The county most spotlighted in the piece was Buchanan County, Virginia. Ironically, despite its severe dependence on federal disability payments, Medicaid payments and remote area medical clinics, Buchanan County voted over 80% for Donald Trump in 2016, and 75.94% for Ed Gillespie this past November. Trump's tax bill slashed taxes for the wealthy and large corporations, few if any of which are found in Buchanan County, and will fuel Republican desires to slash the social safety net spending. Gillespie, had he been elected championed a similar tax cut in Virginia that would have left Virginia with a $1.5 billion deficit which would have likewise brought spending cuts in programs that aid an already desperate area of Virginia. Both votes are yet further displays of the irony that rural regions vote against their own economic interest typically because GOP candidates play upon the residents' racism, homophobia and general rejection of knowledge and modernity itself. How residents expect to turn their regions around economically when their bigotry and backwardness make them anathema to modern and progressive businesses. A further irony is that newly inaugurated Governor Northam - a pediatric neurologist by profession - whom Buchanan County rejected last November has pledged spend time working in the RAM clinics mentioned in the cited article. Here are excerpts from the piece in The Atlantic:
Remote Area Medical ("RAM) was founded in 1985 by Stan Brock, a 79-year-old Brit who wears a tan Air-Force-style uniform and formerly hosted a nature TV show called Wild Kingdom. Even after he spent time in the wilds of Guyana, Brock came to the conclusion that poor Americans needed access to medical care about as badly as the Guyanese did. Now Remote Area Medical holds 20 or so packed clinics all over the country each year, providing free checkups and services to low-income families who pour in from around the region.
Inside, the clinic’s patrons looked more or less able-bodied. Most of the women were overweight, and the majority of the people I talked to were missing some of their teeth. But they were walking and talking, or shuffling patiently along the beige halls as they waited for their names to be called. There weren’t a lot of crutches and wheelchairs.
Yet many of the people in the surrounding county, Buchanan, derive their income from Social Security Disability Insurance, the government program for people who are deemed unfit for work because of permanent physical or mental wounds. Along with neighboring counties, Buchanan has one of the highest percentages of adult disability recipients in the nation, according to a 2014 analysis by the Urban Institute’s Stephan Lindner. Nearly 20 percent of the area's adult residents received government SSDI benefits in 2011, the most recent year Lindner was able to analyze.
[F]ive of the 10 counties that have the most people on disability are in Virginia—and so are four of the lowest, making the state an emblem of how wealth and work determine health and well-being. Six hours to the north, in Arlington, Fairfax, and Loudoun Counties, just one out of every hundred adults draws SSDI benefits. But Buchanan county is home to a shadow economy of maimed workers, eking out a living the only way they can—by joining the nation’s increasingly sizable disability rolls.
Just about everyone I spoke with at the Grundy clinic was a former manual worker, or married to one, and most had a story of a bone-crushing accident that had left them (or their spouse) out of work forever.
In October, the sun-dappled mountains blazed with red and orange as the leaves turned. If you wanted to send someone a postcard to convince them of the merits of Virginia, this would be it.
But if this place has the scenery of the Belgian Ardennes, it has the health statistics of Bangladesh. People here die about five years earlier than they should. About a third of people smoke, and a third are obese. A quarter of the people live in poverty, compared with about 11 percent in the rest of the state.
These Appalachians, many of them former coal miners, are among the nearly nine million American workers receiving disability payments today, compared with 1.4 million in 1970. Spending on the program has risen nine-fold over the past four decades. Clusters of recipients can be found from California to Maine, though as Lindner points out, the states with the highest numbers tend to be in the South and Southeast.
Critics say the program’s expansion is partly driven by Americans who are perfectly capable of working but are unwilling to do so. Since the mid-1980s, government spending on the elderly and disabled has ballooned, even as tightened eligibility rules have slashed welfare aid for needy mothers and children.
But visiting a place like Grundy reveals a more complicated picture. There are undoubtedly some who exaggerate their ailments in order to collect their checks. But many of the coal workers here have experienced horrific on-the-job accidents and can’t go back to the mines. Other residents have been battered by diabetes, obesity, and tobacco. Others still suffer from severe depression and intellectual disabilities that would preclude most kinds of work. And most importantly, there are no other options here: no orthodontist’s office where someone can work the front desk; no big firms brimming with entry-level secretarial jobs. It’s not even clear how a person would go about calling around for a job here: My iPhone stopped working a few miles outside the county line.
Locals blame the town’s economic slump on the decline of coal, which they in turn blame on the Environmental Protection Agency’s regulations. Several yards were dotted with campaign signs urging passers-by to “Stop Obama/Vote Gillespie.” (Sixty percent of Buchanan county voted for Ed Gillespie, the Republican candidate for Senate, though he lost in the state overall.)
The population of the county has shrunk by about 15,000 people since that year . In May alone, 188 workers were laid off in a mine near Grundy. The industry has been slammed by the newfound natural gas reserves and is expected to contract further by 2020. Still, coal remains the largest private employer in Buchanan, and its heavy impact continues to be felt even by those who no longer work in the mines.
Compare all of this with Arlington County, 400 miles away in the northern part of the state, which has one of the nation’s lowest rates of disability. Only 1 percent of people in Arlington are on disability, and it’s regularly ranked one of the overall healthiest (and richest) counties in the nation. Here, there are well-paved bike routes and a Metro-accessible Whole Foods. People complain when they can’t take their tiny dogs into Starbucks.
Virginia, in other words, is a state divided not only by politics, professions, and mountains, but also by how run-down its citizens are. While Buchanan county’s fortunes have been inextricably tied to coal, those of Northern Virginia are hitched to the government.
An outmigration of the young and talented has left behind an aging population that is ill-equipped to deal with a changing economy. Thirty-two percent of Buchanan's residents never graduated from high school, compared with 15 percent nationwide.
Because getting to a doctor is hard and expensive, people self-medicate with prescription painkillers, alcohol, and tobacco. Eventually, said Smiddy, the pulmonologist, “they become dysfunctional. They're weaving behind the car. They're setting the stove on fire. It's not that they're bad people. They’re probably faith-based people, family people. Most are just trying to function.”
The problem is, even if society were to decide that there should be fewer people on disability, that the system has become too bloated with sneaky pretenders, it isn’t clear what a fifth of the population of Grundy would do to survive. It’s entirely possible that some of the town’s residents are faking their disability claims, but it’s hard to imagine that most of them are. People who are rolling in undeserved government dough generally don’t line up at the crack of dawn to get their teeth fixed in an elementary school cafeteria.
The problem, as Smiddy sees it, isn’t just that the economy is limited, or that the region’s education and medical systems could use an overhaul. The county’s health has been so poor for so long, he says, that locals have set their expectations too low. And once everyone—the people, their employers, their doctors, the government—accepts that bleak vision, it hardens into reality. It makes it so there’s no life after coal.