The Real Shutdown: How Partisan Politics Are Strangling Rural Healthcare in South Carolina
- CUBNSC
- Oct 9
- 6 min read
By Javar Juarez | CUBNSC | October 9, 2025
Edgefield South Carolina- I spent my birthday this last week not at a restaurant or a party, but at the University of South Carolina’s Health and Justice Conference, fittingly titled “Doing Better.”
It felt right — to use a day that marks my own life to reflect on how many others are losing theirs to a system in decline.
The conference explored how law and medicine intersect to shape access to care — and how politics has turned both into battlegrounds. What I didn’t expect was that the conversation would lead me to Edgefield County, South Carolina, where the struggle to keep one small rural hospital open became a mirror of America’s real emergency.
The session that stayed with me most came from Robert Harrison, JD, LLM, DBE, FACHE, FAALM, a man who has lived at that intersection. His warning was both clinical and moral: our nation’s rural healthcare system is collapsing, and partisan politics is accelerating its death.
Harrison began his lecture softly, like a preacher lowering the lights before a truth-telling:
“Find the thing that breaks your heart,” he said. “Let that guide your work.”
For him, that heartbreak is the collapse of rural health care — and once he spoke it aloud, it became mine too.
What Breaks the Heart: The Real Shutdown
Harrison didn’t deal in abstractions. He spoke in data that sounded like grief:
Only 20 percent of Americans live in rural areas, yet they contain 35 percent of the nation’s hospitals — most of them fighting for survival.
Nearly half of all rural hospitals are losing money.
Over 430 are “vulnerable to immediate closure.”
Since 2011, 424 rural hospitals have stopped offering chemotherapy — not because patients disappeared, but because sterile compounding rooms cost too much to maintain.
He reminded us:
“Things have consequences. And those consequences are killing people.”
From the Lecture Hall to Edgefield County
Days later, those words followed me to Edgefield County, South Carolina, where I visited the Edgefield County Hospital — a 25-bed rural facility tucked among pine trees and prayer. What I found wasn’t despair but determination.
County Council Chair Dean Campbell told me the partnership with Self Regional Healthcare didn’t happen by chance. It came from urgency — and foresight.
“Seeing systems like those in Barnwell County close signaled to us that something needed to be done to ensure the future of healthcare in Edgefield,” Campbell said. “Our hospital was struggling financially, not because of mismanagement, but because of the ever-changing and ever-decreasing Medicare and Medicaid funding that made it impossible for a county hospital to survive on its own.”
Barnwell County’s former Southern Palmetto Hospital was forced to shut down in January 2016 after years of declining patient numbers and mounting unpaid care costs.
Campbell explained that the County Council and the hospital board worked together to find a partner — a healthcare system large enough to bring stability, yet close enough to share the community’s values. Self Regional, based in Greenwood, expressed interest and soon became the county’s lifeline.
“Self has already made investments at the Edgefield site,” Campbell added. “And just this week, the County Council approved an extension of the contract — from ten years to thirty — carrying us through 2055.”
That decision was more than paperwork; it was preservation.
When asked what role the community plays in keeping healthcare strong in Edgefield — given the county’s deep network of churches, civic organizations, and local partners — County Administrator David Caddell said their greatest contribution was quiet but powerful.
“Well, I think it’s what they didn’t do that was important,” he explained. “We just had to do a tax increase for EMS to add a fourth ambulance, and the community was very supportive of it. Not one person spoke against it — medical care touches everyone.”
For Caddell, that kind of collective trust is what separates Edgefield from the many rural counties that have lost their hospitals.
“We’re a small county, but we try to think ahead when we can,” he said. “So many county-run hospitals have closed up shop. It’s just not financially sustainable for a county to run one. We’re blessed that Self Regional operates ours — they have the network, the specialists, the buying power. Without that, Edgefield couldn’t keep its hospital open.”
It’s that blend of foresight and faith — in both people and partnerships — that keeps Edgefield’s hospital from becoming another casualty of rural decline.
The partnership now means doctors rotate into smaller towns like Johnston, where some residents literally walk or bike to appointments. It also gives Self Regional the confidence to invest millions in new equipment and infrastructure — upgrades that could one day save a neighbor’s life.
The Human Cost of Closure
When I asked what would happen if Edgefield lost its hospital, Caddell didn’t sugar-coat it:
“The contingency would be hard,” he said. “You’d have longer transport times, fewer specialists, and people with limited mobility who couldn’t see a doctor at all.”
North Augusta’s emergency room might handle heart attacks and strokes, but for allergic reactions, pneumonia, or injuries that need a few days’ care, Edgefield’s hospital is critical.
He described why the county refuses to privatize its EMS service:
“We’re committed to keeping at least one paramedic on every ambulance,” Caddell said. “Your chances increase drastically when that level of skill is on board.”
In a county where the nearest trauma center is over an hour away, that decision can mean the difference between life and death.
Community Over Politics
Edgefield’s story exposes what Robert Harrison warned about at the Health and Justice Conference: partisan neglect disguised as fiscal responsibility. When Congress halts funding in the name of border debates or budget optics, it is rural counties like Edgefield that pay the moral and medical price.
What makes this reality harder to ignore is geography. South Carolina Senate Majority Leader Shane Massey — one of the state’s most influential lawmakers — calls Edgefield home. In 2024, Massey said he saw “no real willingness” to consider Medicaid expansion, signaling continued resistance to a policy that could help sustain hospitals like the one in his own community.
The struggles facing rural hospitals across South Carolina aren’t abstract; they’re unfolding in the very district where the power to fix them resides.
And yet, amid the politics, Edgefield’s people remain unified. Their quiet solidarity — seen in their willingness to support the county’s investment in emergency services and healthcare — speaks louder than the noise of a Washington shutdown or Statehouse politics. It is proof that when communities lead with compassion instead of partisanship, preservation becomes possible.
Training Tomorrow’s Lifesavers
Edgefield isn’t waiting for Washington to save it. Its own EMS training officer and emergency-management director now teach EMT and paramedic classes at the local technical college and coordinate with the high school system to create a pipeline into the medical workforce .
It’s a small county thinking ahead — proving that foresight doesn’t depend on population size, only on leadership.
The Real Emergency
Rural hospitals like Edgefield’s stand on margins thinner than a pulse line, kept alive by partnerships, prayer, and the mercy of local budgets. Yet in Washington, the debate isn’t about saving them — it’s about optics and ideology.
As Harrison said, “We can’t fix cost, access, and quality all at the same time. But the fact that it’s hard doesn’t mean we just say, ‘Too bad.’”
That “too bad” is what too many South Carolinians hear when hospitals close or Medicaid expansion dies in committee.
When the noise of politics fades, what’s left are counties like Edgefield — doing everything right, still begging to survive.
The real cost of partisanship isn’t measured in dollars.
It’s measured in lives.
Author’s Note:
This essay combines field observations from Edgefield County Hospital (October 2025) and recorded interviews with County Administrator David Caddell and Edgefield County Council Chair Dean Campbell, alongside remarks from Robert Harrison, JD, LLM, DBE, FACHE, FAALM, delivered at the University of South Carolina Health and Justice Conference on October 3, 2025.
Data references: Kaiser Family Foundation, The Commonwealth Fund, Chartis Center for Rural Health, American Hospital Association.
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