Very true. But for every Cleveland Clinic there are a hundred other midwestern cities that lack a similar tier institution, but you might have three similar institutions to CC in NYC or on the west coast to choose from. Having to drive over an hour to see your specialist while you are senile is not ideal, but is a reality for a lot of people in the midwest by virtue of the sprawl and low density of services.

Have you commuted or driven around NYC or LA? Unless you live in the same neighborhood, your commute to the hospital is already going to be 30-60 minutes. Not to mention that of the top hundred hospitals in the country, only a handful are in NYC or LA.

One could make an argument that living in rural areas is worse than urban ones when it comes to access to top medical care, but that has nothing to do with the NYC/LA vs. the rest of the country.