A RURAL HEALTH-CARE CRISIS IS LOOMING

President Trump's One Big Beautiful Bill slashes Medicaid budgets to shrink Obamacare and fund tax cuts for the wealthy. Now dozens of hospitals in nonurban locations across America may shut down. And the human cost could be incalculable.

- By Charles P. Pierce

YEARS AGO, WHEN RE-searching a book about my family and Alzheimer's disease, I went down to Duke University's medical center to do some interviews on a number of aspects of that particular demon of the mind. One day, I was talking with some social workers whose job it was to monitor and evaluate possible Alzheimer's patients in the hills of western North Carolina. The social worker with whom I was talking and I had a bit of a laugh trading car-key stories. But then she began to talk about her work in the hills and hollows of the Blue Ridge Mountains. The people in these isolated hamlets on the dirt roads were ill served by the American healthcare system, she explained, and didn't trust it very much.

Now, anyone who ever has dealt with a loved one afflicted with Alzheimer's will tell you that, often, the hardest struggle is taking away the patient's car keys. For some reason—and the maniacal American tendency to equate automobiles with freedom is probably a big part of it—that is a line that still-functional AD patients will not cross. Keep your hands off my fob! It's not unheard-of for the attempt to result in actual physical violence, particularly if the patient no longer recognizes the person who is trying to take the keys. Usually the easiest solution is simply to wait until the patient is asleep, or out of the house, and hide the keys in a safe place.

When it comes to Alzheimer's, folks tend to isolate themselves even more tightly. There is an element of shame and embarrassment in the possibility that the neighbors will find out that Dad has taken to wearing two pairs of pants. (To be fair, this is something common to many Alzheimer's families everywhere, very much including my own.)

We soon got back to the issue of car keys, and the woman told me that, in these places where she worked, there was something that the patient clung to even more fiercely than the right to drive the family pickup. "The shotgun," she said.