Legacy costs: Yadkinville may soon lose its community hospital, a jarring reflection of North Carolina's troubling urban-rural divide and the bickering over how to divvy up sales-tax proceeds.

• Author: Otterbourg, Ken
• Position: Point Taken

I am not a cynic. But I confess to being jaded. Still, it took my breath away when Yadkin Valley Community Hospital shut its doors in late May. Hospitals are like Waffle Houses: they're not supposed to close, and when they do, there's a great well of sadness that lingers longer than the failure of the average enterprise.

Of course there's a crisis in rural health care, but for most of us, it's just something you see on the evening news. Then, it's back to sports or business, which are really the same thing: players getting paid too much for what are at best marginal performances.

The Yadkinville hospital's demise is now the subject of litigation between the hospital's owner, Yadkin County, and HMC/CAH Consolidated, the Kansas City-based company that ran the 20-bed facility. There's a lot of back and forth about who's to blame, but it boils down to not enough profit and not enough patients. Simply put, the residents of Yadkin County were going elsewhere for their health care needs. Now, it is unclear when or if the hospital will reopen.

The fate of the hospital got me thinking about a prank we used to pull when I worked at the Winston-Salem Journal, before the Internet ate our lunch. We would tell summer interns there had been a bad accident in Yadkinville. A train, we shouted, had jumped the tracks and hit a liquor store. The newbie would jump into action and call the authorities, only to quickly learn there was no train and no ABC store in the county. How we chuckled in our nerds' paradise.

The tomfoolery ended in 2006, when Yadkinville voters approved the sale of beer and liquor, but there's still no train. You can't exactly draw a straight line between a county that misses out on the railroad, keeps up the good fight against alcohol for years, then--at least for now--loses its hospital; but on the other hand, there's a connection of sorts. The decisions communities make --or have made for them --about development in one generation can impact the next one and the one after that. To use a railroad metaphor, sometimes you don't know where the tracks lead until the train stops.

I once wrote about beer merchants who had stores just beyond the Yadkin County line, selling six-packs to folks on the way home. It was a lesson in economics, not morality. Consumers want what they want--whether it's beer or medical services--and they really don't care about borders.

But governments do. Deeply. Their first order of business is to build a fence. The...