It turns out the specialized medical needs are kind of special, and they fly people to where there are facilities when they're needed. And only affects a special portion of the population. For everyone else it doesn't matter.

For fuck sake people crossed the entire US in a god damn wagon while risking being shot at by random tribes and eaten by bears. What's stopping people now is that they can't afford food or a place to park the damn wagon without getting harassed by the cops.