Dr. Warren Albrecht | United States
Imagine if Barack Obama said during the debates with John McCain in 2008 that people in rural America “struggle with experiences in areas of life that carry major consequences, including financial insecurity, housing problems, trouble accessing affordable, quality health care, and a lack of high-speed internet access”. One would think that the Bush presidency was a failure. But this quote is indeed the summary of Life in Rural America, Part 2. Obamacare is indeed the failure.
The US News and World Report and others including the American Medical Association have publicized the findings of a series of polls performed by the cooperation of the Robert Wood Johnson Foundation, National Public Radio and The Harvard T.H. Chan School of Public Health. Reading through the press release or other publications, problems with healthcare seem to be the take-home message.
The poll, Life in Rural America, is a two-part series with Part 2 released in May 2019. The poll is conducted to review different issues in Rural America including an opioid epidemic, addiction, healthcare (Obamacare) and the economy. The press release heading is,
Poll: Four in Ten Rural Americans Report Problems Paying for Medical Bills, Housing, or Food; Majority Optimistic About Having an Impact on Improving Their Communities
Further, the poll data was also divided into subsets for native Americans and blacks. Though blacks constituted 8% of the people surveyed, 52% of blacks said their families have had problems paying for medical, housing, or food bills. 45% of blacks in the survey said their quality of life in small communities “fair to poor”. That is an interesting finding when compared to the rest.
Obamacare in Rural Areas
Pertaining to rural healthcare the poll states,
Though most rural Americans have health insurance [through Obamacare], about one-quarter (26%) have not been able to get health care when they needed it at some point in the past few years. Nearly one in ten rural adults (8%) say hospitals in their local community have closed down in the past few years.
More than 90% have local hospitals, but any specialized treatments mean unavoidable travel. Rural towns need working young to middle age people. The hospitals need to be able to support medical procedures to reduce travel to larger tertiary care facilities. The opportunity for rural entrepreneurs needs to grow. The failure of Obamacare has stunted the growth of this market.
Many try to document the big reason for closing rural hospitals is that some states did not expand Medicaid. Becker’s Hospital Review is one of these. But you still need patients with Medicare and Medicaid to walk through the door. Rural hospitals support the community with well-paid jobs. Support the community with job possibilities and Small Town, USA survives.
Failure of Medicaid and Medicare
This was prophesied in The American Spectator,
In 2009, the industry agreed to support Obamacare by accepting $155 billion in cuts to their Medicaid and Medicare payments in exchange for a promise that “reform” would flood hospitals with millions of newly insured patients whose coverage would offset the concession. Predictably, Obamacare fell short of its goals and 97 percent of its enrollees were dumped into Medicaid, which pays hospitals well below the cost (cost, not charges) of treating patients covered by that program.
So even with Medicaid expansion, the rural hospitals with perhaps now the oldest and sickest patients would be the least governmentally reimbursed. Insurance competition with a variety of health insurance options is what was needed. As pointed to by National Review, “Coverage is not access”. Many physicians are not accepting Medicaid or limiting patients in their practice with Medicaid. Medicare is failing. The usual example of this is the figure:
The average two-earner couple pays about $150,000 over their lifetime in Medicare taxes and premiums, while collecting almost $450,000 in benefits.
Medicare will bankrupt our system. We have not had anything near a free market in healthcare since the American Medical Association. The AMA created along with Blue Cross Blue Shield coverage. If the patient writes the check, then it is a free market. Otherwise, the government is in control.
Telemedicine, A Hope Lost
Under Medicare.gov, for Telemedicine, one would still pay 20% for the doctors’ bill minus Part B deductibles. This is after the Affordable Care Act has been the law for almost a decade. I expected Obamacare to save money. Medicare still has many restrictions which makes providing Telemedicine impossible. A problem is the hospitals or clinics pay for the investment for Telemedicine and have no better reimbursement or worse. Also, without adequate broadband service, the Telemedicine is poor.
The poll shows,
About one in five rural adults (21%) say accessing high-speed internet is a problem for their family. Among rural adults who use the internet, a majority say they do so to obtain health information (68%), for personal finance (61%), and for work-related activities (54%).
That shows 80% have adequate internet, but if greater than 50% use it for daily family living or work, then expanding this could be the key to bring small companies and people working from home to the rural communities.
In a white paper about developing broadband networks, the American Enterprise Institute concluded,
The menu of choices for policymakers is relatively simple: if we want a dynamic broadband marketplace in which citizens enjoy high-performance networks at reasonable prices, it is necessary for regulators to be humble enough to allow the competitive dynamic to unshackle human ingenuity.
The Real Conclusion
82% of surveyed adults described themselves as working-class to middle-class. Many of these voters originally supported Barack Obama, but who gave Donald Trump the win over Hillary Clinton. All we have to do is listen to what they are telling us.
One of the key findings of the poll is,
When asked what was the most important thing that could be done to improve their health, more than a third (36%) of rural adults identify options related to fixing health care, including improving access, quality, and reducing costs.
In 2017, the Washington Post/ Kaiser Foundation poll was reviewed in the Washington Post. This looked at rural America and a population which supported Donald Trump over Hillary Clinton. I interpreted the Washington Post poll as searching for why rural America does not support Hilary Clinton.
Rural Americans also are broadly skeptical that the federal government is fair or effective at improving people’s economic situations. More than 60 percent say federal efforts to improve living standards either make things worse or have little impact.
Politicians and mainstream media will try to use The Life in Rural America poll to show that Donald Trump is failing the rural communities. But if one truthfully looks at the questions and results, one must conclude that Federal Government services have been failing for decades and the pinnacle of President Obama’s legacy, The Affordable Care Act and Obamacare have failed rural America. One could even say more specifically rural black America. Listening to the candidates for President in the Democrat Party and President Trump, there is little hope for change in the near future.
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