For me personally, it is not some "nature vs dirty streets" argument at all. When I read the writings of the mentioned, it's not all "ag is beautiful." They had specific experience with how power became centralized in European cities which led to governance and societies which were short term/locally optimized to the detriment of all.
And yet, this is exactly what is happening now. Despite being given disproportionate political power (the Senate), the closure of rural hospitals has not stopped or slowed. Politicians are not farmers, they're not rural laborers, they're overwhelmingly lawyers and white collar workers who spend their times in cities, or at best, rich enclaves within the district they represent.
Politicians are not selected today like they were when the founders lived. In rural districts, when given the choice between
A. A carpetbagger endorsed by the most recent Republican president who talks about wedge issues whose outcome has almost no impact on daily life
B. A local star who promises to make his votes cost his party a lot of pork (money for projects in his district, like keeping hospitals open), and represent his district's very specific economic interests
most districts are voting for candidate A in the primary.
I think it's just a natural realignment. Urgent cares take a lot of the hospitals action. Pretty much everyone can afford a decent car and knows that the better hospital isn't the rural one. Expanding ambulance and air evac is a big thing right now. Even in urban and suburban settings you are still dealing with fair travel times to hospitals. If you can get decent ambulance, air ambulance, and urgent care there's really not as much of a need for rural hospitals.
And the airlift company sells me a coverage plan for $120 a year (which also covers skiing accidents), while there is nothing I can do to reduce an ambulance rides price that will be in the thousands.
