21st Century Rural Health Care Delivery 

Tom Timberman • April 3, 2019

Reality Check:

The April 20 issue of Common Sense reviewed health care issues in rural areas of the Eastern Shore:

  1. Community hospitals are closing or reducing services substantially;
  2. Beds and nursing staff are among the first to go;
  3. With only temporary overnights possible until helicopter or ambulance takes you to a city;
  4. Specialized services are often only available by importing doctors once or twice a month, or by patients driving long distances to another facility, e.g. coronary, oncology, pediatrics, endocrinology, gastroenterology, gynecology, urology, or most surgeries;
  5. Inadequate Public transportation.

How are rural communities dealing with these problems?

First, it’s essential we understand that the small, full-service community hospitals of the 20th Century will not return. For-profit companies own them now and the services they provide are directly related to the profit margin each service delivers. The health care facilities remaining in the nine counties usually offer large emergency clinics or departments, blood, x-ray and scan testing; and possibly 3-5 beds. The latter are not for recovery, healing, or convalescence, because in the 21st Century, these take place in the patient’s home.

Patients requiring diagnostic expertise and hospitalization will be taken to acute care hospitals in Easton, Annapolis, Baltimore, or elsewhere within the local facility’s particular network. So how to get good medical care in a small town?

Seduction and Bribery:

Some rural or isolated US communities have refocused their priorities on the minimum basic services they think are needed instead of trying to revive the old community hospital model.

In recruiting new staff, local authorities have recognized that most young doctors leave medical schools, internships, and advanced training with large debts.Thus they often offer packages of inducements to family practitioners and specialists. These packages may contain:

  1. Loan repayments in installments determined by the number of years the doctor agrees to stay. If the doctor settles permanently in the community, the norm is to pay the whole balance;
  2. Free housing and office;
  3. Loan of a car or van;
  4. Depending on the quality of the local public schools or any special needs of the doctor’s children, tuition support.

A similar approach is aimed at middle-aged physicians thinking of retiring in 5-10 years and looking for a less frantic life. The methods have also been used to attract nurses, technicians, and other health practitioners, as have on-signing bonuses and moving expenses.

Federal Qualified Health Centers (FQHC):

Section 330 of the Federal Public Health Service Act is aimed at “…enhancing the provision of primary care services in under-served communities.” The Act identifies “Specially Protected Population Segments,” such as agricultural workers, homeless, and public housing residents. These outpatient clinics qualify for specific reimbursements from Medicare and Medicaid. An individual’s ability to pay is matched by a sliding fee discount scale. Once certified by an applicant, the organization (public or non-profit) can receive grants from the U.S. Health Resources Services Administration.

The Eastern Shore is fortunate to have a first class FQHC in the Choptank Community Health Center. It supports the Denton Medical Center, the Easton Pediatric Center, the Fasett Magee Health Center, the Federalsburg Medical and Dental Center, the Bay Hundred Health Center in St. Michaels, and the Goldsboro Medical and Dental Service. The application/approval process is lengthy.In the meantime, the seduction and bribery methods above are being used by many communities seeking to upgrade the healthcare services available to them.

Common Sense for the Eastern Shore

By Friends of Megan Outten July 29, 2025
Megan Outten, a lifelong Wicomico County resident and former Salisbury City Councilwoman, officially announced her candidacy recently for Wicomico County Council, District 7. At 33, Outten brings the energy of a new generation combined with a proven record of public service and results-driven leadership. “I’m running because Wicomico deserves better,” Outten said. “Too often, our communities are expected to do more with less. We’re facing underfunded schools, limited economic opportunities, and years of neglected infrastructure. I believe Wicomico deserves leadership that listens, plans ahead, and delivers real, measurable results.” A Record of Action and A Vision for the Future On Salisbury’s City Council, Outten earned a reputation for her proactive, hands-on approach — working directly with residents to close infrastructure gaps, support first responders, and ensure everyday voices were heard. Now she’s bringing that same focus to the County Council, with priorities centered on affordability, public safety, and stronger, more resilient communities. Key Priorities for District 7: Fully fund public schools so every child has the opportunity to succeed. Fix aging infrastructure and county services through proactive investment. Keep Wicomico affordable with smarter planning and pathways to homeownership. Support first responders and safer neighborhoods through better tools, training, and prevention. Expand resources for seniors, youth, and underserved communities. Outten’s platform is rooted in real data and shaped by direct community engagement. With Wicomico now the fastest-growing school system on Maryland’s Eastern Shore — and 85% of students relying on extra resources — she points to the county’s lagging investment as a key area for action. “Strong schools lead to strong jobs, thriving industries, and healthier communities,” Outten said. “Our schools and infrastructure are at a tipping point. We need leadership that stops reacting after things break — and starts investing before they do.” A Commitment to Home and Service Born and raised in Wicomico, Megan Outten sees this campaign as a continuation of her lifelong service to her community. Her vision reflects what she’s hearing from neighbors across the county: a demand for fairness, opportunity, and accountability in local government. “Wicomico is my home; it’s where I grew up, built my life, and where I want to raise my family,” Outten said. “Our county is full of potential. We just need leaders who will listen, work hard, and get things done. That’s what I’ve always done, and that’s exactly what I’ll continue to do on the County Council.” Outten will be meeting with residents across District 7 in the months ahead and unveiling more details of her platform. For more information or to get involved, contact info@meganoutten.com
By John Christie July 29, 2025
Way back in 1935, the Supreme Court determined that independent agencies like the Consumer Product Safety Commission (CPSC), the National Labor Relations Board (NLRB) and the Merit Systems Protection Board (MSPB) do not violate the Constitution’s separation of powers. Humphrey’s Executor v. United States (1935). Congress provided that the CPSC, like the NLRB and MSPB, would operate as an independent agency — a multi-member, bipartisan commission whose members serve staggered terms and could be removed only “for neglect of duty or malfeasance in office but for no other cause.” Rejecting a claim that the removal restriction interferes with the “executive power,” the Humphrey’s Court held that Congress has the authority to “forbid their [members’] removal except for cause” when creating such “quasi-legislative or quasi-judicial” bodies. As a result, these agencies have operated as independent agencies for many decades under many different presidencies. Shortly after assuming office in his second term, Donald Trump began to fire, without cause, the Democratic members of several of these agencies. The lower courts determined to reinstate the discharged members pending the ultimate outcome of the litigation, relying on Humphrey’s , resulting in yet another emergency appeal to the Supreme Court by the administration. In the first such case, a majority of the Court allowed President Trump to discharge the Democratic members of the NLRB and the MSPB while the litigation over the legality of the discharges continued. Trump v. Wilcox (May 22, 2025). The majority claimed that they do not now decide whether Humphrey’s should be overruled because “that question is better left for resolution after full briefing and argument.” However, hinting that these agency members have “considerable” executive power and suggesting that “the Government” faces greater “risk of harm” from an order allowing a removed officer to continue exercising the executive power than a wrongfully removed officer faces from being unable to perform her statutory duty,” the majority gave the President the green light to proceed. Justice Kagan, joined by Justices Sotomayor and Jackson, dissented, asserting that Humphrey’s remains good law until overturned and forecloses both the President’s firings and the Court’s decision to award emergency relief.” Our emergency docket, while fit for some things, should not be used to “overrule or revise existing law.” Moreover, the dissenters contend that the majority’s effort to explain their decision “hardly rises to the occasion.” Maybe by saying that the Commissioners exercise “considerable” executive power, the majority is suggesting that Humphrey’s is no longer good law but if that is what the majority means, then it has foretold a “massive change” in the law and done so on the emergency docket, “with little time, scant briefing, and no argument.” And, the “greater risk of harm” in fact is that Congress provided for these discharged members to serve their full terms, protected from a President’s desire to substitute his political allies. More recently, in the latest shadow docket ruling in the administration’s favor, the same majority of the Court again permitted President Trump to fire, without cause, the Democratic members of another independent agency, this time the Consumer Product Safety Commission (CPSC). Trump v. Boyle (July 23, 2025). The same three justices dissented, once more objecting to the use of the Court’s emergency docket to destroy the independence of an independent agency as established by Congress. The CPSC, like the NLRB and MSPB, was designed to operate as “a classic independent agency.” In Congress’s view, that structure would better enable the CPSC to achieve its mission — ensuring the safety of consumer products, from toys to appliances — than would a single-party agency under the full control of a single President. “By allowing the President to remove Commissioners for no reason other than their party affiliation, the majority has negated Congress’s choice of agency bipartisanship and independence.” The dissenters also assert that the majority’s sole professed basis for the more recent order in Boyle was its prior order in Wilcox . But in their opinion, Wilcox itself was minimally explained. So, the dissenters claim, the majority rejects the design of Congress for a whole class of agencies by “layering nothing on nothing.” “Next time, though, the majority will have two (if still under-reasoned) orders to cite. Truly, this is ‘turtles all the way down.’” Rapanos v. United States (2006). * ***** *In Rapanos , in a footnote to his plurality opinion, former Supreme Court Justice Scalia explained that this allusion is to a classic story told in different forms and attributed to various authors. His favorite version: An Eastern guru affirms that the earth is supported on the back of a tiger. When asked what supports the tiger, he says it stands upon an elephant; and when asked what supports the elephant, he says it is a giant turtle. When asked, finally, what supports the giant turtle, he is briefly taken aback, but quickly replies "Ah, after that it is turtles all the way down." John Christie was for many years a senior partner in a large Washington, D.C. law firm. He specialized in anti-trust litigation and developed a keen interest in the U.S. Supreme Court about which he lectures and writes.
By Shore Progress, Progessive Maryland, Progressive Harford Co July 15, 2025
Marylanders will not forget this vote.
Protest against Trumpcare, 2017
By Jan Plotczyk July 9, 2025
More than 30,000 of our neighbors in Maryland’s first congressional district will lose their health insurance through the Affordable Care Act and Medicaid because of provisions in the GOP’s heartless tax cut and spending bill passed last week.
Farm in Dorchester Co.
By Michael Chameides, Barn Raiser May 21, 2025
Right now, Congress is working on a fast-track bill that would make historic cuts to basic needs programs in order to finance another round of tax breaks for the wealthy and big corporations.
By Catlin Nchako, Center on Budget and Policy Priorities May 21, 2025
The House Agriculture Committee recently voted, along party lines, to advance legislation that would cut as much as $300 million from the Supplemental Nutrition Assistance Program. SNAP is the nation’s most important anti-hunger program, helping more than 41 million people in the U.S. pay for food. With potential cuts this large, it helps to know who benefits from this program in Maryland, and who would lose this assistance. The Center on Budget and Policy Priorities compiled data on SNAP beneficiaries by congressional district, cited below, and produced the Maryland state datasheet , shown below. In Maryland, in 2023-24, 1 in 9 people lived in a household with SNAP benefits. In Maryland’s First Congressional District, in 2023-24: Almost 34,000 households used SNAP benefits. Of those households, 43% had at least one senior (over age 60). 29% of SNAP recipients were people of color. 15% were Black, non-Hispanic, higher than 11.8% nationally. 6% were Hispanic (19.4% nationally). There were 24,700 total veterans (ages 18-64). Of those, 2,200 lived in households that used SNAP benefits (9%). The CBPP SNAP datasheet for Maryland is below. See data from all the states and download factsheets here.
Show More