> Rural family doctors can and do still deliver babies in the absence of ob-gyns. But the proportion of generalist doctors willing and trained to do so has been declining for decades. Many family physicians I met while touring rural areas as part of a Brookings and American Enterprise Institute commission on rural life cited liability risks as the motivator of their retreat from maternity care. Adverse birth outcomes are among the most common claims against physicians in medical-malpractice lawsuits, and awarded judgments can be very high, which inflates the liability-insurance premiums that doctors must pay. In addition, in places with few ob-gyns, a generalist is more likely to have to handle high-risk cases without expert help.
Simple Idea: Very sharply limit lawsuits against medical professionals and organizations who are acting as "last ditch" providers of essential care.
This simply removes liability without reducing objective risk, the solution imho is to incentivize people of reproductive age who intend to carry a child to move to urban areas where services are and will continue to be available, as the current trajectory is a continued decline in medical services as rural America continues to evaporate.
From the piece:
> Further, only 4 percent of the country’s ob-gyns practice in rural areas, which is where 10 percent of women ages 15 to 49 live. And that proportion is likely to fall even more because many new entrants to the field are not willing to do a residency or start a practice in states that restrict abortion, many of which are more rural.
> An even greater challenge will be the massive cuts to Medicaid within the One Big Beautiful Bill Act, many of which Congress set to go into effect after this fall’s elections. Medicaid covers more than 40 percent of American births overall and an even higher proportion in rural areas. More generally, the program is crucial to the financial viability of many rural hospitals, such that even if the cuts didn’t touch pregnant women at all, they could still deprive women of care by producing more rural-hospital closures. As an inducement to get votes from conservative rural congressional members, the OBBBA included a $50 billion Rural Health Transformation Fund, but this is substantially less money than the Medicaid cuts will total across rural America.
Rural America is too far into the gravity well to reach escape trajectory of a positive outcome. There is no will to spend today what it would cost to fix this (ie provide sufficient funding to maintain rural healthcare services and systems at a reasonable baseline for the local rural healthcare consumer base), and over time, the cost will only continue to rise.
> This simply removes liability without reducing objective risk
If that liability change kept more health care facilities and providers going in rural areas - then, compared to current trends, it would greatly reduce the risk.
> ...the solution imho is to incentivize people of reproductive age who intend to carry a child to move to urban areas where services are and will continue to be available...
Try talking to a few politicians from rural areas about just how unpopular this idea might be. (For anything beyond a tiny number of high-risk pregnancies.)
Rural areas need healthcare funding, funding that is not coming. Rural area politicians will talk (because talk is cheap and free versus action) until retired, out of office, or expired, but will not change the underlying structural issue of lack of funding needed to support a healthcare system needed for young people to remain in rural America. What outcome will this lead to? We can argue time horizon, but the trajectories in question are clear and remain on their paths until events occur that would change those trajectories, and therefore, future outcomes. That is my mental model on the topic of critical systems and infrastructure rural America requires to exist, and if at all possible, retain young people or encourage them to move there. 21 states now have more deaths than births every year, and this will only grow overtime to every state, for example.
I have a tracker I should probably just open source around the decline of hospitals, schools, churches, road infrastructure, farming, fossil aquifers, etc as it relates to the "Era of Contraction" in the US. Added to my TODO list.
Rural America voted for that policy. What's your point?
https://archive.today/rsXwr
Related:
https://www.marchofdimes.org/maternity-care-deserts-report (will be updated by the end of August 2026 with most recent data [2025]).
https://ruralhospitals.chqpr.org/
https://www.shepscenter.unc.edu/programs-projects/rural-heal...
https://ers.usda.gov/data-products/charts-of-note/110927
> Rural family doctors can and do still deliver babies in the absence of ob-gyns. But the proportion of generalist doctors willing and trained to do so has been declining for decades. Many family physicians I met while touring rural areas as part of a Brookings and American Enterprise Institute commission on rural life cited liability risks as the motivator of their retreat from maternity care. Adverse birth outcomes are among the most common claims against physicians in medical-malpractice lawsuits, and awarded judgments can be very high, which inflates the liability-insurance premiums that doctors must pay. In addition, in places with few ob-gyns, a generalist is more likely to have to handle high-risk cases without expert help.
Simple Idea: Very sharply limit lawsuits against medical professionals and organizations who are acting as "last ditch" providers of essential care.
This simply removes liability without reducing objective risk, the solution imho is to incentivize people of reproductive age who intend to carry a child to move to urban areas where services are and will continue to be available, as the current trajectory is a continued decline in medical services as rural America continues to evaporate.
From the piece:
> Further, only 4 percent of the country’s ob-gyns practice in rural areas, which is where 10 percent of women ages 15 to 49 live. And that proportion is likely to fall even more because many new entrants to the field are not willing to do a residency or start a practice in states that restrict abortion, many of which are more rural.
> An even greater challenge will be the massive cuts to Medicaid within the One Big Beautiful Bill Act, many of which Congress set to go into effect after this fall’s elections. Medicaid covers more than 40 percent of American births overall and an even higher proportion in rural areas. More generally, the program is crucial to the financial viability of many rural hospitals, such that even if the cuts didn’t touch pregnant women at all, they could still deprive women of care by producing more rural-hospital closures. As an inducement to get votes from conservative rural congressional members, the OBBBA included a $50 billion Rural Health Transformation Fund, but this is substantially less money than the Medicaid cuts will total across rural America.
Rural America is too far into the gravity well to reach escape trajectory of a positive outcome. There is no will to spend today what it would cost to fix this (ie provide sufficient funding to maintain rural healthcare services and systems at a reasonable baseline for the local rural healthcare consumer base), and over time, the cost will only continue to rise.
(think in systems)
> This simply removes liability without reducing objective risk
If that liability change kept more health care facilities and providers going in rural areas - then, compared to current trends, it would greatly reduce the risk.
> ...the solution imho is to incentivize people of reproductive age who intend to carry a child to move to urban areas where services are and will continue to be available...
Try talking to a few politicians from rural areas about just how unpopular this idea might be. (For anything beyond a tiny number of high-risk pregnancies.)
Rural areas need healthcare funding, funding that is not coming. Rural area politicians will talk (because talk is cheap and free versus action) until retired, out of office, or expired, but will not change the underlying structural issue of lack of funding needed to support a healthcare system needed for young people to remain in rural America. What outcome will this lead to? We can argue time horizon, but the trajectories in question are clear and remain on their paths until events occur that would change those trajectories, and therefore, future outcomes. That is my mental model on the topic of critical systems and infrastructure rural America requires to exist, and if at all possible, retain young people or encourage them to move there. 21 states now have more deaths than births every year, and this will only grow overtime to every state, for example.
I have a tracker I should probably just open source around the decline of hospitals, schools, churches, road infrastructure, farming, fossil aquifers, etc as it relates to the "Era of Contraction" in the US. Added to my TODO list.