Angeles, Miami, New York, Philadelphia, Phoenix, San Francisco and Washington.
  • Another 13 are high-growth hubs in or around smaller cities: Austin, Charlotte, Denver, Las Vegas, Minneapolis, Nashville, Orlando, Portland (Ore.), Raleigh, San Antonio, San Jose, Seattle, and Tampa.
  • Smaller, fast-growing cities and a few privileged rural counties will also add jobs, while vast swaths of the South, Midwest and Plains will lose jobs.
  • The New York metro area, home to 20 million people, added more jobs over the past year than did all of America’s small towns and rural areas, with a population of 46 million people, combined.

McKinsey’s forecast reinforces concerns about persistent economic inequality in America. Inclusive growth is a must, or it is likely that our society will fall apart. The problem: No one, and certainly not Republicans, have a magic wand that will bring back jobs to rural and small-town America.

Anyone who’s been paying attention knows that job growth is mostly occurring in places that vote for Democrats, while the stagnation is mostly in places that vote for Republicans. In 2016, Trump was smart to tailor a pitch to those parts of America, but their situations haven’t improved since his election.

And the divide is getting larger. Over the past year, only 12% of 389 metro areas had any significant job growth, according to an analysis of Bureau of Labor Statistics data by Aaron Sojourner, a former White House economist, now an associate professor at the University of Minnesota:

So, after 17 years of significant and broadly-spread growth, fewer towns and cities are now doing so well. And, of the 47 metros that gained significant numbers of jobs over the past year, 21 were on McKinsey’s top 25 list.

Meanwhile, the regional jobs data from the BLS shows that non-metropolitan areas, which account for 18% of jobs, had just 5% of job growth over the past year.

OTOH, income inequality is greatest in those cities with the highest jobs growth. But, we can’t write off one quarter of the US population simply because they live in low-growth areas. And politically, it’s essential. Rural America is overrepresented politically — we can’t ignore them.

But, what to do? Sanders and Warren have addressed this by trying to raise tax revenues from corporations, and funding free college. They along with others, believe in some form of Medicare-for-all, which could help address the fact that rural America is older, sicker, and poorer than ever before.

Yang proposes a universal basic income of $1,000/month for everyone.

Trump proposes tax cuts for the wealthy, tariffs and weakened environmental regulations, but despite all three, the situation has gotten worse since his election.

McKinsey suggests that communities that are being left behind ought to try almost everything: improved transportation to get residents to jobs, rural broadband, and lifelong job training.

Building consensus about how to address job growth and income inequality is the key to America’s future. This is what the 2020 presidential election should be about.

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Random Tuesday Thoughts

(Wrongo and Ms. Right are away until July 9th visiting our CA family. Expect the next column to be posted then.)

The Daily Escape:

White Sands National Monument, NM – 2019 photo by Bernard-F

#1: Wrongo watched the video of Trump walking across the Korean DMZ. While most foreign policy professionals will have a cranky reaction to the event, it represents progress. Both sides had stopped negotiations and in fact, were not even talking, after Trump walked out of the Hanoi meeting.

Whether it is a breakthrough that leads to a deal remains to be seen. OTOH, Trump took his daughter Ivanka and Tucker Carlson to the DMZ, while sending John Bolton (who he called “Mike”), and Mike Pompeo on to other tasks. Anything that drives the GOP neocons crazy can’t be all bad.

The incoherence of Trump’s global strategy shows itself in extending himself to North Korea, a country that has nuclear weapons, and the means to deliver them. The US has no agreement with NorKo to contain its weapons of mass destruction. We don’t even have a peace agreement after the War that ended in 1953, but we’re talking.

Contrast that with Trump’s walking away from the signed Iranian nuclear deal, which was negotiated to prevent an exact North Korea-type situation from happening. Inexplicable.

#2: Forbes has a very interesting article on new solar power capacity in California:

“Los Angeles Power and Water officials have struck a deal on the largest and cheapest solar + battery-storage project in the world, with a prestige solar battery supplier, at prices that leave fossil fuels in the dust and may relegate nuclear power to the dustbin.”

Cheaper than fossil fuels, the new plant will be built north of LA, in Kern County. LA officials said that it will be the largest and lowest-cost solar and high-capacity battery storage project in the US. When up and running, it will operate at half the estimated cost of power from a new natural gas plant. The plant is expected to deliver its first megawatt by April 2023.

#3: Reuters reports that Trump’s “deal” with China may not be a deal at all. In their article, China warns of long road ahead for deal with US after ice-breaking talks, Reuters quotes the official China Daily, an English-language daily often used by Beijing to put its message out to the rest of the world. It warned there was no guarantee there would ever be a deal: (emphasis by Wrongo)

“Agreement on 90 percent of the issues has proved not to be enough, and with the remaining 10 percent where their fundamental differences reside, it is not going to be easy to reach a 100-percent consensus, since at this point, they remain widely apart even on the conceptual level.”

#4: Next, it’s that time of year again where Americans camp out for days in order to visit with a pop-up rural clinic nurse. Why? Because we have the most expensive “health care” on earth, and a system absolutely designed to keep it that way:

“They were told to arrive early if they wanted to see a doctor, so Lisa and Stevie Crider left their apartment in rural Tennessee almost 24 hours before the temporary medical clinic was scheduled to open. They packed a plastic bag with what had become their daily essentials after 21 years of marriage: An ice pack for his recurring chest pain. Tylenol for her swollen feet. Peroxide for the abscess in his mouth. Gatorade for her low blood sugar and chronic dehydration.”

A view from the volunteers:

“…a clinic volunteer….patrolled the parking lot late at night and handed out numbers to signify each patient’s place in the line. No. 48 went to a woman having panic attacks from adjacent Meigs County, where the last remaining mental-health provider had just moved away to Nashville. No. 207 went to a man with unmanaged heart disease from Polk County, where the only hospital had gone bankrupt and closed in 2017.”

With Republicans doing everything they can to break the Affordable Care Act, and then refusing to fix it, this is what their actions have caused. Rural hospitals are closing, people in rural counties have no health care. And the GOP tells them to blame Democrats. The reality is that Republicans in these states have cut funding for the programs that kept red state rural clinics and hospitals operating.

#5: Columbia University reported that scientists have discovered a gigantic aquifer of relatively fresh water trapped below the Atlantic Ocean. This undersea aquifer stretches from Massachusetts to New Jersey, extending more or less continuously out about 50 miles to the edge of the continental shelf.

The water was trapped in mile-deep ice 15,000 to 20,000 years ago. When the ice melted, sediments formed huge river deltas on top of the shelf, and fresh water got trapped there. It would have to be desalinated for most uses, but the cost would be much less than processing seawater.

See you next week!

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Monday Wake Up Call – January 8, 2018

The Daily Escape:

Frozen Waterfall in Adirondacks – 2018 photo by I_am_Bob

A December 29th WSJ article charted the growing gulf in health and well-being between urban and rural America:

About 1 in 7 Americans live in rural parts of the country—1,800 counties that sit outside any metropolitan area. A generation ago, most of these places had working economies, a strong social fabric and a way of life that drew a steady stream of urban migrants. Today, many are in crisis. Populations are aging, more working-age adults collect disability, and trends in teen pregnancy and divorce are diverging for the worse from metro areas. Deaths by suicide and in maternity are on the rise. Bank lending and business startups are falling behind

These rural counties now rank the worst among the four major US population groupings (the others are big cities, suburbs and medium or small metro areas). In November 2016, these rural districts voted overwhelmingly for Donald Trump, based in part on his pledge to revive these forgotten towns by scaling back trade agreements, ending illegal immigration and encouraging manufacturing companies to hire more American workers. He also promised a $1 trillion infrastructure bill that would help create jobs, but, like the other promises, it may never become a reality.

Back in the late 1970s – 1980s, the nation’s basket cases were its urban areas. A toxic stew of crime, drugs and suburban flight made large cities the slowest-growing and most troubled places. But violent crime in the cities (despite claims by a well-known, Very Stable Genius) have declined to the point that there no longer is any “safety premium” from living in rural America.

Today, by most key measures of socioeconomic well-being, the largest cities are as safe, and are much wealthier than our rural and small metro areas.

For decades, America’s small towns barely grew. Rural families had just enough children to offset losses from those who left, and those who died. The decline in median household income is reflective of that trend. The graph below is based on census data. It shows that household incomes (adjusted for inflation) peaked around the end of the Clinton administration and continue to decline, and not just in rural areas:

 

 

These rural parts of America are caught in the vise of limited economic opportunity coupled with terrible health outcomes.

About half of these counties would be called “failed states” if they were countries, meaning that the infrastructure of skilled labor, healthcare, privately owned commerce and aggregate demand for goods and services are not enough to make them economically viable.

Education gaps also have long-term consequences. More jobs, particularly full-time jobs with benefits, require a bachelor’s or advanced degree. Without a larger share of college graduates, small towns have little hope of closing the income gap.

Solution? We need to create a way to finance those who might be willing to move to economically viable regions. Many people today can make a living just by being connected by phone and internet.

If they were to choose to reside in a rural town, they would become an economic generator, helping these communities that truly need the help. If the nascent infrastructure proposals by the GOP include building up our nation’s broadband system, it could help to support a dispersed work group more easily.

Every demographic region except rural America has improved on most quality of life measurements. In those aspects where things have gotten worse, such as diabetes and suicide rates, rural America has the highest rates.

Time for America to wake up: We need a Marshall Plan right here at home to renovate our small towns and rural areas. To help you wake up, listen and watch the Philadelphia sextet The War on Drugs perform “Holding On” from their 2017 album “A Deeper Understanding”. Watch the atmospheric video:

Takeaway Lyric:

I went down a crooked highway
I went all outside the line
I’ve been rejected, now the light has turned and I’m out of time

Those who read the Wrongologist in email can view the video here.

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