President Barack Obama has nominated a rural doctor from Gulf Coast Alabama to be the nation's next Surgeon General. Dr. Regina Benjamin (above with the President) is a rural Alabama family physician who operates a nonprofit medical clinic along the Gulf Coast, makes house calls and accepts every patient who comes to her door. Benjamin is 51 and lives in the shrimping community of Bayou La Batre. She became the first black woman and the first doctor under age 40 elected to the American Medical Association's board of trustees, and in 2002 became the first black woman to head a state medical society.
Dr. Benjamin saw her clinic destroyed by Hurricane Katrina and, once it was rebuilt by volunteers, watched it destroyed by fire. She rebuilt the clinic, telling the story of a patient who handed her an envelop containing $7 for the effort. "If she can find $7, I can figure out the rest," Dr. Benjamin said. Benjamin received $500,000 in a MacArthur Foundation "genius award" that she used to help rebuild the facility. She must be confirmed by the Senate. She is the highest-ranking rural resident in the Obama administration.
The Blue Dog Democrats (Democratic House members more fiscally conservative than the rest of the party) have said they want "significant changes before they can support a sweeping health care overhaul," according to the Associated Press. In particular, the Dogs want changes that will benefit rural communities, doctors and, in particular, hospitals. The Blue Dogs (there are 52 of them in the House) say they can't vote for the health care reform bill that is currently being discussed.
You can read the letter from the Blue Dogs here. The letter says any health care reform needs to be cheaper — that or savings need to be found in the current system. They say the current bill "fails to include adequate structural changes that will succeed in lowering costs and increasing value." You can't just add new people to an overly expensive system.
In particular, the Blue Dogs demand "rural health equity." In a letter to House Democratic and Republican leaders, the Dogs write: "Rural communities face unique challenges in delivering health care, and our reform efforts must not overlook them. The short-term extensions of rural provisions included in the discussion draft are critical, but we must not fail to address the underlying problems and inequities that plague rural providers. A strong rural package is critical to our support."
Rural men and women are more likely to be pulling the night shift than are urban workers. So finds a new study from the Carsey Institute, at University of New Hampshire.
Sociologist
Rogelio Saenz studied when workers, metro and non-metro, arrived at the
job. He found that rural people were over-represented in
non-traditional shifts; a higher ratio of rural workers clocked in
after noon and before 6 a.m.
Saenz further found that white
workers were proportionally most likely to be employed during the
“traditional” work hours, whereas “those who tend to be more marginally
tied to the labor force (persons of color, the foreign-born, those with
English-speaking limitations, and the poor) tend to be more likely to
work during the early morning, afternoon, and evening hours."
Saenz
notes that people on second and third shifts may be deprived of
“normal” social opportunities – like school activities and access to
health care and day care.
There is also mounting evidence that night-shift workers have a greater incidence of cancer and other illnesses.
North Dakota Sen. Kent Conrad (above) is reaching into rural America's past to find a solution to the nation's health care problem. (Health care in this country costs too much, has only mediocre results and it leaves 45 million with no coverage at all.) Conrad suggests creating health care co-ops to compete with private insurers. "Mr. Conrad said his proposal stems from his experience with the rural electricity, farming and telephone co-ops in his state that are owned and run by members," according to the Wall Street Journal.
There aren't many details to the co-op scheme, although it is gaining favor among Senate Democrats. The notion is that the co-op would sell insurance to small businesses or individuals, who would then become part owners of the entity. These co-ops would negotiate rates and maybe even hire some of their own doctors.
There are those who don't think much of the idea. They point out that the Blue insurance companies started out as non-profits. Half of all people covered in the U.S. are in non-profit health plans, says another critic, yet there is no difference in prices. Another criticism might be that electric co-ops aren't always great for consumers either. The leaders of a large Texas rural electric cooperative were indicted for arranging payments of co-op money to relatives of co-op executives.
The McCook (Nebraska) Daily Gazette opined this morning: "The president is asking us, especially those of us in rural America, to take a giant leap of faith." President Obama spoke about health care this morning, outlining his thoughts for reform. The Nebraska editor has questions for the new President, who says he can cut what the nation currently spends on Medicare and Medicaid:
"Medicare and Medicaid already reimburse doctors and hospitals 20 to 40 percent less than private insurance rates, and the health care providers raise rates for patients with private insurance. Recent studies say that amounts to $89 billion more per year, or an extra $1,800 per family that those with private insurance have to pay for those on Medicare and Medicaid. Making up for the under-reimbursement for Medicare and Medicaid have been a long-term struggle for rural Nebraska hospitals, and the idea of cutting those payments still farther is incredible.
"Expecting the mutually exclusive idea of 'government efficiency' to make up the difference in time to keep a number of rural hospitals from going out of business is beyond belief. Judging from the distribution of stimulus funds, what guarantee is there that rural Nebraskans won't be forced back into the old trap of having to travel to Omaha or Denver to receive the latest in medical care? And, judging from the experience of Europe or Canada, what guarantee do we have that we won't have long waits for rationed health care, especially from specialists? An ex-Nebraskan now living in Australia compared that country's health care system to America's -- 20 years ago.
"Rural America will have to be on its guard to avoid being shortchanged in health care reform."
The good thing about rural America is that people make their own way. It's a place where small business thrives. Then again, the bad part about rural America is that more people work for small businesses, which, in this country, means that fewer people have health insurance. National Public Radio's Howard Berkes reports, "Half of all jobs in rural places are tied to small businesses, a rate 13 percent higher than in cities and suburbs. And people who work for small businesses are twice as likely to be uninsured, according to Jon Bailey of the Center for Rural Affairs in Lyons, Neb....Also common in rural areas are farmers and ranchers, who disproportionately depend on individual insurance plans."
"Health insurance is killing rural America," farmer Linus Solberg (above) told Berkes. "Because people just can't keep up and pay their bills. And that shouldn't be in America. "We can put people on the moon," he said. "We can go up and fix this Hubble satellite that we have up there. And we can't have health care for all these people. It's ridiculous."
As the nation begins a long debate about the future of health care, little has been written (or spoken) about the special needs of rural communities. Berkes sheds some light on why the health care discussion needs to have a special place for rural Americans.