Healthcare Advocacy - Rural Healthcare - Hot Mess

January 3, 2023

Jan 03, 2023

Healthcare Reform

January 3, 2023

Good Day Healthcare Advocates

Happy New Year to all of you Healthcare Advocates. Every day that we learn, grow and advocate for better healthcare for all of us is a good day. Thank you also to all of you advocates who have recently subscribed.

I want to also thank Jessica Cravens who writes Chop Wood, Carry Water for using one of our calls to action regarding the ACO-REACH attack on Medicare in her publication. You can read her daily newsletter and help save democracy here.

Many of you have suggested topics for us to research and present and several topics, such as reproductive care, rural healthcare, and prescription insurance are underway. Please send me a comment using the button below, to suggest topics and thank you.

Mission

The Healthcare delivery system in the United States is a patchwork that leaves much to be desired. It is the most expensive system among the top 35 industrial countries and covers far fewer participants delivering lower levels of quality care than many of our peer nations. This blog will provide:

Current problems in healthcare
Actions you can take
References.

Current State of Affairs – Rural Healthcare – A Hot Mess

About 50M people or 15% of the country lives in rural areas and they are facing significant healthcare challenges. These include lower life expectancy and worse outcomes than more populated regions. There are also more elderly people, increased behavioral health issues and more chronic diseases than in urban areas.

Specifically, there are fewer primary care doctors, urgent care facilities, labs, and hospitals in rural America than in urban areas. And the population suffers for it.

As an example 180 hospitals have closed in rural America in the last 14 years leaving huge gaps in care. Most point to financial instability of the hospitals due to a lack of insured patients. According to the US Census Bureau, the number of patients without health insurance in the US is about 9%. The number of uninsured in rural areas is 14.9%. Additionally, new laws allow people to purchase high deductible policies to cover emergencies but since the deductibles can be more than $10K many people do not seek care. So the population is not able to financially support enough hospitals and healthcare suffers. If we were supporting hospitals based on population size and not the number of insurance policies we wouldn’t have this problem. Think Universal Healthcare.

As an aside, it is worth noting that 12 states did not expand Medicaid and as a result the rate of hospital closure dramatically increased. The Commonwealth Fund analyzed this and found that the Medicaid expansion would have cost those states very little because there would have been a larger pool of patients and thus practitioners and thus a bigger tax base that would offset the expenditures. Sigh.

There is a similar situation for primary care. Wages are lower in rural areas and usually people who choose to practice in a rural area grew up there. Still there are large distances between patients and practitioners.

What can be done? 20 bills were presented to the 117th Congress to address such issues. 2 passed. They were the American Rescue Act 2021, and the Consolidated Appropriations bills of 2022, 2023. They helped with COVID and some infrastructure but there is not enough in them to fix the problems.

There are a variety of solutions to these problems but we need to address them systemically, not apply bandaids to each wound as it is discovered. Here are a few:

Telemedicine can help but you need to have broadband/cellular access which is not always available. Broadband access everywhere is just a key infrastructure everyone needs.
- Common medical records readily available will also facilitate better telemedicine. Other countries have this now.
Immediate 1st level tests and imaging would help telemedicine work better.
- Could be done by a traveling practitioner, local labs, or with home tests fedex’d to a lab - all of these can be done now.
Instead of new hospitals, convert some community centers to medical centers staffed by physician assistants and nurses who can triage/treat and allow mobile surgery teams on a circuit to handle most surgeries that can be scheduled (non-emergency)

These are just a few ideas. There are programs that are available for communities to work on these kinds of solutions. See references below. But funding is still needed.

Part of the problem is that financial viability is dependent on the number of insurance policies in a community, not the population in the community. That’s why HR 1976 “Medicare for All” is needed because it contains capital improvement funding for such projects in rural medical deserts.

What You Can Do – Contact Legislators

Contact Elected Officials (see references below for contact info). I will get an automated system up and running soon.

“My name is __________________(name) and I live in __________________(zipcode) and I am your constituent. We all deserve a healthcare system that works for all of us. We need Universal Healthcare like HR1976 now. And while you’re at it we need to expand the infrastructure needed to implement it. That includes more providers in rural areas (think of debt forgiveness in exchange for rural service), support for infrastructure improvements like more broadband coverage, and of course accessible medical facilities at all levels. I and 50M Americans are counting on your help. Thank you.”