Saturday, August 1, 2015

The President's Rural Term Paper


WDBJ As part of the roll-out of the Obama administration's account of its policy for rural America, the President met with reporters from eight smaller television markets. Here Hollani Davis with WDBJ in Roanoke, Virginia, interviews the President. You can see her report and interview here.

We get the picture. People in rural America work hard.

Or so says a new report from the Obama administration. Four times in the first four sentences, we are told that people who live in rural America are "hard working" or "work hard" or are accustomed to "hard work." Alright already.

It's also not very hard to see how members of the Obama administration sees rural America. To them, it's one big farm.

The title of the administration's new report, "Strengthening Rural Communities: Lessons from a Growing Farm Economy," tells the story. Rural = farm. In the "Executive Summary," just after all the hard working stuff, there are six bullet points. All six have to do with increases in farm sales and exports.

Okay, the next few paragraphs describe "broader efforts by the Administration to advance the economic security of Americans living in rural areas...." There is mention of "improving educational opportunities, providing access to affordable healthcare, and investing in infrastructure." The report notes that the President established the "first-ever White House Rural Council" which has been "coordinating these efforts...."

But this report, which President Obama is releasing the same day he is doing television interviews with 8 television reporters from smaller markets, is mostly about agriculture.

And it's a good story. The ag economy has been strong, with rising prices, rising exports, rising land values and rising manufacture of farm machinery for use both in this country and abroad. The report has an explanation for why this happened and how it can continue.

But, first, there is a non-ag portion of the report. Rural America "faces a number of unique challenges," says the report:

First, incomes are lower and poverty rates are higher in rural areas than they are in urban areas Second, a lower proportion of the rural population is of working age (20-64), and the share of the U S population living in rural counties has steadily declined over time  Third, a higher portion of rural residents are on disability and therefore unable to participate in the rural workforce  Fourth, educational attainment lags behind that of urban areas for the working-age population.

The White House Rural Council has "taken steps" to:

(1) Increase capital flow to rural areas and improve job creation and workforce development; (2) enhance telecommunications in rural areas, support renewable energy efforts, and open new markets for rural communities; (3) expand access to health care services, improve education, and housing; and (4) promote outdoor recreational opportunities to generate economic growth.

(Here is a White House blog entry on the one year anniversary of the Rural Council.) 

To sweeten the pot, the Obama administration announced a $2 billion fund Monday to "help small businesses expand and hire." The money will be distributed through the Small Business Investment Company over the next four years. 

The report lists all manner of other initiatives and strategies. The Navy will use advanced biofuels, for example. Federal agencies will increase the use of advanced biofuels. There is a new "strategy" to "restore and sustain the health of our forests." There is also a tourism "strategy" that has "recommendations for new policies and initiatives to promote travel opportunities throughout the United States, including tourism opportunities in rural communities."

Some of the points in this part of the report are a stretch, at least in terms of credit going to the Obama administration. For instance, the administration notes that about 65 percent of all interstate highway miles run through rural areas. The Obama administration doesn't exactly take credit for the entire interstate highway system, which was first mapped in the 1950s. It just states a fact — and then doesn't say it is working to increase spending on rural roads. The report just says interstates run through rural communities. 

KTIV Matt Breen, KTIV-Sioux City, Iowa, was one of eight local news reporters to interview President Obama in the Cabinet Room of the White House. You can read his report here. The report concentrates on agriculture perhaps because most farms have been unusually prosperous in the last few years. (Dairy would be an exception, of course.) The report goes through the numbers — the increasing exports, the higher prices, the expanding ag production.

The administration sees a number of factors it believes are important for continuing farm prosperity. For example, the report touts research as important to maintaining rural economies. The Obama administration is seeking $2.3 billion in its 2013 budget for ag research and development.

And exports. The U.S. runs a trade surplus in ag products and the administration says that is helped by new trade agreements. 

The administration also is asking the Congress to pass tax credits for the production of alternative fuels. And it is promoting "diverse industries," which end up being ag related: organic farming and "agri-tourism."

The report ends by saying it has "laid out a strategy for smart, cost-effective government action that could keep America’s agriculture economy in high gear for decades to come." (Please read it.) But it seems the report, if meant to be the Obama administration's view of rural America, ends way too soon. There is a heck of a lot missing. For example:

• There is little mention of education. (Almost none.) The Obama administration's "Race to the Top" education initiative has been criticized by many for being skewed against rural schools. (Sen. Bernie Sanders of Vermont made this point last week.)

There's no mention of Race to the Top in this report. Nor is there any discussion of how Title 1 regulations disadvantage rural schools.  There has been an ongoing effort to get this law changed — but there is no mention in this week's report. 

• Many rural counties are dependent on natural resources. People mine, log and drill. There is no mention in the report of coal or oil and gas in this report, and only one paragraph about forests. There are all kinds of safety and environmental concerns in gas, oil and coal counties — a score of coal strip mining protesters were arrested on Capitol Hill last week. And counties with logging on federal lands are struggling to keep funding for their schools. But there is no discussion of any of these controversies in the report.

• The report is all about agriculture — but there is no acknowledgement of what, at one time, was the administration's prime rural initiative: attacking market monopolies in the agriculture industry.

The Obama administration held half a dozen hearings across the country to collect testimony on potentially illegal market concentration in the seed, cattle, poultry, hog and grocery businesses. The Attorney General and the Secretary of Agriculture attended most of these hearings. Farmers and ranchers risked retaliation from suppliers and buyers when they gave testimony. 

The administration held the hearings and then took no action. It has done nothing in any of the areas covered by the hearings.

The administration also promoted new regulations under the Grain Inspection, Packers and Stockyards Act but they were never fully enacted. (The rules would have helped level the playing field between farmer-producers and buyers.) Congress blocked the regulations, but the full force of the administration never appeared to be behind the new rules. There is more about the average age of farmers than about meetings called across the country by the Attorney General and the Secretary of Agriculture.

Last week, former GIPSA administrator J. Dudley Butler wrote that the Obama administration had never followed through on campaign promises made to farmers and ranchers.

"(W)hile on a recent visit to North and South Dakota, ranchers often reminded me that during your campaign you made numerous promises about leveling the playing field to ensure the survival of rural America," Butler wrote last week in an article published in the Daily Yonder. "Independent farmers and ranchers were excited for the first time in a long time. To date, most of these promises remain unfulfilled, and many of these same farmers and ranchers now feel abandoned by your administration." 

• Neither has the administration yet made a statement about a farm bill that passed out of the Senate Agriculture Committee that does not contain any funding for rural development.  The administration's report lists the grants made to schools and medical facilities under the rural development title of the farm bill, but it does not mention that the rural development title is missing in the bill currently before the Senate.

The White House report was released the same day President Obama did interviews with eight news reporters from smaller market television stations touting the administration's success in rural America.



Out of touch?

As with most issues, this administration is simply "out of touch" with the people and "in the pockets" of corporations. The likely alternative is no better.


Yet another reason to effect change outside the partisan political arena and to lead by example and non-compliance!

In or Out?

Add rural health care as outside of the awareness of the past 32 years of administrations and Congresses.

Having the RN, MD, DO, NP, and PA workforce most specific for rural health care delivery is key. Ever greater specialization and centralization and concentration is the wrong way. No administration can afford the increasing costs for primary care incentives and primary care delivery costs for 200 million Americans left behind, especially 60 million in Rural America.

Most specific for rural primary care workforce is family practice MD, DO, NP, and PA. Family practice employed NPs and PAs have decreased to less than 25% for a career result for recent graduates. For primary care recovery and for rural primary care recovery, NP and PA graduates must be permanent in family practice result. Movement is the opposite direction across the class years and across the years after graduation. Family medicine is permanent but remains at 3000 annual graduates just as in 1980. The source most important for all populations left behind for over 100 years has been left behind for 32 years.

Investments of 250 million and another 200 million for primary care training in the past two years could have been specific to permanent family practice result. This was not the choice. The funds were non-specific to family practice and will only result in 30% primary care from the graduates supported - and even less family practice result. This did not prevent claim after claim of primary care result.

No leader of a political party or a health professional association has developed a design that will recover primary care. Without a move to primary care workforce recovery overall, rural and other underserved areas will remain even further behind.

The only source that can actually work for expansion has to be permanent in primary care result, because the support design is so bad that 50 - 80% of the graduates are driven away from primary care prior to entry into the workforce. The only source that can work is broadest generalist family practice, because this is, was, and always has been the only population based distribution source - the requirement for recovery for each population left behind.

Next time you see proposals that claim primary care or rural or underserved benefits all you need do is examine the proposal for 100% permanent broadest generalist result, or 100% rural result, or 100% underserved result. Less than 100% is a tipoff that the intervention is really about some other agenda.

When you design an intervention worthy of investment, you make sure it actually exceeds the best that currently exists - and then triple this for a worthy result. Slighly better with our current designs is a result that is just a little better than half enough.

Robert C. Bowman, M.D.

Exactly right....and the Postal Service

Bob is exactly right. And nobody know more, so read his post.

Also, we forgot the Postal Service.

What else needs to be on our list?