Thursday, April 13, 2017

Rural America's Dying Hospitals

Congressional Republicans are talking about taking a second swipe at "repeal and replacement" of Obamacare.  What's frightening is the reality that in order to attract the votes of the misnamed "Freedom Caucus" - i.e., extreme right wingers who oppose any government spending on healthcare - any proposed bill would be even more horrific than the "American Health Care Act" that Paul Ryan pulled from consideration.  Meanwhile, (i) Donald Trump, a/k/a Der Trumpenführer, is threatening to sabotage Obamacare, and (ii) Republican controlled state legislatures (including Virginia's) are refusing to expand Medicaid under Obamacare.  The result?  Hundreds of thousands, if not millions of Americans nationwide, continue to lack healthcare coverage and their numbers could sky rocket. But individuals, including children, are not the only victims of GOP intransigence.  There are other victims dying financially: rural hospitals are particularly at risk of closure.  A lengthy piece in the Washington Post looks at what is happening in a poor rural area in Tennessee.  Similar stories are taking place elsewhere, and as numerous hospital associations have warned, rural areas of Virginia may soon be joining regions that no longer have hospitals.  Combine the reactionary nature of many rural areas that is a disincentive to new, progressive businesses with lack of hospital services and the downward economic spiral will likely accelerate.  Here are highlights from the Post article:
This town of the Tennessee Delta, seat of a county that once grew the most cotton east of the Mississippi, relied for decades on a little public hospital built during the Great Depression a few blocks from the courthouse square.
The red-brick building was knocked down in the 1970s when a for-profit chain came along and opened a modern stucco hospital on the north side of town. There, thousands of babies were born, pneumonias and failing hearts were treated and the longtime family doctor across the parking lot could wheel the sickest patients who arrived at his office right into the emergency room.
But these days, plywood boards are nailed up behind the hospital’s sliding glass entrances. Black paint is smudged across signs over its doorways. The nearest ER is more than a half-hour ambulance ride away.
The demise of Haywood Park Community Hospital three years ago this summer added Brownsville to an epidemic of dying hospitals across rural America. Nearly 80 have closed since 2010, including nine in Tennessee, more than in any state but Texas.
In every rural community, the ripple effects of a lost hospital are profound, reverberating beyond the inability of would-be patients to get immediate care. Many of the best jobs in town vanish. Local leaders trying to recruit new industry face an extra hurdle.
Haywood County’s budget has become a twisted mess as demand for the services of its ambulance authority has ballooned. “The emergency room now is the back of an ambulance,” said Bill Rawls, who grew up in Brownsville and was sworn in as its first black mayor the month the hospital closed. . . . Rawls is struggling to bring at least an emergency room back to Brownsville. In his office in the small city hall adjacent to the fire department, he has a letter from a woman whose 8-year-old nephew was playing in the family driveway on a late winter morning last year when their Dodge sedan rolled backward, pinning him under a tire. Without a hospital in town, she explained, “needless to say he did not make it.”
The Affordable Care Act has not gained much ground here. In 2016, just 664 Haywood County residents bought health plans through its marketplace for people without coverage through a job. By one estimate, 2,200 residents would qualify for Medicaid benefits if Tennessee expanded the program under the law; the Republican governor tried but was rebuffed by the more conservative legislature.
Unless a patient is transported, neither Medicare nor Medicaid will pay for the ambulance run. The ambulance authority sends out bills, but in such a poor county, “there is no way to turn them over to collections,” Smith said. Some people bring in $5 or $10 when they can. In 2016, the ambulance service wrote off more than $1 million in unpaid charges.
With no hospital in Haywood and 535 square miles to cover, the crews have been stepping up their protocols. They can insert chest tubes, start intravenous antibiotics and intubate patients to help keep airways open.

Every Republican voting resident of Southwest Virginia needs to read this piece and understand that this is what their falling for GOP appeals to bigotry and religious extremism is going to bring them. No local hospitals, the loss of the best jobs in town, and even more difficulty in trying to court businesses to moved to the area. Much of this damage is self-inflicted.  I worry about the children, but the adults are reaping the fruits of their own shortsightedness,

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