Lynda Waddington at the Iowa Independent reminds us that in much of rural America it's not insurance that's the problem, but access to doctors, nurses, pharmacies, home health care and mental health treatment. We can pay for health care just as well as people in the cities. There's just less to buy.

“We have some serious challenges in Iowa as it relates to the number of providers that we have,” Tom Newton, executive director of the Iowa Department of Public Health, tells Waddington. “We do have a high percentage of our population in Iowa that is insured at this time, and I would tell you that even some of them struggle right now to get access to health care. You can’t just assume that by providing people with a source of payment that you’ve provided them with access to health care.” In Iowa, as in many rural states, the number of health care professionals is "plummeting," Waddington writes. One of the problems is a rapidly aging health care workforce.

"The alarming demographics and shrinking number of health care workers in rural areas are not just limited to primary care doctors," Waddington writes. “We aren’t just talking about those people that are traditionally thought of as health care providers – it’s dentists, it’s mental health and it’s even pharmacy,” said Cheryll Jones, a southeastern Iowa pediatric nurse practitioner who serves on the board of the Iowa Rural Health Association. “There aren’t necessarily huge numbers of pharmacies in rural areas. So, even if you have a provider, you may have to travel a fair distance to get your prescription filled."

Microsoft's Bill Gates gave his first major speech on agriculture today in Des Moines. Gates has committed $1.4 billion from his foundation to agricultural development, reports Philip Brasher in the Des Moines Register. About 5 percent of that amount will go to biotech projects. Gates' speech was a defense of genetically engineered crops as a way to help poor farmers increase food production. Gates criticized those who were "instantly hostile to any emphasis on productivity" while ignoring food production in a world affected by climate change. 

“They act as if there is no emergency, even though in the poorest, hungriest places on earth, population is growing faster than productivity, and the climate is changing,” Gates said. The Microsoft founder said transgenic crops "can help address farmers' challenges faster and more efficiently than conventional breeding alone." The Gates Foundation will  help develop drought-resistant corn for use in East Africa. Brasher reports that Gates said the seeds would be licensed royalty free to distributors so that there would be no extra cost to farmers. 

“Of course, these technologies must be subject to rigorous scientific review to ensure they are safe and effective,” Gates said. “It’s the responsibility of the governments, farmers and citizens, informed by great science, to choose the best and safest way to help feed their countries.” Gates said the next green revolution “must be guided by smallholder farmers, adapted to local circumstances and sustainable for the economy and the environment.”

The Senate Finance Committee passed its version of health care reform Tuesday afternoon, but Kaiser Health News reminds us that neither this bill nor any of the others sloshing about Congress will do much about the nation's doctor shortage. Phil Galewitz reports: "Even as Congress moves to expand health insurance coverage to millions of Americans, it's doing little to ensure there will be enough primary care doctors to meet the expected surge in demand for treatment, experts say." 

Primary doctors are key to rural health and there aren't enough of them. The American Academy of Family Physicians predicts a shortage of 40,000 primary care docs in the next ten years. (In the chart above, demand is represented by the blue line; supply of primary care doctors is in red.) “I don't see anything in the legislation that will greatly increase the primary care pipeline," said Dr. Russell Robertson, chairman of the Council on Graduate Medical Education. Galewitz said there's general agreement on how to increase the number of primary care doctors: open more residency positions and increase how much primary care doctors are paid. But nobody wants to add these costs into a health reform bill that has a price tag already too large for many to swallow. To add 15,000 Medicare-funded medical residency positions would cost about a billion dollars a year.

Nor has there been much luck adding to the pay of primary care doctors, since the money would have to be wrenched from specialists. But primary care physicians are key to holding down overall health care costs. They make, on average, less than half of the average for specialists.

Patchwork Nation's Dante Chinni asks today, "Is the recession finally coming to 'Tractor Country'?" Chinni and Jim Gimpel have divided the country in demographic blocks and have been reporting how different the nation appears depending on your geography. Tractor Country is the Great Plains, and as we at the Yonder know, this area has suffered less during the recession than the rest of the country. Chinni visited Sioux Center, Iowa, last week, however, and found that "it's not the standard measures — like unemployment — that reveal the story in these places. It is the quieter numbers inside the economy like commodity prices." 

In particular, the price of beef. At the Tri-Stae Auction House, buyers were picking up old dairy cows on the cheap. Cattle were going for $150 to $200 less per head than two years ago. “We have not seen huge losses in the number of cattlemen, at least not yet. But the bankers are a little more nervous than usual,” said Mike Koedam, who mans the microphone at the auction house. “The cattlemen have had a tough time for the last two years.”

Chinni reports that Tractor Country remains "relatively stable." The attitude toward debt is different here than in more high-flying parts of the country. "But many here see at least some parallels with the recession of the early 1980s, which hit the coasts and big cities first," Chinni writes. "As the recovery came to those places, the troubles were just beginning in agricultural America, eventually leading to the collapse of many small farms."