Roundup: The Distribution of Doctors

Doctor shortage may be a myth • Religious battle over interstate advertising • Health co-op in financial trouble • Update in Racoon River fight • The value of video stores • Farmers were the original foodies

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The folks at Vox look at a new report by the Institute of Medicine that says there is "no credible evidence" of a doctor shortage in the U.S. But there is definitely a “distribution problem.”

On the geographic distribution issue — that physicians aren't going where they're needed most — there's quite a lot of consensus. Physicians are normal people who are drawn to attractive places to live, just like everyone else. But it's more than that: doctors who live in wealthy communities are often paid much more handsomely.

"Right now Medicare pays more to providers who work in more expensive areas — providers who work in Manhattan get more than providers who work in Milwaukee," [Harvard economist Amitabh]

Chandra said. "Maybe what you want to do is offer additional payments to physicians working in underserved areas."

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Last year Chipotle Mexican Grille said it couldn’t get enough grass-fed beef in the U.S. and added Australian suppliers. Now the Mexican-food chain has suspended serving carnitas at 600 restaurants because it says it can’t get enough “responsibly raised” pork in the U.S.

The New York Times reports:

The fast-growing restaurant chain announced on Tuesday that it had suspended a major pork supplier after a routine audit found that it had failed to meet the company’s standards for animal welfare. “Without this pork, we cannot get enough pork that meets our Responsibly Raised standard for all our restaurants, and we will not be able to serve carnitas in some locations,” Chipotle said in a statement, referring to its standards for the humane treatment of livestock.

Another provider has upped its supply of pork to the chain to help make up the shortfall, and the restaurant says it’s recruiting additional hog farmers, according to Business Insider.

The company currently oversees 700 farmers who must follow strict guidelines for raising pigs, such as feeding the animals a vegetarian diet and giving them access to the outdoors.

"We would like to double the number of farmers over the next couple of years," Tripician said. "Though we have demand now that would even exceed us doubling the farmers."

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Anyone who lives in, or has road-tripped through, the South has seen religious billboards and monuments: huge white crosses, Bible verse admonishments, etc. Now a new player is getting into the game. Atheists are filling billboards with messages to counteract their spiritual counterparts. The problem with this media war, argues The Daily Beast, is that the war itself is useless.

The rural Southern political billboard is… a surefire way to force others to witness your own self-satisfaction but an ineffective way to accomplish anything other than that. These billboards and roadside displays aren’t a form of rhetoric so much as they are what Walt Whitman might call “barbaric yawps,” inchoate assertions of presence in the wilderness.

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CoOportunity Health, one of the Obamacare medical-insurance cooperatives thought most likely to succeed, is in danger of shutting down due to its “hazardous financial condition.” The company is no longer taking applications and expects most of their clients will find other health insurance by the February 15 enrollment deadline.

About two dozen such co-ops have been set up nationally. One of the main goals was to provide choices in states, such as Iowa, where the health-insurance market was dominated by one or two carriers. CoOportunity was initially seen as one of the co-ops most likely to succeed. That was largely because its founders included David Lyons, a former Iowa insurance commissioner, and Gold, a former executive at the state's dominant carrier, Wellmark Blue Cross & Blue Shield.

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This week, Iowa Governor Terry Branstad told The Des Moines Register that “Des Moines has declared war on rural Iowa,” in response to Des Moines Water Works’ plan to file a federal lawsuit against three rural counties in Iowa over water quality in Raccoon River. 

The Des Moines Water Works Board voted last week to sue officials in Sac, Buena Vista and Calhoun counties, targeting several drainage districts that feed into the North Raccoon River. Weekly samples taken from the river in Sac County since March have shown high concentrations of nitrates, utility officials said.

Graham Gillette, chairman of the Water Works Board, said last week that the lawsuit is not aimed at seeking damages. The board is concerned about protecting Iowa waterways, he said.

Gov. Branstad called for a more “collaborative approach.” 

Branstad suggested one of the solutions to the nitrate problem could be improving access to broadband services in rural Iowa to permit farmers to use precision agricultural practices that reduce overuse of chemicals and fertilizers. Another is the use of filter strips and other farm conservation practices. He supports the state's nutrient reduction strategy, a voluntary initiative aimed at reducing nutrients from surface waters that flow into Iowa's streams and rivers and eventually to the Gulf of Mexico.

"We are very ready and willing to sit down with the people from Des Moines Water Works and look at how we can get together and work with them," Branstad said.

The presence of nitrates raises to the cost of treating drinking water. Agriculture is a major source of the nutrient in surface water.

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Unicorns. Pot of gold at the end of the rainbow. Mom & pop video rental store. Only one of these things is real, but only barely. For a long time, a physical, brick-and-mortar video shop was nearly a guaranteed success, especially if, like stores in my hometown, they combined forces with a tanning salon. Seemingly overnight streaming video, led by Netflix, put many of these stores out of business. Even the behemoth Blockbuster fell.

But there are still some folks still fighting the good fight. The Chattanooga Times Free Press found a few shop owners still serving the folks in their community not satisfied with the typical Redbox offerings.

"The video store business used to be a really good business," says. "Now it's not one you can depend on to make a living if you have big bills without having something else with it, but it still does good."

Even the arrival of Redboxes to neighboring Dunlap, Tenn., and the rise of streaming media haven't managed to sound the death knell for the Haskins. Quite the contrary.

The convenience of the newly installed kiosks initially wooed away a few customers, Hankins says, but many of those attracted by the siren whir of its automated dispenser have since come back.

"Most of them didn't like having to put their credit or debit card in there and not being able to read the back of the box to find out what the movie is about," she says.

 

— Shawn Poynter

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Alan Guebert, writing for the Mitchell Republic, claims that people raised on farms are accidental foodies.

Most of the ingredients these professional-amateurs used in our breakfasts, dinners and suppers came either from our farm and garden or were purchased — hogs, peaches, roasting hens, eggs, apples and such — from neighbors within 10 miles of our kitchen table.

So, in almost perfect ignorance, we ate farm-to-table, our farm to our table, for decades. We were foodies, indeed, and "locavores" to boot, long before anyone on either coast cooked up either word or concept.

If you grew up on a farm or a ranch two or more generations ago, you, too, were a foodie and locavore because, back then, rural food leaned more on home butchering and canning than grocery-getting and buying. Eating local was more about what you had on hand, not what you carried home from town.

 Being a foodie before being a foodie was cool is so hipster it hurts. 

 

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