Weeks: Health Care Exceptionalism
In One Child Town: The Health Care Exceptionalism Case Against Agglomeration Economies, Elizabeth Weeks (Georgia Law) dives directly into current debates about whether rural communities warrant continued investment. Focusing on health care as a lens for this analysis, Weeks argues in favor of more rural investment.
Weeks makes this case for rural investment in the context of recent scholarship that has argued, to the contrary, that policy efforts should focus on assisting rural residents in relocating away from dying rural communities in favor of places with a greater concentration of economic opportunity. For example, David Schleicher’s 2017 Yale Law Journal article, Stuck! The Law and Economics of Residential Stagnation, gained signficant attention for arguing that many rural residents do not choose to stay in rural communities but, rather, are “stuck” in light of a host of anti-mobility impediments baked into law and policy. These and other pro-mobility arguments tend to focus on claims about the agglomeration benefits in denser economies and communities, where close networks of diverse economic actors can more readily benefit not only from economies of scale but also the spillover effects of local knowledge exchange, deeper labor markets, and (sometimes) reduced costs of living—at least in terms of transportation and other infrastructure access.
Weeks is realistic about rural challenges and also skeptical of overly sentimental arguments in favor of rural investments. She acknowledges that “soft” arguments focused on value of place, home, heritage, and relationships tend not to address the macroeconomic issues that pro-mobility and agglomoration advocates identify.
Thus, Weeks turns to health care and argues health law and policy provide a uniquely helpful lens for briding economic and humanitarian arguments about rural futures. Ultimately, Weeks makes an argument that rural America warrants investment, not just for intangible reasons, but in the name of health. Weeks identifies features of rural health care provision that are legally and practically exceptional and argues that rural residents cannot be best served simply by relocation. She critiques these pro-mobility arguments as overlooking (1) the negative health effect of migration on both migrants and those left behind, (2) the positive health benefits of home and being treated close to home, and (3) long-standing public policy recognition of rural health care exceptionalism.
One Child Town urges that before we move rural residents away from declining towns to areas of greater density and opportunity, the U.S. must carefully consider the health effects of this kind of migration—and that these effects, once considered, warrent directing resources toward sustaining rural places across the country.
