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.
"Don't worry about the insurance companies," David Pearson said. Insurance companies are going to do just fine. But rural hospitals ought to be worried about the various health care reform bills now before Congress, said the president of the Texas Organization of Rural and Community Hospitals (TORCH). "Right now, we're barely getting by."
Pearson was talking to a meeting of the (really good) Texas Rural Innovators Forum about health care reform. He said the small hospitals TORCH represents aren't supporting any of the bills now being considered. (Pearson noted that none of the bills addressed access to health care, a primary concern in rural America, which has lost hundreds of hospitals over the last generation.) He did say rural hospitals have several concerns. For example, Pearson said rural hospitals aren't funded the same way as urban hospitals. Any change in funding needs to treat rural and urban hospitals with that in mind. Rural hospitals also treat undocumented workers when they come for care. Most of the bills currently under consideration cut funding for treatment of immigrants. Immigration policy shouldn't be resolved by a health care bill, Pearson said.
If there is a public plan, Pearson said, it needs to pay at least as much as Medicare or rural hospitals won't be able to provide care. Finally, Pearson said that any oversight board established in new legislation ought to be required to have rural representation. "Rural is unique," Pearson said, "and we're worried."
To prove that everything can become a conspiracy, the Washington Post reports this morning that a resistance is building to H1N1 flue shots. Some states and many hospitals are requiring health care workers to get a vaccination — and many workers are resisting. The trend toward mandatory shots is growing because a low percentage of health care workers get vaccinated each year, and because institutions are worried about what will happen if the H1N1 virus spreads widely.
On the other hand, however, people don't want to be told what to do. Many don't feel like the shots are safe. One third of British nurses surveyed said they would avoid the shots for safety reasons. And in the U.S., people don't want a shot because it comes from the government. "You start with health-care workers but then expand that umbrella to make it mandatory for everybody," said Lori Price of Citizens for Legitimate Government, a Bristol, Conn.-based group that opposes government expansion. "It's all part of an encroachment on our liberties."
Meanwhile, the federal government plans to buy enough vaccine for every American, like it or not.
An Associated Press investigation has found widespread contamination in the drinking water at schools. The contamination was "most apparent at schools with wells, which represent 8 to 11 percent of the nation's schools," the AP reported. "Roughly one of every five schools with its own water supply violated the Safe Drinking Water Act in the past decade, according to data from the Environmental Protection Agency analyzed by the AP." We suspect that most schools using well water are in rural communities.
The AP reports that in "California's farm belt, wells at some schools are so tainted with pesticides that students have taken to stuffing their backpacks with bottled water for fear of getting sick from the drinking fountain." There are 132,500 schools and those with unsafe water represent only a small percentage of those. California had the most violations, followed by Ohio, Maine, Connecticut and Indiana.
The AP said the problem of tainted school water has "gone largely unmonitored by the federal government." "It's an outrage," said Marc Edwards, an engineer at Virginia Tech University who has been honored for his work on water quality. "If a landlord doesn't tell a tenant about lead paint in an apartment, he can go to jail. But we have no system to make people follow the rules to keep school children safe?"
The Indian Health Service spends less on health care per patient than the federal prison system. Some tribes have supplemented this low rate — only to have the IRS tax the benefits as income.