We see this over and again: An assertion that people in rural America have less insurance than those living in the cities. This statement of "fact" appears in reports and in speeches. Most recently, U.S. Secretary of Agriculture Tom Vilsack said that "there are significantly higher number of uninsured people as a percentage of population in rural communities." 

Is Vilsack right? Well, no, he isn't. The Yonder analyzed the most recent Census figures and found that the percentage of people under the age of 65 without health insurance is HIGHER in URBAN America than it is in rural.  For some reason the exact opposite is reported time and again. Most recently, the Center for Community Change issued a report finding (according to a summary) that "rural areas have the highest proportion of both uninsured and under-insured." Folks that just ain't so — at least the latest official data comes to the exact OPPOSITE conclusion. Surely too many people are without a way to pay for health care, but it's not a problem that's any worse in rural America than it is in the cities. 

Why would Secretary Vilsack be so far off base? All he has to do is go down the hall to his Economic Research Service which released a report on rural health care in the last month. The ERS found that rural people have health problems — higher rates of mortality, disability and chronic disease than in the cities. But the ERS also found, like the Yonder, that metro and non metro rates of health insurance coverage are the same. 

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.

Most people get their health insurance through their jobs. But having health insurance appears to be related more to income than to employment.

A renowned family physician explains what the rural outcomes of proposed health care reforms are likely to be. Take a deep breath.