By James M. Decker 

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As many of my readers know, back in June of 2018, Stamford Memorial Hospital closed its inpatient care services and emergency room. This has created a certain level of anxiety and concern within the community, particularly with regard to emergency services. Old folks and young folks alike get concerned when they realize that, in case of a heart attack, car wreck, or workplace accident, the nearest emergency room is now 15 miles away, rather than across town. It’s a tougher sales pitch to attract businesses when local healthcare services are reduced.

The good news and bad news is that this issue isn’t isolated to Stamford. If you do a Google search for rural hospitals, the results you find are frightening. In the last decade, something like 90 rural hospitals have closed. 20 of those are in Texas. The National Rural Health Association, our nation’s foremost advocates for rural healthcare, estimates that something close to 800 more rural hospitals are at risk of closing. That’s about one-third of all rural hospitals in the entire country.

It helps a little to know that it’s not just us. There’s not something systemically wrong with our community that caused this. At the same time, it’s daunting to know that the problem is that enormous. A problem like that has no easy fixes. The solutions are that much tougher.

Hence the title of this essay. We all hear about “thinking outside the box,” the concept of thinking with new perspectives. It’s critical to success in life, business, and community leadership. However, I’ve come to believe that fixing rural healthcare requires something even more creative than that. We don’t need to just think outside our box, by looking at ways to tweak our usual line of thought with a new perspective. We might need to just throw away the old box and start building a new box.

Healthcare is vital to a rural community. You can’t keep residents and business and you can’t attract new ones without it. But what does “healthcare” actually mean? What are our actual priorities? We’ve all grown accustomed to the usual menu of services: a clinic for outpatient visits, an ER for emergencies, an ambulance when needed, hospital beds for inpatient stays, and big city hospitals and specialists when it gets too serious. I’m 34 years old and that’s been my entire frame of reference for healthcare my entire life. And as we’ve seen in Stamford and dozens of other communities, that layout is very difficult to sustain in rural communities.

It’s not exactly sunflowers and lollipops in big cities, either. There’s a reason why our national political debate has been consumed by healthcare reform, and reforms to reform, for the better part of a decade. Healthcare is hard. It’s a complicated, convoluted tangle of free markets, government intervention, lobbyists, service providers, insurers, re-insurers, and a billing system that no one on earth truly understands. It’s the 800 pound gorilla in America, not just in Stamford.

Like some of my past essays, I’m not coming to you with answers today. I’m coming to you with thoughts to start the conversation in my mind and hopefully in yours. If rural healthcare was easily fixed, someone would have done it years ago.

Sometimes you have to take a step back to look at the puzzle, in order to solve it. The more I think on this topic, the more I think we need to take a much bigger step back than we’ve been taking. The usual menu of services to which we are accustomed may or may not be the menu that we need for the future. We need healthcare services in our rural communities and I think that clearly starts with quality emergency care.

But how does it need to look? Instead of tweaking our status quo by merely thinking outside the box, it might be time to build a fresh new box, with a whole new look and a path for future success. More on that to come.

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James Decker is a lawyer, farmer, and mayor in Stamford, Texas, and the creator of the forthcoming “West of 98” podcast and website. He may be contacted through Facebook at Listen to our podcast interview with James here.


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