Letter From Langdon: Health Care System Not Built for Rural America
Source: Health Resources and Services Admin. (April 2007) via raconline
Rural economies have plenty to shoulder when it comes to toting the load. One of the biggest loads is health care.
In Rural Missouri, as in rural areas in other states, it seems there are two different classes of citizens when it comes to health care. Public servants, many of whom are employed by states or the Federal government, have at least partially funded health care plans, most with low deductibles. Likewise, workers for large businesses also enjoy health insurance, but most will tell you that wages are kept low due to the cost of health coverage. Workers are forced to trade health security for adequate wages.
Farmers and shopkeepers who own their own businesses have to provide 100 percent of the cost of their health care, just like most minimum wage workers. With a single visit to the doctor’s office costing $60 or more, and treatments that can total tens of thousands of dollars, you have to wonder how low-income parents can provide adequate health care for their children, let alone themselves.
One way that they can afford it is because most small town hospital administrators say no one is turned away based on their ability to pay. Contrast that to the specialty hospitals in big cities where payment is discussed before treatment begins. Small town hospital administrators will tell you that competition from big hospitals limits the number of insured patients they have the opportunity to treat, even as big hospitals shift responsibility for patients with limited resources back to small local providers.
The lack of care for so many people has led to some novel approaches. The Missouri School of Religion-Center for Rural Ministries in Jefferson City trains nurses to act as health counselors, educators, advocates, volunteer coordinators and integrators of faith and health. Parish nurses work as volunteers or as paid staff members, but their ability to treat illness is limited.
Doctors, small hospitals, and even rural ministries try to do what they can; after all, their primary goal is to provide care to their neighbors. They team up to share equipment and personnel in ways that will allow them to remain financially and professionally viable. That helps, but a national plan for health care that eliminates haves and have-nots of health care seems like a good method to join rural America with urban America.
That’s not happening, either in Missouri or nationally. The administration of Missouri Governor Matt Blunt has tightened eligibility rules for Medicaid and the state sponsored health insurance for children of low-income families, turning away nearly $1.2 billion in Federal aid as a result. Most of that money is already in the Federal budget so whatever Missouri doesn’t spend is redirected to other states. The current Bush Administration plan to reduce eligibility for children’s health insurance recipients seems to be directing what happens in Missouri.
It’s going the wrong direction for rural America. The Administration’s plan shifts still more of the burden of health care on those least able to support it, namely wage earners, the self-employed, and their beleaguered small town health care providers.
For a nation that prides itself on life, ahead of both liberty and the pursuit of happiness, a policy of health care for all would seem mandatory.