A rural hospital in Wedowee, AL.
Photo: Getty

Here is a story of how America murders its citizens through negligence, poverty, and racism. The Mississippi Clarion-Ledger reported yesterday on how a 23 year-old Mississippi woman, pregnant and mother to a toddler, died of an asthma attack in January near Houston, MS—where the local hospital has no emergency room.

Shyteria Shardae “Shy” Shoemaker had asthma, and when she began struggling to breathe one night at her cousins’ house, they called 911 and drove her to the nearest hospital, where they believed an emergency room would be open to save her. But it wasn’t; Trace Regional Hospital in Houston closed its emergency room five years ago.

It gets worse. While they were trying to save her life, her cousins were reportedly forced onto the ground after police believed them to be a threat. Per the Clarion-Ledger:

The dispatcher instructed them to drive to the Houston Fire Department instead, LeKearis said. They arrived at 1:26 a.m., according to 911 records. Two firefighters were outside waiting for them, Blankenship said.

But the cousins said they didn’t think the firefighters were responding quickly enough, so they went back to the car and sped a block away to the downtown square where they tried to flag down a police officer in his car.

[...]

When the cousins arrived at the square in Houston, LeParishe said they went to an officer in his car for help. The officer saw the black men outside his car and hesitated, LeParishe said.

“He looked like he was shocked ... like he was scared, like we were gonna rob him,” LeParishe said. When another officer arrived on scene, LeParishe said “he was talking about we were too loud, too rowdy.”

The officer yelled at them to get at the ground and put his hand on his Taser while they complied, LeParishe said.

LeParishe believes he spent the last moments of his cousin’s life lying on the freezing ground as though he were a criminal suspect.

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Would you perhaps be a little loud or “rowdy” if your cousin was dying in your car? Are black men supposed to quietly and meekly ask police officers to please help their dying relative, just in case the police think they’re a threat?

The firefighters were unable to resuscitate her, and it took 26 minutes for an ambulance to arrive, which then had to drive 20 miles to the nearest open hospital. There’s supposed to be an ambulance stationed in Houston at all times, but according to the Clarion Ledger, the one EMT on duty that night had a family emergency and left at midnight.

The story of how Shy Shoemaker died is part of the larger story of the disparities in American healthcare. Rural hospitals are closing across the U.S., in part because of a declining rural population. But these hospitals are also a casualty of America’s insurance-based healthcare system; when not everyone has insurance, and when those uninsured individuals are concentrated in high-poverty areas, rural areas with high-poverty rates—and higher rates of sick people—will be hit hard. (Urban hospitals that serve primarily the poor struggle, too: D.C.’s only public hospital is “functionally bankrupt.”) Many rural hospitals have very few patients, and when a significant number of those people have no insurance, things quickly go south. Literally: The South is where rural hospital closures are at their worst.

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And it’s not just the uninsured. In February, the president of the Mississippi Hospital Association told the (Tupelo, MS) Daily Journal that hospitals are also facing more unpaid bills from people who have insurance but whose deductibles are outrageous, saying “not many people can afford $5,000 in charges in a year’s time.”

We are in a situation where millions of people pay for health insurance they can’t use. Paying for healthcare is not like paying for other things; eventually, if you get sick enough, you have to go to the doctor whether or not you can afford it. And if you can’t, someone else is paying the bill. This is why a healthcare system where not everyone has insurance makes no sense.

The best solution to all of these problems would be an adequately funded single-payer system, but there are other policy decisions that led to situations like this. Mississippi, for instance, is one of the states that refused to expand Medicaid under the Affordable Care Act.

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Medicaid expansion helps keeps rural hospitals open, because it reduces the number of uninsured people using services, which is what happened to the hospital in question:

The emergency room at Trace Regional Hospital closed in the summer of 2014. Administrators at the time said the emergency room lost more than $2 million in one year after people came there for treatment and did not pay.

The more people covered by Medicaid, the less frequently a hospital would have to provide care for free.

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Mississippi Republicans are proud of this, too. At a January luncheon, lieutenant governor Tate Reeves, the president of the state Senate, reportedly chanted—yes, chanted—at reporters: “I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi.”

Shy Shoemaker did not have to die. The basic issue is lack of funding—a closed E.R., poor ambulance service—but the bigger issue is, as Frances Gill wrote in Jacobin last year, the profit motive in healthcare at large:

The rare stories of success that have emerged from the rural hospital closure crisis are stories of hospitals that have made capital investments into long-term improvements. But when each hospital has to mind its own bottom line, hospitals that are struggling cannot afford to invest in new equipment, to refurbish their facilities, to update their electronic health records system, to implement telehealth capabilities, or to spend money on hiring and retaining staff. Large hospital groups that own multiple facilities have no incentive to make these kinds of choices. They have no reason to invest in the community they are serving. For large firms that own dozens of health centers, the more financially sound decision is to simply shut down the hospitals that are struggling.

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The fact that we have an insurance-based healthcare system that not only penalizes and kills individuals for being poor, but that causes the decay of the services themselves, is a policy choice. Mississippi is choosing to reject Medicaid expansion. America is choosing to reject a more equitable healthcare system. And until these things change, we are choosing to keep a system in which Shy Shoemaker dies and leaves a baby girl behind.