(Image belt;Screen+Shot+2014-07-30+at+9.20.13+AM.jpg)Many rural patients “bypass” rural hospitals and get admitted at urban facilities, a federal study shows. Rural from rural America who stay at rural hospitals tend to be older and on Medicare. They are also less likely to get medical procedures like surgeries.
A senior staff member of the National Congress of American Indians cringes to remember his costume at his 21st birthday party. What will it take for the owner of the Washington, D.C., NFL team to have a similar epiphany over his team’s mascot?
(Image belt;percent-change-nonemp2002-2012.png)The one bright spot in rural America’s small-business development in the last decade was in “nonemployer” businesses, what we typically know as self-employed workers. The bad news is that earnings in this category dropped dramatically over the last decade.
A writer and director in works on his latest film, a movie he describes as a “Scooby-Doo episode with a really high body count.” Author Julianne Couch takes us behind the scenes and to the edge of "Firebox Lake".
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Tighter limits on wood-burning heating appliances are designed to improve air quality and human health. But industry representatives worry that the tighter restrictions will make the cost of new stoves prohibitively high.
Photo by Ed SuominenThe EPA is cracking down on woodburning stove emissions.
The Environmental Protection Agency’s proposed new restrictions on emissions from wood-burning stoves have garnered praise and criticism from a variety of health, manufacturing and small business organizations.
The proposed rules, which will reduce allowable emissions for many new woodstoves, could have a bigger impact in rural areas, which burn up to twice as much wood for heat as metropolitan areas, according to a George Mason University report.
The American Lung Association and the Alliance for Green Heat support the tighter restrictions, reports Jim Gillam in the Chimney Sweep News, an industry publication. The Lung Association says the changes will help protect the environment and human health.
“The EPA set the current standards for wood-burning devices in 1988,” the Lung Association states, according to Gilliam, “years before the first of the landmark studies that demonstrated that particles like those that make up wood smoke can be deadly. Improved technologies in use today can greatly reduce the harmful pollution from these devices.”
But the claim that the tighter standards will improve human health doesn’t take into account that most wood for heat gets burned in rural areas, says Stonehill College economics professor Sean Mulholland.
“If a tree burns in the forest and no one’s there to breathe the smoke, does this reduce human health?” he writes in a U.S. News and World Report online opinion piece.
“Because most of the emissions reductions will take place in rural areas with low population densities, the [EPA] rule overestimates total health benefits realized by averaging these reductions across all U.S. residents,” Mulholland writes. “So a reduction in particulates in the rural community of Forest City, Maine, has the same estimated value as a reduction in the densely-populated urban city of Oakland, California.”
Farmers will have to grow as much food in the next 26 years as they’ve grown in the previous 1,500. And they will have to do it as climate change brings increasingly erratic weather. Maybe it’s time to start asking questions besides “What, me worry?”
Photo via Risky BusinessRoad washed away by extreme flood in Jamestown, Colorado.
Back in his day, Dad always stressed the risky side of farming. As proof he’d pull from a desk drawer his personal handwritten record of Langdon yearly corn prices during the 1950’s. Next to those were annual yields. The message was clear; if prices don’t get you, yield and weather will.
I should have asked more questions.
I thought I had all the answers. When I looked around the neighborhood all I saw was accumulated wealth of successful farmers rooted all the way down to the Depression era. Now I’ve figured out the hard way, secrets are held not in the answers you have, but in the questions you ask, like:
Why were they there?
Because the only farmers I saw were those who had survived.
How does one farmer succeed where so many have failed?
Being optimistic helps. Farmers believe hail storm losses won’t be total, the drought won’t last and rain will fall, the levee could hold if the river drops and, if all else fails, prices should rise. But as optimistic farmers like me grow older, they’ve learned that even if the government doesn’t mess things up, Mother Nature might.
Like an old farmer once said, “I’d rather be lucky than smart.”
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Photo by Lauren Rosenfeld for Al Jazeera AmericaKate Swift-Scanlan, a nurse practitioner in Raleigh, North Carolina, speaks at a rally for Medicaid expansion spearheaded by the Moral Monday movement.
Rural hospitals are suffering from state decisions not to expand Medicaid, reports Al Jazeera America. In the "Coverage Gap", an Al Jazeera Fault Lines feature that aired this week, the network exposes the reality of hospital closings and shortages in rural America.
Rural hospitals have historically relied on federal subsidies that allow them to serve large numbers of Medicaid-dependent patients. In states that have chosen not to expand Medicaid, these hospitals no longer have access to the federal money that supported their practices. In many states, the hospitals have been forced to cut budgets, lay off staff, and in some cases, close entirely.
The United States has overtaken Japan as Australia's largest beef export market. As US cattle numbers drop to the lowest they have been in 60 years, American businesses have been forced to look overseas. Australia's market has been able to fill the gap left by American suppliers, despite the fact that Australia's herd numbers have also sunk to the lowest they have been in 20 years.
According to Tim McRae, Meat and Livestock Australia's chief economist, seasonal weather conditions are the key to cattle farmers' success. Beef and veal exports are expected to reach 1.1 million tons this year, matching the record set in 2013. However, Australian cattle farmers hope for the price of beef to increase soon, as prices have not significantly changed despite the record-high global demand.
Gov. Steve Beshear and U.S. Rep Hal Rogers have issued two requests for proposals to create a high-speed Internet network within Kentucky. The project will take approximately two years to complete and will include more than 3,000 miles of fiber infrastructure. The Kentucky politicians hope that one of these proposals, one seeking private partners to establish, open, and operate the network and the other seeking equity partners for this same purpose, will further advance the statewide project.
This plan is particularly important for Kentucky, the 46th state in the nation for high-speed broadband Internet availability and the state within which almost a quarter of the state's population cannot access broadband. The statewide broadband network aims to improve these conditions, placing emphasis on increasing service in Eastern Kentucky.
The so-called gulf between rural and urban America is really a fertile space of intense economic, political and environmental interaction. For the benefit of us all, higher education – especially land grant universities – should do more to cultivate research and public service that helps us understand this place of productivity and innovation.
Most Americans—taxpayers, politicians, and policy makers—have an urban-centric world view. Yet all Americans have a large and growing stake in the demographic and economic vitality of rural people and places. At a minimum, we cannot forget that urban Americans depend on rural America for food and fiber, natural resources (for energy), recreation and entertainment, and much more.
The so-called urban-rural divide is not a divide at all. It is a space of intense social, economic, political, and environmental interaction. It also is space where rural and urban interests are sometimes in competition, for example over land use management, while in other instances rural and urban interests are conflated.
The new interdependency of urban and rural America is perhaps illustrated best in the agricultural sector. America’s “food system” cannot be examined in isolation from other aspects of the economy and society. The restructuring of the meatpacking industry makes our point. Rather than shipping cattle or hogs to slaughterhouses in faraway cities, such as Chicago and Kansas City, most are now processed close to where they are raised in rural areas. For some small towns, this has been a demographic and economic boon, especially in the Midwest and Southeast, such as poultry and pork processing.
The contemporary agricultural economy has also opened up niches for some small- to medium-sized producers who benefit from direct access to large urban markets. This development has been especially rapid at the urban-rural interface. The metropolitan farmer is not an oxymoron.
Photo by Mary Anne AndreiHog barns are often stuffed to near capacity, allowing disease to spread easily.
My dad and writer George Santayana both belonged to the pragmatist school of philosophy.
Santayana said, “Those who cannot remember the past are condemned to repeat it.”
Dad said, “I suppose if everyone jumped off a cliff, you would too.”
To practical, parent-types like Dad – and to pragmatist philosophers – jumping off a cliff has an obvious, proven result.
But risk-takers believe it needs a test.
Apparently, our government doesn’t think cliff-jumping will result in a predictable splat. Because we seem dead set on testing whether concentrated hog genetics and large hog operations are going to create trouble. Any hog farmer from the 20th century can answer that question for you based on experience.
Hog-raising is one of the most concentrated industries in the world. Over the last 20-plus years, while pork production held steady, more than 70% of U.S. hog farmers got out of the business. The smaller operations have been replaced by large farms connected to names like Tyson, Cargill and Smithfield.
The big corporations didn’t do it on their own. Rather, they passed on the risk to individual farmers.
Corporate meat shields itself from liability by breaking up the phases of production. Hog farmers used to raise pigs from “farrow to finish” – from birth to slaughter weight. Now contract farmers specialize in one phase of production, such as growing breeding stock, breeding, gestating, farrowing pregnant sows, or feeding pigs to finish. But it’s not a bidding war where corporate owners pay what the market demands, but a reverse auction where contractors grab what they can to survive.
The federal government needs to overhaul the rules that govern small, rural hospitals. Otherwise, we’ll see a drastic number of closures and a loss of critical medical services for small communities. Who is going to step up?
Photo by Hyun Namkoong/North Carolina Health NewsA sign supporting a small, rural hospital on the side of the road near Belhaven, North Carolina, a small coastal town.
The number of patients admitted to small, rural hospitals is dropping rapidly, creating big changes in the economics of rural healthcare.
From 1996 to 2012, the average number of acutely ill inpatients at “critical access hospitals” fell by half, from an average of 8.7 to 4.35 per hospital per day.
If the current rate of decline continues, most of the inpatient business at these hospitals will be gone in the next decade.
Inpatient care accounts for a third or less of the revenue of critical access hospitals. But it’s a vital stream of money for institutions that operate in the black by only 1% of their budgets, on average.
Why are patient admissions declining, and how should we respond?
Critical Access Hospitals
A critical access hospital, or “CAH,” is a rural hospital with no more than 25 beds that meets certain criteria for distance from other hospitals or has been declared critically needed by its state’s governor. Unlike most hospitals, a critical access hospital is paid whatever it costs to care for its Medicare hospitalized patients and, in many states, its Medicaid patients.
The federal government developed the designation of critical access hospitals during the late 1990s, in part to address a spate of rural hospital closures. Now, with the drop in inpatients (plus some changes from Obamacare and the failure of some states to expand Medicaid), the problem of hospital closures is back in the news.
Where Have All the Patients Gone?
The inpatients who previously might have been treated at a critical access hospital are likely going to larger hospitals, as opposed to getting treatment at some other kind of community hospital.
Part of the change comes from an important “age cohort” effect. Twenty years ago, researchers found that people older than 65 thought their small, rural hospital was good or excellent. But back then, people under 45 were less likely to think so.