RURAL ROUTES/Margot Ford McMillen

Republican Inaction Leaves Rural Hospitals Endangered

Just a couple of weeks ago, the community hospital in my county seat announced that it is closing. Please note that, for a rural county, local health care is one of the most important services that can be provided.

While cities may think they can take hospitals for granted, and even provide choices backed by universities, churches or private industry, rural places can’t. And, even in the largest, most prosperous cities, independent hospitals are in trouble. Less than two weeks after the announcement of our hospital closing, two big hospitals in Columbia said they are exploring a merger.

Not that most diseases are treated on the basis of choice. When a doctor says, “You need regular treatments,” you go where s/he sends you. And if it’s your kid that needs the treatment, well, you know the rest.

Our county isn’t alone. Back in 2014, USA Today reported that 43 rural hospitals had closed in the previous three years, and that the pace was quickening. Ambulance services are equally in danger, and if the county can’t provide it, private providers step in with predictably higher prices. Hospitals like ours cited especially the cost of treating indigent patients who put off seeking care until they are really sick. Since a hospital can’t turn away a patient, the costs are part of the red ink at the end of the year.

When we heard about the closing, a shock went through the county. The hospital had been in trouble before, but there had been time to react. Back in the 1980s, the building, second in Missouri to be built when a state law allowed counties to own hospitals, was in bad shape. A committee was formed, a bond issue passed, land purchased, a new building built and the medical community moved forward. The old building was converted to low-income elder care.

This year, it’s different — there was no warning. Somehow, the newspaper and even the local business leadership had lost touch. The hospital had been partially privatized — run by a for-profit company from Georgia. Then, it was partially sold to the university and, again, run by outsiders. The situation in Columbia suggests that the pattern could be repeated.

No doubt about it, the demise of our local hospital will be expensive for citizens, and for the state. Our town is home to a state prison and a state mental hospital. Those populations had depended on the community hospital for X-rays, lab work and some treatments; now, personnel will have to drive them to hospitals at least 30 miles away. Local industry includes a nuclear power plant way back on a winding county road, a heavy equipment manufacturer, a gigantic warehouse, two small colleges, and several nursing homes. Again, the loss of a local hospital means more expenses for those folks.

Worst of all, our 12,800 town residents will have to travel, taking with them the money that would have gone into the local economy. And, there are two independent pharmacies, a Walgreen’s and a big box store where prescriptions are filled. Common sense says that if you go to the doctor in another town, you’ll get your prescriptions there. And what about the offices for physicians, nurse practitioners, physical therapists, and laboratories?

The employees are devastated. Not only have they lost their jobs, but the work gave them community status. From doctor to janitor to groundskeeper, they were part of a team. As one account manager told me, “It was MY hospital. I was born there. I love it.” She blames the out-of-town management.

Others blame the state legislature, which has stubbornly refused to vote for Medicaid expansion in Missouri. Medicaid expansion would have brought federal money in to pay some of those bills for indigent folks, but the legislation was blocked with arguments that, somehow, mystifyingly, Obamacare had caused high medical bills. Note that when Hillary Clinton mentioned Medicaid expansion in a campaign speech in Kansas, the governor changed his “maybe” vote to a firm “no.”

But maybe there’s hope for the future and, thank you, John McCain, for your July 28 fake-health-care-program no vote. Based on all your tendency to stick with the R’s when it came to repealing Obamacare, we didn’t expect it and we’re grateful. Maybe your cancer diagnosis has made you understand how critically important it is for someone to have your back when times are tough.

You and your colleagues have good health care, partially covered by government money, AND you’ve had a chance to sock away money for emergencies in a Health Savings Account. Few of your fellow citizens have had the money to do that. And so, when most of the estimated 23,800 new cases of glioblastoma are diagnosed this year, those folks might not even receive treatment. More than a factor in the type of care, cost is a factor in whether a person gets care at all.

So, how do we fix this mess? Truly, single-payer health care might save hospitals and ambulance services. But before the Republicans can embrace single-payer, they want to argue their way through mean-spirited alternatives like Repeal-And-Not-Replace.

In the meantime, even if single-payer gets traction, it’s too late for my county.

Margot Ford McMillen farms near Fulton, Mo., and co-hosts Farm and Fiddle on sustainable ag issues on KOPN 89.5 FM in Columbia, Mo. Email: margotmcmillen@gmail.com.

From The Progressive Populist, September 1, 2017

Populist.com