You may have heard it said that 80% of Americans live in metropolitan areas rather than in small towns or the country as was once the case. That’s true but it doesn’t really tell the whole story.
You can find the list of metropolitan areas here. About 20% of Americans live in one of the ten largest metropolitan areas. Something like a third of Americans live in one of the twenty largest metropolitan areas.
There are several problems with thinking about the United States this way. First, some of these metropolitan areas are very large. For example, the Chicago metropolitan area includes Naperville, Elgin, and parts of Indiana and Wisconsin. There’s quite a bit of difference between living in Chicago and living in Kenosha. Or living in Northbrook and living in Kenosha for that matter.
Second, the travel time from one point to other points within the same metropolitan area can be quite daunting. Getting from Crown Point, Indiana to Kenosha, Wisconsin will take you several hours, probably two or more depending on weather, traffic, and so on. Getting there, conducting your business, and return can take the better part of a day. Not something you’d want to do on a regular basis.
Finally, there’s a tremendous difference between living in the New York metropolitan area, the largest in the country in terms of population, and the 91st, Des Moines, Iowa.
All this by way of preamble to the problems being encountered by a young friend of mine. This particular young friend recently moved from one of the ten largest metropolitan areas to another metropolitan area, the new one not in the top 50 metropolitan areas. My young friend is having an enormous problem finding an internist—every practice my friend has identified is closed. This presents a problem in coping with an ongoing health problem this friend has. My friend can’t establish a relationship with an internist because the practices are closed but the hospitals won’t deal with my friend (who does have insurance) unless my friend has established a relationship with a primary care physician. It’s Catch 22.
I recognize that’s anecdotal but I also suspect that it’s normal (in the technical sense).
I think it can also be important how close a given MSA is to other MSAs. Central Illinois has several small metros (btw/ 100 and 200th in size), each might be an hour from three or four other small metros. Each might be also be about two hours from either Chicago, St. Louis, or Indianapolis. Sometimes that can mean densities are understated, and frequently it results in some competitive specialization. Some of the MSAs are known for having far more healthcare services than others, even though the sizes are not that different.
Even worse, persons more enterprising than your friend who travel overseas will not find any physician who accepts Obamacare, Medicare or Medicaid. That fact doesn’t stop Obama from requiring monthly premiums for non-existent care.