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Health care in rural areas

Our rural areas might be the canary in our health insurance coal mine. Today's Denver Post has an article describing how some rural physicians in Colorado are beginning to take single-payer national health insurance seriously:

A Nebraska-bred country boy, a Republican- voting, ranch-owning, small-town doctor, he hardly fits the profile of a wild-eyed revolutionary. But White and a handful of cohorts are, in fact, trying to foment upheaval.

The revolution they are proposing: a national health-insurance program. Nothing short of that will fix what White calls "our god-awful broken system." White says he didn't jump to this conclusion. He was pushed.

Pushed by the same forces that plague health care across the country: steep insurance premiums; soaring prescription-drug costs; 45 million Americans without health insurance; bureaucracy; and Medicare and Medicaid reimbursements that don't cover costs.

The problems facing rural areas are fundamentally the same as those facing urban and suburban regions. The growing number of uninsured patients drives up the costs of health care for patients with insurance, and simultaneously drives down reimbursement rates to physicians and hospitals (the so-called 'death spiral'). The only winners in our current system of private health insurance markets are the big nationwide insurers like Aetna.

Rural areas, with their stripped-down roster of players in the health-care industry (employers, insurers, hospitals, etc.), differ from the rest of the country only because it's easier to see what's going on. The pool of wealthy patients that can afford to pay their ever-increasing health care insurance premiums is smaller in rural areas. Fewer people in rural areas can afford to indulge their ideological preferences as a means of postponing the ultimate confrontation with the problems of our private health insurance system (and with the problems of our public insurance systems, Medicare and Medicaid).

We might hope that rural America might begin to push for national health insurance, but I remain skeptical. Rural support for George W. Bush suggests that we shouldn't underestimate the power of ideology to override common sense. Patients will continue to lose their insurance, insurers will continue to leave rural markets altogether, physicians will continue to see their reimbursements shrink and will themselves continue to relocate to more lucrative locations, hospitals will continue to close.

Based on what we've seen in the last elections, though, none of this will matter. The power of the AM-radio demogogues will keep our rural population in thrall to the extreme free-market ideology that's responsible for their health care woes. And the Democrats won't offer any real alternative, so long as they allow themselves to be led by the Clintonesque DLC under the leadership of people like Al From.

Our rural areas may be our health-care canaries, but they're not going to be our health-care saviors.