Amazon.com delivers everywhere in a day or two and their inventory dwarfs the selection and prices of big city stores.
Medical costs have been driven to insane levels by too many lawyers and politicians. Typically the CEOs of pharmaceutical and medical device manufacturers are lawyers, not doctors. They have to be.
Amazon delivers very little of their own product. UPS and FedEx deliver for them, and those businesses are built entirely on economies of scale.
I agree with your point about medical costs, but there's no doubt that hospitals in rural areas wouldn't offer specialized treatments and procedures because they don't have the volume of business they would need to justify the cost of building the facilities and buying the equipment.
When a Torontonian explains things, that’s when the confusion begins.