The Health Care Crisis in Rural America

Grafton, West Virginia

Here in Virginia, many feel that West Virginia's exit from Virginia during the Civil War was a net positive for Virginia.  That belief is re-enforced daily by West Virginia's near basket case status and its residents' constant voting against their own self-interest. Throw in the embrace of ignorance and religious extremism, and it is perfect recipe for a never ending downward spiral.  A piece in the Washington Post looks at the dental care crisis in West Virginia but which is common in other rural areas.  One comment on the piece summed up my views:

It's an old story. Poor rural whites depend on the government but try to destroy it by voting for the worst people they can find. Republicans exploit their ignorance and bigotry to get them to vote against their own self-interest. It's hard to feel sorry for them.

Harsh?  Perhaps, but nonetheless descriptive of the problem.  The Post article looks into the causes of the crisis and the difficulty of finding a solution.  Here are article excerpts:

Lynnel Beauchesne’s dental office hugs a rural crossroads near Tunnelton, W.Va., population 336. Acres of empty farmland surround the weathered one-story white building; a couple of houses and a few barns are the only neighbors. But the parking lot is full. Some people have driven hours to see Beauchesne, the sole dentist within 30 miles. She estimates that she has as many as 8,000 patients. Before the office closes at 7 p.m., she and her two hygienists will see up to 50 of them, not counting emergencies.

About 43 percent of rural Americans lack access to dental care, according to the National Rural Health Association, and West Virginia, among the poorest and most rural states, is at the center of the crisis. All but six of the state’s 55 counties include federally designated “Health Professional Shortage Areas,” “Medically Underserved Areas” or both. 

One seemingly obvious solution is to persuade more dentists and other oral-health providers to come to places like West Virginia, a goal of various public efforts. The federal National Health Service Corps program, for example, offers up to $50,000 in loan assistance to doctors and dentists willing to work two years in a designated shortage area. And several states have passed or considered legislation authorizing “dental therapists” — midlevel providers akin to nurse practitioners — to provide certain kinds of primary dental care in areas where dentists are scarce.

[A]dding more providers will not solve the problem of rural oral health. People don’t go to the dentist if they can’t afford to, no matter how many dentists there are. “Affordability is the big thing,” said Richard Meckstroth, chair of the department of dental practice and rural health at West Virginia University.

And affordability cuts both ways. Recruiting more providers into shortage areas can compound the problem, said Meckstroth, putting local dentists into tougher financial straits by increasing competition for a relatively small pool of paying patients. The dentists who arrive under loan forgiveness programs also tend to leave after their two-year obligation is up, what Meckstroth calls a “revolving door” that deprives patients of continuity of care.

According to the state’s Bureau for Public Health, only 40 percent of adults in West Virginia have access to dental benefits of any kind, compared with about 65 percent of working-age adults nationwide.While the state’s Medicaid program covers preventive care for children, adults get no coverage except for extractions or treatment for infections. Medicare offers no dental benefits, either. As a result, according to the West Virginia Oral Health Coalition, 43 percent of West Virginians ages 55 to 64 have lost six or more teeth because of disease or decay; 61 percent of residents older than 65 without a high school diploma have lost all their teeth.

The lack of affordability and access to dental coverage in West Virginia is of course tied to the state’s overall economic precariousness. Bruce Cassis, a dentist who practices in Fayetteville, said access to high-quality dental insurance in his area has declined along with the fortunes of coal. “Less than 5 percent of my patients are affiliated with the coal industry,” Cassis said. “Thirty years ago, they used to be 60 percent of my patient base.” Today, the major employer in his region is the county school board. “They have the best insurance in the area.”

The same is true for the Perrines and Beauchesne, whose best-insured patients typically have government jobs, such as with the school district or the fire department.

Still, the dental-care crisis in rural America is closely linked to the broader economic challenges in the parts of the country that have not yet caught up in this recovery. “How you improve access in rural America,” says Meckstroth, “is to get people jobs.”

Bringing jobs, of course means (i) accepting the reality that the coal industry is moribund, and (ii) an area must be attractive to new business, often those that would be relocating from elsewhere.  This, of course, where West Virginia's (and much of Southwest Virginia) embrace of ignorance, racial bigotry and religious extremism and hate makes the likelihood of businesses moving to the area remote. Meanwhile, those suffering continue to embrace the very things and politicians that have brought on their misfortune. 

Homophobia Costs India An Estimated $31 Billion Annually

I regularly state that homophobia carries an economic cost, especially when the homophobia is government sponsored.  It is a reality that the Republican Party of Virginia refuses to want to hear and it does cost jobs and lost business relocations and/or expansions.  Just ask Arizona Governor Jan Brewer about the economic shit storm that SB1062 brought down on her state.  But the costs apply to entire nations as well.  Some of these anti-gay countries seem to reveal in their ignorance and backwardness - Uganda and Nigeria are two such examples.  But India is another matter as it seeks to become a world economic power.  Yet, a new World Bank study has found that India's homophobia which is back in the forefront is costing the nation $31 billion - yes, billion with a "B."  BuzzFeed has details.  Here are some excerpts:

Homophobia has an annual cost to India of $31 billion or more, according to a draft report presented Wednesday at a forum at the World Bank’s headquarters in Washington, D.C.

This number is just a rough estimate, since economists lack the data to make a firm calculation. But the fact that the question is being asked by an institution like the World Bank is more significant than the number itself. If development institutions decide to make LGBT rights a priority — and could shape the billions of dollars that flow through them every year — LGBT rights advocates could have far more powerful allies than those they’ve won in institutions devoted to human rights.

The World Bank isn’t the first such institution at the table: The United States Agency for International Development (US AID), the United Nations Development Program, and the development agencies of several European governments already have been working on LGBT rights. But the World Bank’s size and reach mean it has the power to shift the global development agenda — it lends more than $35 billion annually, and serves as an important research hub for the development community.

Having a discussion about LGBT inclusion at the World Bank “may have a huge impact … for mainstreaming the issue,” said Luiz Loures, assistant secretary general of the United Nations and deputy executive director of UNAIDS, who traveled from India to participate in the panel discussion, which was moderated by BuzzFeed. Organizations like his only get so far by making the human rights and public health case; people like Loures believe framing the issue in terms of dollars could tip the balance. 

[T]he Indian economy lost the equivalent of anywhere between 0.1 and 1.7 percent of its GDP. This is likely a “conservative” figure, Badgett said, and it is significant even in this range. “You reduce GDP by that much and you call it a recession,” she remarked.

Badgett factored in several ways that homophobia costs a society. The most visible may be increased health costs: If stigma keeps LGBT people from accessing health services, there may have higher rates of HIV and AIDS. But stigma also can contribute to a greater burden of depression and other mental illness, which can make LGBT workers even less productive. And if discrimination keeps LGBT people from working or forces them into lower-paying jobs, the economy loses the full value of their labor.
 

[I]t is still an open question of how far the Bank is ready to go in embracing this agenda. On February 27, the Bank suspended a $90 million health care loan to Uganda just after it enacted a bill imposing up to a life sentence for homosexuality and criminalizing LGBT advocacy. The Bank’s president, Jim Yong Kim, also published an op-ed in The Washington Post declaring that discrimination against LGBT people — like other forms of discrimination — are “bad for people and societies” and “bad for economies.”  

 “Whether you want it or not, the World Bank … has an impact on the lives of sexual minorities” in the countries in which it invests. “Working with the World Bank does not mean adopting everything that the World Bank is doing. But it means taking basically the share [that] belongs to you within the World Bank[’s work].”