For much of western Kansas, good health care is more expensive and less accessible than in other parts of the state and the nation.

While a variety of complex factors, including government policy, are involved, the reasons for the inequities are primarily the result of free enterprise and the economics of supply and demand.

Whether you are talking about high-speed internet, health care or the U.S. Postal Service, costs associated with delivering service in large areas with relatively sparse populations are relatively expensive on a per-customer basis.

In the case of health care, specialization and technology also drive up costs, making it infeasible for every hospital to provide comprehensive care.

The consequences are real. Health care data indicate rural residents are more likely to die prematurely from heart disease, cancer and stroke — even though, as in the case of cancer, they may be less likely to get the disease initially.

The data also show rural hospitals are dying. According to the National Rural Health Association, about 80 rural hospitals have closed since 2010, and hundreds more face insolvency.

Rural hospitals don’t have the customer base or the resources to offer everything to everyone. Neo-natal care, individually customized cancer treatments, open heart surgery, transplants — health care is now so expensive and specialized that not even big metropolitan hospitals offer everything to everyone.

We see it in our own families and among friends. Those who can afford to, or who have decent insurance, travel out of town to see specialists, have surgery or get specialized tests and treatment.

This means that more rural hospitals likely will close. Those that survive will need to make big changes.

No one has a magical cure for what ails rural health care, but it’s obvious that government will need to play a role.

Kansas hospitals have been stressed by the state’s failure to expand Medicaid, according to the Kansas Hospital Association.

That stress could become more severe if the White House and congressional leaders proceed with plans to cut both Medicare and Medicaid. These health care programs — Medicare for senior citizens and Medicaid for the poor and disabled, many of whom are elderly — cover a growing number of patients.

They are vital to the health of rural hospitals, which often don’t fit the one-size-fits-all regulations that come down from Washington.

Undoubtedly, more flexibility is needed. As is more accountability for how well hospitals serve residents. It doesn’t make sense — financially or ethically — for taxpayers to continue to support hospitals and programs that don’t serve a real need in their communities.

It also doesn’t make sense for hospitals to operate as if it were still 1968.

The Bipartisan Policy Center released a report earlier this year that could act as a starting point for change.

The report focused on seven upper Midwest states — North Dakota, Iowa, Minnesota, Montana, Nebraska, Wyoming and South Dakota.

It noted that not every rural community needs or can support what’s known as a “critical access hospital,” a government designation created in the 1990s to help small rural hospitals. Some hospitals may need to close or transform into something else.

The report also urged changes in how hospitals operate financially, and it recommended more long-distance “tele-medicine.”

It also saw a need to find new ways to train and sustain corps of health care professionals in rural communities.

For those involved in rural health care, these are not breaking-news alerts.

But they underscore the fact that shoring up rural health care is not as simple as expanding Medicaid.

The demographics, the technology and the expectations of patients all have changed.

And continue to change.

The danger is that even communities and hospitals willing to change may not get the opportunity, as President Donald Trump and congressional leaders target rural development funds and Medicare and Medicaid.

The cuts are marketed as targeting the lazy and the greedy. Or as eliminating waste. But they also target working families, as well as struggling rural hospitals, nursing homes and other health facilities that are vital to rural communities.

Rather than decimate already weak health care systems in rural America, elected officials in Topeka and Washington should be finding ways to improve accessibility and affordability.

A native of Garden City, Julie Doll is a former journalist who has worked at newspapers in California, Indiana and New York, as well as across Kansas.