I don’t know what the standard is in the US, but to me 80k is definitely not “a small town”. Like, here in Italy we only have 66 cities with more people than that. Someone in an 80k city not finding a gastroenterologist to visit him in three months within 1 and a half hour of driving seems absurd to me.
If having private healthcare causes all these issues with insurance I think it’s really not worth it at this point. I don’t think the quality of the service would decline either since even in free healthcare countries doctors earn a lot and are a coveted job.