Letter from Langdon: Pricing Survival

What’s the real cost of health care for rural residents? Richard Oswald explains how labor and delivery equal debt to most young families. And the price only goes up.

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It cost $15, total, for Dr. McRae to tell my mother, “Yup, you’re pregnant.” And when I was born here on the farm outside of Langdon, Missouri, 1950, it cost another $15 for his drive up from Mound City to say, “Yup, it’s a boy,” and sign the birth certificate.

Back in 1969, when Linda and I had our first child, a monthly visit to the general practitioner for a prenatal checkup was less than $50. Hospital costs for a normal delivery totaled about $300. In those days feeding and clothing a child were the most expensive part of raising a family. Today the cost to a young farm couple for simply birthing a child has gone off the scale. For some parents, it can amount to as much as $20,000.

Linda and I have a married son and a married daughter, each self-employed, living on their own farms with their spouses. Both our children have had to make time payments on the hospital costs of our grandchildren’s births.

Most medical insurance these days simply doesn’t help with that cost. As those fortunate enough to afford medical coverage discover, insurance policies seldom pay anything for pregnancy and childbirth.

When our grandson Carter was born by Caesarian section after a long labor, he and his mother were finally out of danger, but the costs of prenatal care and delivery had gone through the roof.  His parents are still making payments on his birth — and we celebrated Carter’s 9th birthday last week.

Health insurance might have helped pay part of the cost of Carter’s delivery except for the problem many young farmers have at times: paying bills when they’re due. One insurance premium was paid a few days late. The company accepted the payment but knew from our daughter’s medical records of her condition. They then canceled her coverage and returned the premium a few days after cashing her check.

Insurance companies should have to play by the rules, too.

Linda and I finished raising our first three children years ago, but since have adopted a grandson. Ryan is 13 years old and as healthy as any child can be. It costs us $150 per month for his health coverage. That’s just a drop in the bucket compared to what we spend for ourselves, because with the same $5000 deductible we have on Ryan, Linda and I pay over $850 per month for health insurance. Altogether, with insurance and everything we have to pay for out of pocket — prescription drugs, dental, and eye care — we spent over $20,000 to maintain our health and well being last year.

Richard Oswald
Residents of Atchison and Holt counties, in northwest Missouri, viewed architectural drawings of the region’s new Fairfax hospital, now underway.

Our tiny community in northwestern Missouri has answered the need for local health care with a hospital in Fairfax. It serves parts of three Missouri counties as well as several counties in Nebraska and Iowa. The old Fairfax hospital, built in the 1950s, needed to modernize to compete with bigger urban hospitals and specialty health care centers, so planning began for a new facility. The final cost of the new Fairfax hospital will be over $4 million. That price tag highlights the difficulties small and rural communities face: the huge current costs to compete with urban hospitals, and, more basically, to defend life.

One problem rural hospitals have is attracting adequate numbers of good doctors to their staffs.  Rock Port solved the problem by producing one. Aron Burke was born in the county, raised in Rock Port, and after attending medical school came back here to live.

But dedicated, overworked doctors like Aron and his colleague Dr. Michael Knauss, who together serve an entire county, find it hard to take a day off.

A few years back Linda developed a rare health disorder that was diagnosed as everything from ringworm to early stage lung cancer. She went to specialists and doctors all over this part of the Midwest. Linda ended up doing her own research on the Internet to identify her problem but had a hard time getting anyone to listen to her. Then, after he came to Rock Port, she made an appointment to see Aron.

Aron recognized what Linda had right away and began treatment. That was after one specialist had advised her to “live with it” because the treatment would “make her fat and out of sorts”; another doctor’s receptionist revealed to Linda in whispers on the phone that X-rays showed spots on her lungs. That doctor failed to follow through even with a phone call when she realized that Linda wasn’t interested in surgery.

Thanks to our home-raised physician, Dr. Aron Burke M.D., Linda was able to find effective treatment right here at home. Her disease is in remission.

For elderly people who have worked and saved, who have finally made it to retirement and who enjoy Medicare coverage, the problem of costly health insurance remains; they still have to buy Medicare supplements to protect themselves from high treatment costs. Unseen expenses, hidden in most reports, are the costs of driving to and from a faraway doctor’s office, pharmacy, or hospital. If their children have moved away from the rural area in search of jobs and opportunity, elderly rural residents struggle to make it to those appointments without help.

We are told that preventive medicine will save money and lives, but for a farmer like me whose budget is already strained by the cost of insurance, the out of pocket costs of simply going for an annual check up can seem too expensive. It’s much easier to forego the expense of that and hope that all is well. We have only so much money.

It isn’t unusual for farmers, who look like millionaires on paper, to be paupers in real life. Few of us truly feel we are wealthy because the assets that make us seem so well off – our land and equipment — enable us to earn what is normally a fairly modest living. Those same assets that our parents, grandparents and great-grandparents passed on to us, and that we hope to pass on in turn, look good to hospitals and other health providers because they guarantee that payment for expensive treatments can be made. At the same time our livelihood and our heritage are held hostage to pay the skyrocketing costs.

Maybe the old saying applies: “If you have to ask what it costs you just can’t afford it.” But in America we always hope for better. As farmers, people like me and my family hope for better weather, better prices, and better lives for our children.

In a nation where “better” is our constant dream of change, we shouldn’t have to choose life or death based on a bank account. We deserve better.

 

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