I'm reminded of these lines from Hemingway's The Sun Also Rises: "'How did you go bankrupt?' Bill asked. 'Two ways,' Mike said. 'Gradually and then suddenly.'"
People without access to healthcare suffer the consequences immediately. Communities sink into their suffering gradually. In the case of North Adams, going from bustling mill town to once-proud mill town took about 130 years.
The root of the hospital's trouble is familiar—dwindling Medicare and Medicaid reimbursements. Ironically, while the price of providing healthcare to low-income populations is steep, withdrawing care is even more costly.
The stunner in this community is not only that the hospital closed its doors, but that it slammed them shut so abruptly. The people who live in the northern Berkshires need access to medical care.
If a CAH designation would keep NARH operating, then it's time to amend CAH requirements. They were written long before thinning Medicare and Medicaid reimbursements and other economic slings started shuttering community hospitals and hurting people who deserve better from their leaders.