Showing posts with label spatial inequality. Show all posts
Showing posts with label spatial inequality. Show all posts

Wednesday, April 1, 2026

The SAVE Act and rural America

Point Arena, California 
© Lisa R. Pruitt 2025


The Safeguard American Voter Eligibility Act (“SAVE Act”) has returned to Congress and sits before the Senate after passing the House.This bill would amend the National Voter Registration Act of 1993 by requiring every eligible voter to provide proof of citizenship when registering to vote or updating a registration.

The bill would require individuals to appear in person at an election and present approved documentation even for routine updates. These updates can include address changes, name changes, or party affiliation adjustments. Each federal election cycle, approximately 80 million people either register to vote for the first time or update their voter registration information. This bill would impose new logistical hurdles on all of them. Acceptable documentation would include a valid U.S. passport, a certified birth certificate paired with a photo ID, or a naturalization certificate. If a person’s legal name does not match their birth certificate, they must also provide additional legal documents to prove the change.

Supporters of the bill, including many Republican lawmakers, argue that stricter verification requirements will prevent non-citizen voting. Arguing that Joe Biden’s “reckless open-border policies” necessitate this bill because without it we can’t be sure that Americans are the only ones voting in federal elections.

What does the White House have to say about the SAVE Act? The official White House website refers to it as a “common sense, bipartisan bill,” emphasizing that all it “simply” requires is a valid ID to register to vote in a federal election, proof of citizenship, and no mail-in ballots. The website then goes on to list other countries that enforce stricter voter identification laws.

The SAVE Act is not new. Last year it passed the House but failed to advance in the Senate due to nationwide public opposition. It was reintroduced this January. Critics, previously and this time, argue that the SAVE Act solves nothing. Numerous studies and audits have shown that non-citizen voting occurs at extremely low rates. In fact, many view this bill as a way for Republicans to hammer Trump’s narrative of widespread election fraud.

Additionally, the act will determinately impact rural America, which particularly relies on mail-in and online methods for voter registration. Rural Americans already face long travel distances and fewer government service offices. A Center for American Progress analysis found that in some cases rural Americans would need to drive hours to an election office in order to meet the requirements of the act. The maps below highlight two examples. In two rural counties, Catron County, New Mexico, and Harney County, Oregon, residents must travel four hours or more round trip to reach their local election office. In states like Alaska, the burden will be even more pronounced. Alaska’s Senator Lisa Murkowski is one of the only Republicans to oppose the bill, arguing that it will disenfranchise thousands of Alaskans and their ability to vote as a large majority of Alaskan voter registration is done online. 

Credit: Center for American Progress, 2025

Furthermore, while the act imposes no direct fee to vote it requires Americans to provide documentation that can only be obtained by paying a fee. Obtaining documentation that requires payment will discourage low-income rural residents from even participating. Under this act, rural voters will face longer travel time, higher costs, and fewer alternatives. These barriers will not just inconvenience voters but will prevent participation in the voting process.

Friday, March 27, 2026

Recent reports identify rural public health interventions, some with potential to mitigate Medicaid cuts


U.S. Department of Public Health Building.
Image courtesy of Boston Public Library

Healthcare in rural America finds itself a topic of much discussion lately, with mainstream media coverage of the crisis unfolding after Medicaid cuts by the Trump administration's 2025 budget reconciliation bill, which was signed into law July 2025. By some estimates, the new law will increase the number of uninsured people by 10 million in 2034. Other coverage concerns the fate of a $50 billion rural health slush fund that is yet to pay out in the communities who need it most and the recent slew of hospital closures in rural communities.

While the new restrictions on Medicaid eligibility and reduced federal spending will be felt across the nation, rural communities will be hit especially hard, due to the higher rates of people on Medicaid in nonmetropolitan areas. Sarah Jane Tribble, reporting for KFF Health News, writes: 
People who live in the nation’s rural expanses have more chronic diseases, die younger, and make less money. Those compounding factors have financially pummeled rural health infrastructure, triggering hospital closures and widespread discontinuation of critical health services.
Hospital closures (online tool showing a map of recent closures) exacerbate the present struggle to meet rural healthcare needs, where people are generally more vulnerable and less likely to utilize primary care services due to structural barriers like cost and provider shortages. In 2016, Dr. Julia T. Caldwell et al. published a paper in the American Journal of Public Health, which states that "[r]ural adults are less likely to be insured, less likely to use healthcare, and more likely to delay seeking care than urban residents." To put it plainly, access to acute care is bleak in much of rural America right now, and reductions in Medicaid spending and eligibility are poised to make things worse. 

Rural hospital closures, 2005-2010 (in blue) and 2010-present (in yellow).
Graphic courtesy of Sheps Center for Health Services Research, UNC
There is, however, another dimension of the rural health conversation that is gaining traction in public discourse – rural public health. Where the trends in healthcare are alarming, improvement in public health feels tractable. This post focuses on insights from two recent reports – this one from the Aspen Institute (Feb. 2026) and this one from California's Department of Public Health (Feb. 2026) – to highlight opportunities for high-impact rural public health intervention amid the ongoing healthcare crisis. 

Public Health: Rurality in Focus

In general, the healthcare industry aims to treat people who are sick or injured, whereas public health seeks to keep people from getting sick or injured in the first place. According to the American Public Health Association, healthcare focuses on individualized care; public health focuses on entire populations. Because a key responsibility of public health is to collect, analyze, and interpret health data to inform timely public health interventions, policies, and resource planning, it is more likely to analyze and include the axes of identity and experience that inform vulnerability. In fact, rurality has been an axis of analysis in public health research for decades. "Place," meaning where people live, work, and play, is widely understood by experts in the field as a fundamental social determinant of health.

In February 2026, the Aspen Institute and the California Department of Public Health each published reports that examine, in significant detail, the state of rural public health. The Aspen Institute Report is titled "Meeting the Health Needs of Rural America," and represents the tenth installment in the Aspen Health Strategy Group's mission to tackle a single health issue annually through year-long, in-depth study. The California Department of Public Health Report, the State's second-ever "California State of Public Health Report," ("Cal. DPH Report") carves out tens of pages devoted to risks, trends, and interventions specific to rural children, adolescents, and adults.

All-Cause Mortality Rate by Race and Ethnicity in Urban/Rural
Areas, California 2022-2024 (Cal. DPH Rep., p. 32)

This post focuses on one paper from the Aspen Institute Report titled Population Health in Rural America: Changes, Challenges, and Opportunities, authored by rural demographer Shannon M. Monnat and sociologist Tim Slack. Their paper tees up several useful policy proposals, which provide a path to remedying the so-called "rural mortality penalty" – the name for a widening disparity where rural U.S. residents experience higher age-adjusted mortality rates than urban counterparts. The authors suggest that the relative recency of the rural mortality penalty, which emerged in the data only four decades ago, "provides reason to believe it can be reversed." (Aspen Inst. Rep., p. 5). 

Systemic Risks and Opportunities 

Each report does a thorough inventory of factors driving mortality rates across the lifespan, from infants to working-age adults to the elderly. Unsurprisingly, barriers like lack of access to healthcare, transportation, healthy food, broadband internet, and other social services are central to their findings. But each goes a step further to do some accounting of recent social and economic trends driving the numbers: substance abuse and misuse; growing gaps in educational attainment; and persistent economic disinvestment that has hollowed out local institutions and workforce pipelines. Environmental risks (including climate change) and exposures also explain recent losses in resilience and increases in mortality rates. These overlapping stressors compound, reinforcing cycles of poor health outcomes that are difficult to interrupt through healthcare access alone. 

Adult Mortality Rates in Nonmetropolitan (Rural) Counties,
2000-2022 (Aspen Inst. Rep.)
Writing for the Aspen Institute, Monnat & Slack characterize "rural economic and human health" as "intertwined." The data in both studies bears this out. Lower income, wealth, and levels of educational attainment correlate strongly with shorter lifespans and fewer years lived in good health. Importantly, both reports frame these outcomes not as inevitable features of rural life, but as the product of policy choices and disinvestment patterns that can be changed. The California report, in particular, emphasizes that upstream interventions–those that target education, early childhood development, and economic stability–offer some of the highest returns for improving long-term health outcomes (Cal. DPH Report). 

The reports identify education policy reform as a major inroad for uplifting rural communities struggling with economic disinvestment and population decline. 
Education, particularly possessing a bachelor’s degree, has become an increasingly important determinant of health and longevity in the United States. Higher education confers economic, social, and lifestyle advantages that manifest as a “personal firewall” that protects health, even in the face of external and unpredictable threats, such as pandemics, recessions, and natural disasters.
(Aspen Inst. Rep., p. 76). Investments in vocational programs, community colleges, and early childhood education programs like Head Start not only improve education and employment outcomes, they also provide measurable health benefits over time. Many health outcomes and disparities in adulthood are rooted in childhood conditions such as family and community health, neighborhood safety, policies, and systems" (Cal. DPH Report, p. 58). By strengthening local economies and expanding opportunities, these interventions address root causes of poor health, rather than treating symptoms as they occur. In this way, rural public health policy begins to function as a cross-sector strategy for community resilience. 

Conclusion 

The current crisis in rural healthcare access underscores the need for action, but it also highlights the limits of a healthcare-only response. As the reports analyzed in this post make clear, improving rural public health outcomes requires sustained investment in the social and economic conditions that shape health, long before a person ever becomes a patient. Public health offers a framework for identifying upstream opportunities and making interventions where they can have the greatest impact. In the face of hospital closures and shrinking coverage, this broader approach might provide a path forward: one that treats rural health not only as a medical issue but as a function of place, policy, and long-term community investment.

Tuesday, March 17, 2026

The burden of the "American Dream" on rural communities

Photo Credit - Chelsea Peng 2025 "The end of the American Dream and why it’s OK"

On March 14, the House Committee on Small Business held a hearing called “Empowering Rural America Through Investment in Innovation.” Subcommittee Chairman Jake Ellzey, a Republican representing Texas's 6th Congressional District (a mix of Dallas-Fort Worth suburbs and rural counties like Navarro and Cherokee), told the room that “as the demand for AI accelerates, America’s digital infrastructure is rapidly expanding into rural communities.” He promised that for every data center job created, seven more would follow in the surrounding community.

I have spent this semester writing about technology arriving in rural America. The promise is always the same: innovation, jobs, progress. The pattern is also the same: the benefits flow out, and the costs remain.

Three posts, one pattern

In my first post, I wrote about a $25 billion AI data center planned for Tonopah, Arizona, population a few hundred. Backed by a billionaire venture capitalist and a Trump mega-donor, the project would consume as much electricity as a million homes and drain aquifers that residents depend on for drinking water. The tech consumers served by the facility live in cities. The residents of Tonopah got noise, light pollution, and a fight they lacked the political power to win.

In my second post, I stepped back from tech to look at the framing. I had caught myself thinking that rural investment came at urban expense. That zero-sum instinct turned out to be the wrong lens. The federal government spends $850 billion a year on defense and asked $1.8 billion for the Legal Services Corporation. The scarcity pitting rural against urban is a policy choice, not a fact of nature. Rural and urban working people have lost ground to the same forces and share the same interest in functional public services.

In my third post, I wrote about robotic strawberry harvesters arriving in Salinas Valley. Immigration enforcement had squeezed the farm labor supply. The federal government’s response was to lower guest worker wages, and then automation filled the gap. The robots cost $300,000 each, priced for corporate farms. Small growers and the farmworker communities who built Salinas for generations got nothing.

Each story has different characters and geography. But the structure is identical: federal policy creates or worsens a rural problem, and capital arrives promising solutions. The benefits accrue to investors/urban consumers and the people who already live there absorb the costs.

Photo Credit - Will Robinson 2020 "Is the American dream dead?"
The packaging

This pattern persists because it is wrapped in a story that Americans have been told their whole lives: that progress rewards hard work, that innovation lifts all boats, that the people who struggle simply need to adapt. This is the "American Dream," and I have come to believe it is one of the deepest sources of political paralysis in this country.

I said something like this in class a few weeks ago. I told Professor Pruitt and my fellow students that the American Dream is this country’s “original sin.” She pushed back, fairly, and pointed out that there are things about this country that are more original and more sinful. She’s right. Slavery, land theft, and genocide are the material foundations. But the American Dream is the legitimating story that makes those foundations look earned. It converts structural advantage into personal merit and structural disadvantage into personal failure.

I know this because I lived it. I grew up male, Mormon, white, healthy, and financially comfortable. My family believed fiercely in individual agency. I followed the rules and concluded that people whose lives were less "successful" than mine were in that position because of their own bad choices. It took college and a lot of unlearning to see that my “good choices” were only available because the structure was built for me.

The same logic operates at the community level. When a rural hospital closes after Medicaid cuts, residents blame the hospital, not the lawmakers who voted for the bill. When a farmer in Colorado threatens to mechanize rather than pay overtime, the framing is that labor protections killed the farm, not that the farm’s business model depended on paying workers less than the legal standard in every other industry. The American Dream teaches people to punch down and look away from the hand above them.

What would it look like to say no?

There are signs of resistance. At least 25 data center projects were cancelled across the United States in 2025 after community opposition, four times the number in 2024. Rural school voucher programs have been blocked by rural Republicans who understand that their public schools are the backbone of their communities. Bernie Sanders and Alexandria Ocasio-Cortez drew 10,000 people to Greeley, Colorado, a conservative town in Weld County, on a message of class solidarity across the rural-urban divide.

None of these are sufficient. But they share a feature that the American Dream framework lacks: they start from the premise that rural communities have the right to decide what happens to their land, their labor, and their resources. That premise is incompatible with a system that treats rural space as a site of extraction and rural people as obstacles to progress.

Congressman Ellzey’s hearing (referenced at the beginning of this post) promised rural America seven jobs for every data center. Nobody on the panel asked how many jobs, aquifers, and night skies those same communities would lose. Until that question gets equal time, the American Dream will keep doing what it has always done: blaming the most vulnerable among us for their poverty and lack of resources, while lionizing the most powerful people in this country as they get increasingly wealthy

Sunday, March 1, 2026

Rural news, late notice: the mail lag that quietly taxes rural life

American Samoa Post Office (2021) - Pago Pago, AS; Credit: Talanei News 

Without a post office in one’s community, one must resort to traveling farther and farther away in order to have access to this necessary element.
That quote was from a 2011 blog post about post offices as community lifelines. It, along with many other posts on threatened post office closures in 2011 and 2012, highlights a rural baseline: when infrastructure is limited, distance becomes a cost paid in time, fuel, and coordination. In 2026, however, the issue seems less about whether a post office exists and more about the timeliness of mail delivery. The issue of slow mail delivery in rural America is partly caused by public policy.

In 2025, the Postal Regulatory Commission (“Commission”) outlined nationwide changes by the United States Postal Service (“U.S.P.S.”) under its “Delivering for America” plan. The plan was introduced shortly after the Trump Administration called for privatizing the U.S.P.S. While it claims the plan is essential for financial stability, critics argue that the Delivering for America plan more resembles a "march to privatize the U.S. mail." Particularly relevant to rural America under this plan is a concept called Regional Transportation Optimization (“RTO”). The Commission explained:

Under RTO, mail dropped off at Post Offices and collection boxes more than 50 miles from a regional hub is collected the next day instead of the same day.

The Commission warned that rural communities would face disproportionate negative impacts. That is, some mail originating in rural areas enters the U.S.P.S. system later than mail from locations closer to processing centers. Hence, rural areas are more likely to experience the additional day and any subsequent delays. Reports from journalists like Sophie Culpepper help illustrate what that extra day looks like in practice for rural communities.

In her 2026 Neiman Lab Report, Culpepper described community newspapers facing mail delays that arrive late, go missing, or show up in batches. She interviewed publishers in Maine, Michigan, South Dakota, and Virginia, all of whom reported a significant increase in complaints about U.S.P.S. delays last summer. 

In Maine, the Midcoast Villager – which serves Knox and Waldo counties – is the primary or only local news source for roughly 80,000 residents. Publishers told Culpepper that they have little visibility into, or control over, U.S.P.S.’s delivery timelines:

When we’re fighting against something that we really have no control over, that’s terribly frustrating…because I can’t afford to lose a subscriber, let alone many.

Rural Post Office (2024) - Salvo, NC
Credit: Wikimedia Commons Contributors

For a weekly newspaper, punctuality is essential. Culpepper directly linked mail delays to rural livelihoods because local advertising relies on timely delivery. From community announcements like auctions and open houses to business inquiries like invitations to local project bids, if the newspaper is late, rural residents not only miss the news; they lose the opportunity to act while it still matters. 

Newspaper delivery is just one issue where mail speed influences rural life. A similar issue arises in the business context. In a 2026 interview with the Federal News Network, Elena Patel described the U.S.P.S. more as a rural economic platform than as a news pipeline. 

Patel, a Brookings senior fellow and co-director of the Urban-Brookings Tax Policy Center, argued that judging the U.S.P.S. mainly by profitability misses the role the postal service plays in rural economies. Patel pointed out that private carriers can impose geography-based surcharges of up to $20 per package, costs that can wipe out small margins for rural businesses trying to reach distant customers. 

Patel also highlighted the practical functions of post offices in rural areas: shipping goods for e-commerce, maintaining a reliable business address (including P.O. boxes), and accessing counter services such as certified mail. She concluded:

We need to rethink the Postal Service as a public good and fund it appropriately so that it can support rural economies.

Taken together, these stories reveal why the mail delivery system is a rural livelihood issue. Rural areas suffer twice when mail slows down: once in time and once in opportunity. Time is spent on extra trips to town, more phone calls, and contingency plans just to complete basic tasks. Opportunities are missed: auctions and bids close, notices arrive too late, payments are delayed, and small businesses lose customers as shipping slows or becomes more expensive.

This is the quiet tax of a lagging mailbox: not a sudden shutdown, but a consistent decline in timely mail delivery in rural communities. When a national service like the U.S.P.S. is treated as a profit-and-loss problem, delay becomes an acceptable efficiency trade-off.

Tuesday, February 24, 2026

The robots are coming to the Salad Bowl

Pro-immigrant demonstrators in Omaha, Nebraska. Photo Credit: NBC News

In June 2025, President Trump paused immigration raids on agricultural workplaces after Agriculture Secretary Brooke Rollins warned that farmers were growing uneasy about the crackdown. As this blog noted at the time, the pause was short-lived. By October, the Labor Department’s own filing in the Federal Register admitted the crackdown risked “supply shock-induced food shortages.”

Then the federal government made matters worse by lowering wages. A new H-2A  rule (the program sets a federal minimum pay rate for employers hiring foreign agricultural workers) cut the pay rate for guest farmworkers across the country. In California, the rate for unskilled workers dropped from $19.97 to $13.45 per hour, and the United Farm Workers sued. The Economic Policy Institute estimated that farmworkers stand to lose $4.4 to $5.4 billion annually.

This is the context in which agricultural automation is arriving in rural California. The question is who does it serve and who does it displace?

The Salad Bowl goes synthetic

Salinas Valley, California (the “Salad Bowl of the World”) produces the majority of the nation’s lettuce, broccoli, and strawberries. Located in Monterey County, Salinas Valley is over 60% Hispanic or Latino, and the local economy depends on agricultural labor.

In 2025, a nonprofit called the Reservoir opened Reservoir Farms, the first on-farm robotics incubator in California, on 40 acres in Salinas. Backed by companies like John Deere and Driscoll’s (the berry company), the incubator provides startups with fabrication shops, pre-planted test fields, and access to commercial growers. It has since expanded to Sonoma County for vineyard automation.

A “vineyard robot” at work. Photo credit: Cornell Agritech

The startups coming to Salinas Valley build machines designed to do what farm workers currently do by hand. Israeli startup DailyRobotics is deploying robotic strawberry harvesters in California starting April 2026, claiming it works at two to three times the speed of human pickers.

One analysis estimated that strawberry automation alone could eliminate nearly 30,000 farmworker positions in California. The machines, which cost around $300,000 each, are priced for large-scale operations and out of reach for small family growers.

Fast advances in robotics means automated strawberry picking. Photo Credit: DailyRobotics

A manufactured crisis

The labor shortage driving this transition is real, but it is not natural. Over 40% of U.S. farmworkers are undocumented, according to the USDA and the Kaiser Family Foundation. The Trump administration’s immigration enforcement has removed workers from the labor pool while cutting wages for the legal guest workers who remain. In Minnesota, for example, H-2A visa numbers dropped 12% in the first half of 2025.

A prior post on this blog documented this pattern through the 2008 Postville, Iowa raid: 389 arrests in a town of 2,500, the departure of another 1,000 immigrants, the loss of 7% of the county’s workforce, and the bankruptcy of the local factory. The void was eventually filled by a new immigrant workforce from Palau.

The pattern holds internationally. Another post on this blog examined Italy’s “Agro-Mafia,” where restrictive immigration policy has not reduced agricultural dependence on migrant labor but has driven it underground into exploitative networks where workers earn as little as 3 to 4 euros an hour. Punitive enforcement produces either exploitation or automation, depending on who has capital.

Who benefits?

Reservoir Farms says the right things about workforce transition. Its CEO has stated that “automation should augment the workforce, not replace it,” and the Reservoir has partnered with Hartnell College on retraining programs. But as one community organizer in Salinas noted: “We support training, but we also know not every displaced worker will become a robot mechanic.”

Farmworkers harvest strawberries at Lewis Taylor Farms in Georgia. Photo Credit: Lance Cheung

The farmworker communities that have sustained Salinas Valley for generations face a displacement that is social and cultural. Lisa R. Pruitt and Marta R. Vanegas have written about “urbanormativity,” which is the tendency for legal and policy frameworks to render rural populations invisible. Farmworkers in Salinas are doubly invisible: rural and immigrant, performing labor the nation depends on but does not want to see.

This echoes what I wrote about in a previous post on AI data centers in rural Arizona. In both cases, Silicon Valley capital arrives in rural spaces to solve what might be seen as urban problems. Data centers serve urban tech consumers, and harvesting robots serve urban grocery consumers. The costs (labor displacement and strained local resources) fall on the rural communities that host the infrastructure.

The choice ahead

Agricultural automation is probably inevitable. Some of these technologies could genuinely improve conditions for farmworkers. But the federal government that paused immigration raids in June, reversed course days later, cut guest worker wages in October, and admitted to “supply shock-induced food shortages” in a Federal Register filing has offered farmworker communities in places like Salinas no reason to believe help is on the way.

The robots are coming to the Salad Bowl. The question is whether anyone in Washington has thought about what happens to the people already there.

Monday, December 29, 2025

Rural health "slush fund" distributions announced

Fall River Mills, California
(c) Lisa R. Pruitt 2018
The Centers for Medicare and Medicaid Services announced this week the establishment of the Rural Health Transformation Program in relation to Trump's "One Big Beautiful Bill" passed in July--and the so called "rural slush fund" that was a last-minute addition to that law.  An earlier post about that late addition to the law is here, also noting that it was added in part to secure the vote of U.S. Senator Lisa Muskowski's (Alaska) support for the law.  

The Rural Health Transformation Program website touts it as 
empower[ing] states to strengthen rural communities across America by improving healthcare access, quality, and outcomes by transforming the healthcare delivery ecosystem. Through innovative system-wide change, the RHT Program invests in the rural healthcare delivery ecosystem for future generations.

Its stated goals are: 

  • make rural America healthy again
  • sustainable access
  • workforce development
  • innovative care
  • tech innovation
At the end of this post, I cut and pasted from this website more information about the structure and requirements.  For now, however, I want to focus on details of the distribution.  First, all states got a share of the distribution,  and the states that fared best were Texas, Alaska, California, Oklahoma and Montana.  That said, the award amounts to the states did not vary dramatically.  The average amount awarded to each state was $200 million, with the range from $147 million (New Jersey) to $281 million (Texas).  Here's an excerpt from the CMS announcement of the awards, which went to all 50 states.  
This unprecedented federal investment will help states expand access to care in rural communities, strengthen the rural health workforce, modernize rural facilities and technology, and support innovative models that bring high-quality, dependable care closer to home.

It includes this long quote from Health and Human Services Secretary Robert F. Kennedy, Jr.:  

More than 60 million Americans living in rural areas have the right to equal access to quality care.  This historic investment puts local hospitals, clinics, and health workers in control of their communities’ healthcare. Thanks to President Trump’s leadership, rural Americans will now have affordable healthcare close to home, free from bureaucratic obstacles.

It also features this direct quote from Dr. Mehmet Oz, the CMS administrator:  

Today marks an extraordinary milestone for rural health in America. Thanks to Congress establishing this investment and President Trump for his leadership, states are stepping forward with bold, creative plans to expand rural access, strengthen their workforces, modernize care, and support the communities that keep our nation running. CMS is proud to partner with every state to turn their ideas into lasting improvements for rural families.

Roll call covered the matter, with a focus on Texas.  Some key excerpts follow: 

Twenty percent of [a state's] score [on the application for the competitive part] was determined by a state’s policy actions, including vows to pursue waivers to ban SNAP users from buying certain items like soda and candy, reinstating the presidential fitness test for schoolchildren and requiring that medical schools teach students about nutrition, among other things. States could lose money in future years through a “rescoring” process if they don’t follow through on those initiatives, Oz said.

The remaining 30 percent is based on the strength of the ideas that states proposed in their applications.

Projects highlighted by CMS on Monday include ones that aim to expand access to preventative, primary, maternal and behavioral health care. States also are pursuing “food as medicine” initiatives, models to address chronic disease prevention and programs to shore up their health care workforce.

Critics had argued the amount of funding available is nowhere near large enough to offset reductions in federal Medicaid spending made by the reconciliation law, which amounts to $911 billion over 10 years. Sen. Susan Collins, R-Maine, who voted against the bill, had pushed for at least $100 billion in rural health funding.

The $50 billion would offset only about 37 percent of the estimated loss of federal Medicaid funding in rural areas, according to KFF, a health policy research organization.

But Dr. Mehmet Ozi is quoted as saying the funding is not intended to offset the reductions:  

The purpose of this $50 billion investment in rural health care is not to pay off bills.  The purpose of this $50 billion investment is to allow us to right-size the system and to deal with the fundamental hindrances of improvement in rural health care.

This excerpt from PBS Newshour coverage hits more squarely at the politics of the matter and what the Trump administration's CMS is trying to accomplish with these awards in relation to its wider "Make America Healthy Again" agenda: 

Several Republican-led states — including Arkansas, Iowa, Louisiana, Nebraska, Oklahoma and Texas — have already adopted rules banning the purchase of foods like candy and soda with SNAP benefits.

The money that the states get will be recalculated annually, Oz said, allowing the administration to "claw back" funds if, for example, state leaders don't pass promised policies. Oz said the clawbacks are not punishments, but leverage governors can use to push policies by pointing to the potential loss of millions.

"I've already heard governors express that sentiment that this is not a threat, that this is actually an empowering element of the One Big Beautiful Bill," he said.

Carrie Cochran-McClain, chief policy officer with the National Rural Health Association, said she's heard from a number of Democratic-led states that refused to include such restrictions on SNAP benefits even though it could hurt their chance to get more money from the fund.

"It's not where their state leadership is," she said.
Next, I quote from the analysis of a rural health care consultant working out of Texas, which came across my LinkedIn feed: 
Just reviewed the state allocations from CMS’s landmark $50B Rural Health Transformation Program, and the per‑rural‑person math is fascinating. I'm a CPA and I love excel...so you know I had to create my end of year fun facts related to the CMS awards for RHTP.

If you missed the announcement, here is a link to the full article

For context, the average award across all states is $1,957 per rural person.
Texas received $329 per rural person — a solid, meaningful investment in our rural communities. 

N.B.   It is not clear how this consultant is defining "rural" for purposes of these calculations.  

To put that in perspective:
Rhode Island: $31,525 per rural person
Just above Texas: Ohio ($345), NC ($360), PA ($390), MI ($413)
Next tier below RI: NJ ($5,343), AK ($4,949), MA ($3,332), DE ($3,231)

Texas’s total award is $1.4 billion over five years — the largest in the country. While we weren’t guaranteed the top spot, the hard work by the Texas team at HHSC on the application positioned us to lead in rural innovation.

I was personally hoping for closer to $2.1B, but we’ll take this $1.4B and put it to work transforming the rural health landscape across Texas. Huge congratulations to the HHSC team and all our partners who made this possible.

Here’s to an innovative, data‑driven 2026 and beyond for rural Texas! 🌟
Finally, I'm pasting here the details on the program (as promised above), which is essentially the call for applications: 

Program Structure

RHT Program funding is $50 billion to be allocated to approved States over five fiscal years, with $10 billion of funding available each fiscal year, beginning in fiscal year 2026 and ending in fiscal year 2030.
  • 50% to be distributed equally amongst all approved States
  • 50% will be allocated by CMS based on a variety of factors including rural population, the proportion of rural health facilities in the State, the situation of certain hospitals in the State, and other factors to be specified by CMS in the NOFO
Uses of Funds

States must use RHT Program funds for three or more of the approved uses of funds:Promoting evidence-based, measurable interventions to improve prevention and chronic disease management.
  • Providing payments to health care providers for the provision of health care items or services, as specified by the Administrator.
  • Promoting consumer-facing, technology-driven solutions for the prevention and management of chronic diseases.
  • Providing training and technical assistance for the development and adoption of technology-enabled solutions that improve care delivery in rural hospitals, including remote monitoring, robotics, artificial intelligence, and other advanced technologies.
  • Recruiting and retaining clinical workforce talent to rural areas, with commitments to serve rural communities for a minimum of 5 years.
  • Providing technical assistance, software, and hardware for significant information technology advances designed to improve efficiency, enhance cybersecurity capability development, and improve patient health outcomes.
  • Assisting rural communities to right size their health care delivery systems by identifying needed preventative, ambulatory, pre-hospital, emergency, acute inpatient care, outpatient care, and post-acute care service lines.
  • Supporting access to opioid use disorder treatment services (as defined in section 1861(jjj)(1)), other substance use disorder treatment services, and mental health services.
  • Developing projects that support innovative models of care that include value-based care arrangements and alternative payment models, as appropriate.
  • Additional uses designed to promote sustainable access to high quality rural health care services, as determined by the Administrator.
This KFF Health News site tracked the states' applications for these funds.  

Monday, December 8, 2025

Chronicle of Higher Education features LSU-Alexandria as an institution successfully serving rural students

Dan Berrett reports on Louisiana State University-Alexandria's success in surviving the rural area amidst which it sits.  The headline is Rural America, Growth Area? and the sub-head is "There’s a growing population of high-school seniors waiting to be reached — if colleges can figure out how to better serve them."  Here are some key excerpts:  
On the surface, Louisiana State University at Alexandria might seem like an institution in trouble. It’s a public regional campus in a rural swath of the state, located in a city of under 50,000 that hugs the Red River and is “surrounded by forest and farmland,” says Adam Lord, a spokesperson for the university. Central Louisiana, according to Lord, is “defined by work-force shortages, growing health-care deserts, and limited access to degree programs.” Less than one-third of the city’s adults have at least an associate degree, below both the state and national average.
But the institution saw its enrollment more than double between 2013 and 2023, largely by focusing on the regional and state population. The heavily rural, 11-parish area in which the campus sits accounts for 94 percent of its student body, and the state’s residents make up 70 percent of its online learners. LSU-Alexandria has grown largely by expanding its online enrollment and touting its low cost and high value. The undergraduate-only institution has developed pipelines to the state’s graduate professional programs. It’s created programs for the rural work force — including aviation, disaster preparedness, and cybersecurity — and programs that feed into local companies, like RoyOMartin, a plywood manufacturer, and utilities and hospitals.

Where its graduates once left for Texas, the institution is now trying to keep them at home.
* * * 
The notion that rural areas are growing runs counter to a decades-long narrative of decline.
* * *
The largest increase in undergraduate enrollment — more than 9 percent — over the past two years has been among institutions in rural areas, according to the National Student Clearinghouse Research Center.

“There is a slight gain in the number of rural students. That’s the news,” says Patrick Lane, vice president for policy analysis and research at WICHE.

* * * 

Several scholars of rural higher education who spoke with The Chronicle come from such areas themselves, and they consistently recall feeling alienated when they arrived on campus — not unlike what first-generation students and students of color describe, says Tony Pipa, a senior fellow in the Center for Sustainable Development at the Brookings Institution, who has written about rural America and produces a podcast on the subject. “They feel like a fish out of water,” he says of rural students. “Rural is an identity.”

That sense of identity can leave a lasting impact, says Andrew Koricich, a professor of higher education and student affairs at Appalachian State University.
* * *
When rural scholars meet each other, they might find common ground discussing how many 
stoplights or how few people were in the communities in which they grew up, Koricich says. The sense of identity expresses itself in deeper ways, too. “I think there’s a piece of it that is very much around self-sufficiency,” he says. “You meet other rural scholars and we have similar stories about how we had to figure out everything ourselves.”
I really appreciate the attention here to rurality as identity, which is consistent with a recent finding by political scientists regarding rural voters.  

Friday, November 28, 2025

Rural public media struggling in the face of funding cuts

We became aware this summer, when the Trump administration announced cuts to public broadcasting and the abolition of the Corporation for Public Broadcasting, that rural areas would be hit especially hard.  This is because rural stations are more reliant on federal funding.  Rural areas also tend to have fewer media outlets, which means that those supported by public dollars are less easily replaced by the private sector--including in the reporting on weather and natural disasters.    

This week, Reveal reported on the closure of a public radio station, KYUK, in the Bethel/Kuskokwim Delta region of Alaska.  Here's an excerpt: 

When a typhoon hit Alaska, public radio station KYUK was on the air, broadcasting critical information about conditions, evacuations, and search and rescue operations. An estimated 1,600 people were displaced, and many were saved in the biggest airlift operation in state history.

“The work that we do in terms of public safety communication literally does save lives,” said Sage Smiley, KYUK’s news director.

KYUK is small, scrappy, and bilingual. It broadcasts in English and Yugtun, the language of an Indigenous population that lives in villages along two massive rivers. The station airs NPR content, but also high school basketball games, local call-in talk shows, and even a show hosted by the volunteer search and rescue team, answering listeners’ questions about ice conditions and safety. The station is a lifeline for this unique region.

KYUK covers an area the size of the state of Oregon, but after Congress passed the Rescissions Act over the summer, it lost 70 percent of its operating budget. Republicans have targeted public media since its inception in the late 1960s. But this is the first time they have successfully ended the Corporation for Public Broadcasting, wiping out more than $1 billion in funding for public media.
For more on that typhoon in mid-October, see NPR's coverage here

Thursday, November 6, 2025

NYT's Thomas Edsall on the current food stamp controversy, including rural and racial differences

Thomas Edsall's column in the New York Times this week is under the provocative headline, "It Would be Trump's Honor to Pay for Food Stamps."  Here's the part of Edsall's column that mentions rural Americans:  

In “Rural Versus Urban: The Growing Divide That Threatens Democracy,” the coauthors Suzanne Mettler and Trevor Brown point out that while urban and rural counties relied on government transfer programs at similar rates in the 1970s and 1980s,
They diverged from the 1990s onward as rural places faced economic tumult and residents came to rely more on government benefits. By 2019, the eve of the pandemic, rural people benefited from social transfers by $1,749 more per person per year than their urban peers.
In 1970, Mettler and Brown calculated, rural and urban households received social benefits of $2,220 and $2,244, respectively, a 1.1 percent difference. By 2019, the average annual government benefit for rural residents rose to $10,558 and for urban residents to $8,809, a 20 percent difference. 
Mettler and Brown cite research by Jennifer Sherman, a sociologist at Washington State University, to describe the agonized struggle of the rural poor who, when faced with a major economic setback, are forced to turn to government for help:
When they themselves need to use such benefit, they experience a deep sense of stigma and shame. They drove to stores far away to use SNAP benefits, hoping to avoid the gaze of their neighbors and community members.
Given the way people have traditionally talked about these programs, one of the most striking things about government data on SNAP use is just how high the white share of food stamp recipients actually is.

In West Virginia, 97.7 percent of SNAP recipients whose racial and ethnic identity was recorded are white; Indiana, 66 percent; Iowa 75.5 percent; Kentucky, 83.4 percent; Missouri, 67.1 percent; Montana, 76.6 percent; North Dakota, 66.9 percent; Ohio, 64.9; Oklahoma, 60.9 percent; Utah, 86.6 percent; and Wyoming, 78.8 percent.

On this issue of "white share of food stamp recipients" I am pleased to see Edsall note that.  It's an issue I've often foregrounded, along with the fact that middle class folks who are resentful of those who receive public benefits are as resentful as the whites who do so as they are of the people of color who do so. The resentment is not driven by racism, certainly not solely so.  The intra-racial tension is as significant as the inter-racial tension.  Read more here and here.

Tuesday, November 4, 2025

Legal Services Corporation releases long-awaited report at Rural Reach event

Panel of paraprofessionals who provide assistance to legal aid clients
"Rural Reach" event, Oct. 29, 2025, Madison, Wisconsin 

Here are the broad outlines of this important report, "Justice Where We Live:  Promising Practices from Rural Communities, quoting from the press release

For millions of Americans living in rural communities, access to civil legal help is out of reach, according to a report released today by the Legal Services Corporation (LSC). The report, “Justice Where We Live: Promising Practices from Rural Communities,” is a first-of-its-kind exploration of the barriers rural Americans face in accessing legal help – and the community-driven solutions already making a difference.

Across the country, 41% of counties are considered “legal deserts,” with few or no lawyers available to serve residents (source: Legal Evolution). In rural-heavy states like Wisconsin, which ranks among the bottom three nationwide for lawyers per capita, families and individuals often face life-altering legal problems — from housing insecurity to domestic violence — without meaningful access to assistance.

To address this urgent need, LSC convened its Rural Justice Task Force in 2021. Funded in part by Ascendium Education Group, today’s report release marks the Task Force’s work by highlighting four key challenges.
  • The shortage of attorneys in rural areas.
  • The digital divide limiting access to online resources.
  • Geographic and transportation barriers.
  • Cultural differences that can hinder trust in the legal system.
Alongside these challenges, the report highlights innovative solutions already underway in rural communities and offers recommendations for lawmakers, courts, legal aid providers, law schools, and others. Promising practices — from technology-enabled legal services to new recruitment pipelines for rural lawyers to expanding opportunities for professionals beyond lawyers to help those facing legal issues — show that progress is possible and replicable.

“If we want to know how to deal with the challenges that face rural Americans, the best thing we can do is talk to rural Americans and the people deeply rooted in those communities,” said Fr. Pius Pietrzyk, LSC Board Vice Chair and co-chair of the Task Force. “In this new report, we've taken a deep look at the reasons families cannot seem to get the civil justice they deserve, and our Constitution promises them, and offers concrete solutions not just for legal services offices, but for all Americans.”

“Access to justice should never depend on where someone lives, but for too many in rural Wisconsin and across the country, that’s the reality,” said Rebecca Rapp, General Counsel and Chief Privacy Officer of Ascendium, who serves as co-chair of the LSC Task Force alongside Pietrzyk. “This report shines a critical light on the barriers rural residents face and points to solutions they have developed to close the justice gap in rural areas and beyond.”
The gallery walk at the "Rural Reach"
event featured innovative approaches
to serving rural residents where they
are.  Oct. 29, 2025

For rural residents, the stakes are high. LSC’s research shows that more than three-quarters of rural households face at least one civil legal problem each year, yet 86% receive inadequate help. Without legal assistance, families risk losing homes, veterans struggle to access earned benefits, and seniors face crushing debt with nowhere to turn.

The report emphasizes that while the challenges are steep, progress is possible.

“We know what works to close the rural justice gap,” said Ron Flagg, President of Legal Services Corporation. “We need to invest in programs that bring legal help to where people live — from growing the pipeline of rural attorneys, to supporting licensed legal paraprofessionals and community advocates, to using technology that connects clients to help across long distances.”

These ‘fixes’ only work, though, “with sustained commitment at the local, state, and federal levels,” Flagg added. “Together, we can ensure that geography never determines whether someone can access justice.”

 A big focus of the event--not highlighted here--was a push toward the use of para professionals--sometimes called "justice workers"--to help meet legal needs in rural places.   The final panel of the day featured four such paralegals or justice workers from Montana, New Hampshire, Wisconsin and Georgia.  Interestingly, a program to empower paraprofessionals in Washington State--there called LLLT (limited license legal technicians)--was shuttered a few years ago.  Now such programs--at least among a few dozen states--are being seen as the future of filling the justice gap.  Two prior posts on the rural justice gap and how paraprofessionals might fill them are here and here.  

Panel of judges and the American Bar Association President 
speaking in support of licensing of paraprofessionals, sometimes
called justice workers. 

Monday, September 8, 2025

Literary Ruralism (Part LI): Attention to "rural" in Dan Wang's Breakneck, on China's rise

Breakneck:  China's Quest to Engineer the Future by technology analyst Dan Wang was published last month by W.W. Norton.  The promotional blurb touts the book, in part, thusly:  

Wang blends political, economic, and philosophical analysis with reportage to reveal a provocative new framework for understanding China—one that helps us see America more clearly, too. While China is an engineering state, relentlessly pursuing megaprojects, the United States has stalled. America has transformed into a lawyerly society, reflexively blocking everything, good and bad.

I came to the book after listening to Ross Douthat's interview with Wang on the "Interesting Times" podcast.  While Wang's book primarily contrasts the differing approaches to development and infrastructure of the United States and China, it often raises the matter of rural-urban difference and how those differences play out in the two countries.  I was intrigued, for example, by Douthat's comparison of Guizhou, a backwater Chinese province that Wang uses to illustrate an underdeveloped place, to West Virginia.  The transcript from the podcast features this from Wang: 

Guizhou... is a land where a local said, “Not three feet of land is flat, not three days go by without rain and not a family has three silver coins.”  China’s fourth-poorest province, I was surprised to see, had much better levels of infrastructure than one could find in much wealthier places in the United States, like New York State or California.

We saw very tall bridges all around us. We saw a guitar-making hub. We saw a lot of fancy new roads that were a cyclist’s dream. And it was only afterward when I realized how bizarre it was that China’s fourth-poorest province — about the level of G.D.P. per capita of Botswana, much less than Shanghai or Guangdong — was able to build all of these things.

It is a province with 11 airports, 50 of the highest bridges in the world and brand-new, spiffy highways — and that’s because China was just building a lot in its equivalent of a South Dakota or West Virginia.

That's a good introduction to the book excerpts that follow.  I have highlighted the word "rural" in context.  

Modern China has many tools of social control. Within living memory, most Chinese residents worked inside a danwei, or work unit, which governed one’s access to essentials like rice, meat, cooking oil, and a bicycle. Many people still live under the strictures of the hukou, or household registration, an aim of which is to prevent rural folks from establishing themselves in cities by restricting education and health care benefits to their hometown. Controls are far worse for ethnoreligious minorities: Tibetans are totally prohibited from worshipping the Dalai Lama, and perhaps over a million Uighurs have spent time in detention camps that attempt to inculcate Chinese values into their Muslim faith. 

The engineering state can be awfully literal minded. Sometimes, it feels like China’s leadership is made up entirely of hydraulic engineers, who view the economy and society as liquid flows, as if all human activity—from mass production to reproduction—can be directed, restricted, increased, or blocked with the same ease as turning a series of valves. (pp. 5-6)

* * * 

The Guizhou locals we chatted with were prouder of their bridges than anything else. My friends and I cycled across bridges that were set above plunging ravines. State media boasts that Guizhou has become a “museum of bridges,” a few of which are trying to develop into tourism sites: The tenth-highest bridge in Guizhou (which is twenty-third globally) hosts the world’s highest bungee jump. Each time the engineers build a bridge, they inevitably announce that travel times between two towns have been cut from many hours to perhaps a few minutes. That creates real convenience and connection for rural people. Some of these are bridges to nowhere, but after a few years, they become somewhere. 

(I am reminded of what a "bridge to nowhere" connotes in the United States; read some of my analysis of the political implications of the phenomenon here)

Still, beneath Guizhou’s engineering marvels are counties mired in poverty. At $8,000 per capita, the province has the income of Botswana, 40 percent below China’s national average and less than a third that of rich coastal cities like Beijing and Shanghai. One day, Christian remarked on how few working-age adults we saw in Guizhou: Those who don’t have a job making guitars have mostly migrated to other provinces, leaving small children in the care of grandparents. In 2010, only half of Guizhou’s children attended high school—the lowest rate in the country. News reports often featured stories of children having to rise at the crack of dawn and hike through harrowing mountain paths, some with rope ladders, to be able to attend school. 

In spite of the challenges of deep rural isolation, China’s fourth-poorest province—where household income is one-fifteenth that of New York State—has vastly superior infrastructure: three times the length of New York’s highways, as well as a functional high-speed rail network. And Guizhou isn’t exactly an exceptional Chinese province. Across the country, the engineering state has relentlessly built public works, making Guizhou an extreme case of China’s growth strategy rather than a deviation from it. 

Modern China has been on a building spree. It began in the 1990s, after economic reopening took hold, and then received another boost in 2008, when the central government approved vast public works to respond to the global financial crisis. (pp. 27-28)

* * * 

The Fourteenth Five-Year Plan outlines interstellar research and other state-directed megaprojects. There’s something for the ordinary consumer too, but it’s nowhere near as exciting. To promote consumption, the plan suggests measures like “expanding the coverage of e-commerce in rural areas,” “improving product recalls,” and “improving in-city duty-free shops.” Fine measures, but puny relative to orbiting Mars. The economic planners have obviously poured their hearts into the scientific projects, whereas the consumption measures look like a hasty afterthought. When Chinese officials talk about promoting consumption, it often involves building new malls or replacing old industrial equipment. In other words, it’s still more about investing to build stuff rather than shifting the propensity of households to spend a greater share of their income. 

Under Mao, China practiced a more literal form of Marxism, with full state control of the means of production. Deng Xiaoping pivoted the country away from that failed experiment. As Deng was fond of remarking, the defining feature of socialism was not economic redistribution but rather “concentrating resources to accomplish great tasks.” That flexible definition allowed for greater adaptability, generated higher growth, and sustained the regime into the twenty-first century. Under Deng’s definition, the United States has also achieved plenty of socialism. The Manhattan Project, the Interstate Highway System, and the Apollo Program all concentrated resources to accomplish great tasks. Maybe even Reagan’s Strategic Defense Initiative could have been understood as socialism. When the engineering state works, it can produce beautiful cities like Shanghai. But Shanghai is exceptional: It has been China’s richest and most westernized city for the better part of a century. The engineering state also produces a lot of problems. To see them, we should return one more time to Guizhou. 

Under the gleaming new bridges lurk not only poverty but also a massive debt burden. The underlying hope of Guizhou’s construction is that infrastructure will invite lasting economic activity. Part of that has worked out: Guizhou incomes have risen by nearly 10 percent annually from 2011 to 2022, driven partially by urbanization and by the tourism facilitated by new infrastructure.  (pp. 37-38)

* * *  

But most of Guizhou’s infrastructure spending looks dubious. Its super-high bridges aren’t producing the revenue to recoup anywhere near their super-high costs. Of Guizhou’s eleven airports, five have less than a dozen flights each week—and there are three more airports still under construction. Guizhou has become one of China’s most indebted provinces, and it’s starting to feel real fiscal distress. In an unusual move, Guiyang’s finance bureau issued a public outcry in 2022 that it was at the end of its ability to deal with the debt. Quickly afterward, the government deleted its own admission. 

Guizhou’s debt has kindled Beijing’s wrath. In China, the only people scarier than debt collectors are political inspectors from the central government. The Communist Party has unleashed teams of officers from the Central Commission for Discipline Inspection to descend on Guizhou. They are unbound by even the modest levels of legal niceties afforded in China. Rather than investigating legal crimes, their remit is to find “violations of party discipline,” a nebulous charge that includes not only corruption but also misuse of public funds and political disloyalty to the Communist Party. That makes the commission akin to the Inquisition, enforcing doctrine and discipline on its members. (pp. 38-39) 

The worst-affected people are targeted minority groups, who have to bear Beijing’s social engineering. The state has singled out, for example, Tibetans, who are forced to relocate from high-altitude mountains, where they are able to graze their yaks and horses, to lower-altitude farms in part to monitor them more easily. What are yak herders supposed to do when they move down to apartment blocks? Rural people who know only their farming or pastoralist lives are often at loose ends when the government resettles them into rows upon rows of high-rises. Two researchers at the University of Colorado have documented China’s coercive tactics to compel locals to leave their homes. It is a process it calls “thought work,” ranging from presenting resettlement as a voluntary and happy choice to holding intensive one-on-one meetings with recalcitrant folks who do not want to leave. Officials mix inducements with threats until they wear down the farmers. Thus, the state has been able to achieve “voluntary” resettlement rates of 100 percent. 

Reckless construction has often produced rubbish quality. Builders employed cheap materials to construct even schoolhouses. The 2008 earthquake that tore through Sichuan also shattered thousands of schoolrooms, killing five thousand children (according to official figures).  (pp. 48-49)

* * * 

Though rich students in Shanghai score splendidly on international exams, education in China’s rural areas is still often abysmal. The Covid pandemic revealed that the country’s health care system is weak, with shortages of doctors and nurses and six times fewer intensive care unit beds per capita than in the United States. An official like Li Zaiyong might be more interested in building a gleaming hospital filled with sophisticated equipment. Their attention drifts, however, when it comes to installing the trained technicians capable of operating the facility, since the Communist Party is better at rewarding new construction than health outcomes. 

The engineering state is focused mostly on monumentalism. Though there are many public toilets, provision of toilet paper is only a sometimes thing. Nowhere in China is it advisable to drink tap water. Not even Shanghai. The engineering state has engaged in wild spasms of building over the past four decades. That has achieved considerable wonders and a fair degree of harm. The future would be better if China could learn to build less, while the United States learns to build more.

I’ve come to realize that there are many ways that China and the United States are inversions of each other.  (pp. 49-50) 

* * * 

China’s overbuilding has produced deep social, financial, and environmental costs. The United States has no need to emulate it uncritically. But the Chinese experience does offer political lessons for America. China has shown that financial constraints are less binding than they are cracked up to be. As John Maynard Keynes said, “Anything we can actually do we can afford.” For an infrastructure-starved place like the United States, construction can generate long-run gains from higher economic activity that eventually surpass the immediate construction costs. And the experience of building big in underserved places is a means of redistribution that makes locals happy while satisfying fiscal conservatives who are normally skeptical of welfare payments. 

Rather than worry about bond vigilantes, the engineering state has focused on delivering material improvements for the people. Rural folks in Guizhou have seen their material conditions of life improve immeasurably over the past few decades. The mixture of permitting free enterprise while building big infrastructure is part of the reason that the Communist Party has held on to consent of the governed.  (p. 54) 

I'll write a separate post later about the rural-urban divide in relation to China's one-child policy.