America's Rural Hospitals Are Dangerously Fragile

This is the story of a small-town, publicly-owned hospital that, after thriving for decades, is struggling and now in all likelihood about to be appended to a large regional health-care system. The tale of Berger Municipal Hospital is, like that of many sectors of the American economy, one defined by industrial consolidation and the costs that come with it. The story begins in 1929. That year, the city fathers of Circleville, Ohio, in the south-central part of the state, dedicated the town’s new hospital, funded partly with money willed by a local patron named Franklin Berger.

The hospital opened at a time when other small towns had been building them, too. Turn-of-the-century medical breakthroughs such as disinfectants, sanitary surgery, and new technology like X-ray machines (invented in 1895) helped transform hospitals from last-resort warehouses for the sick poor (the rich were usually treated at home by private doctors) into places where all members of a community would go to receive care. Mothers began to deliver babies in hospitals instead of at home, and birthing (and, in more recent years, prenatal care) became big business for community hospitals. Not only would Berger help improve the health of Circleville residents, but it was expected to be a sign of modern welfare that would attract business executives and workers. As was typical, Berger was owned and operated by the city, and then, a generation later, jointly by both the city and surrounding Pickaway County.

Last November, however, Circleville’s voters , one that, in other places, has resulted in an economic hit to the community—mostly in the form of job losses and stagnant wages—as well