I do love AI. If it gives me a clear answer, it’s probably wrong. However, one of AI’s comprehensive, in-depth, multi-referenced, nuanced discussions will derail my train of thought.

Congress and the Administration have been working on a ten-year $3 billion aid package for Rural hospitals. No. They claim to be working on improving rural health. But, they cannot define health, nor can they be sure what is “rural”.

Seems simple to me. Health is what I have until I feel sick. Urban is where I live, if I can see more than one house when I look outside.

For years, Hoosiers have suffered from the Urban-Rural Divide. Urban is where your children want to live until they want less of that and more of this. To make that adjustment, they choose suburban, something close to, but below urban. Suburban is Purgatory in the Celestial classification system.

Urban used to be cities and towns, but as those entities spread out like aging relatives, population density became more fashionable as a measure. Except many people who lived in rural areas tended to work, shop and use services in urban places. Were they Rubans?

Psychologically, Hoosiers are Rural folk. According to faculty I know at Purdue, if you eat, you are part of farming and farming is a rural activity. I tend to believe, if you eat, you are part of plumbing and associated waste treatment, but I don’t have a strong lobbying group on my side.

These days, and subject to change, the Census Bureau defines an urban area as having at least 2,000 housing units or 5,000 persons.

The Office of Management and Budget classifies counties as part of metropolitan areas based on commuting flows. The Department of Agriculture’s Economic Research Service (USDA ERS) is more lyrical and uses a four multi-tone scale for its FAR (Frontier and Remote) system. This is based on the time-distance from the ZIP code of residency to various service availabilities.

If the government seeks to improve rural health care, then the FAR classification system seems most compelling. The issue should be the time-distance not to a hospital, but to specific services within hospitals.

This means outstanding triage everywhere with increasing levels of service within matrices of frequency of demand and required resources given time constraints. That’s probably too complicated for the top level of the Department of Health and Human Services, but practitioners probably work it out daily.

Under the FAR coding system, a zip is level 1, if it is 60 minutes or more from a high level of medical services. For purposes of use in Indiana, this is useless.

According to the latest data I found from USDA ERS (dated 4/15/2015), only 65 of our 36,184 square miles of land area (a robust 0.6%) and just 2,197 persons among our 6.6 million persons (0.034%) are in level 1 of FAR.

I’ll bet we’ll still get multi-millions of the $3 billion. As will Rhode Island. That’s why we have US Senators.
Morton J. Marcus is an economist formerly with the Kelley School of Business at Indiana University. His column appears in Indiana newspapers, and his views can be followed his podcast.

© 2026 Morton J. Marcus

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