By Jim Spencer
SpencerSpeaks.com
Three companies tried to make money running the Washington County Clinic – Banner Health Care,
All failed, said nurse practitioner Becky Hutcheson.
Hutcheson treats patients at the clinic four days a week because there is no doctor available.
“When (Colorado Plains) bailed,†said Hutcheson, “it fell to the county commissioners to take it over.â€
They did so in remarkable fashion, said Denise Denton, former head of the
No one would dare utter the words “socialized medicine†in the Republican stronghold of
“At some point, we decided to educate rural children and agreed to tax ourselves to pay,†said
Hutcheson, who commutes 30 miles from Brush to work in
“There were doctors out here,†Hutcheson said of the mid 20th century. “This little town used to have a hospital. It’s now a nursing home. The hospital closed. People are still upset they lost their hospital.â€
County leaders simply decided that they couldn’t lose their clinic. But Medicare, the government health insurance program for the elderly, and Medicaid, the government health insurance program for the poor, cover roughly 75 percent of the clinic’s patients. Reimbursement rates for both Medicare and Medicaid are so low that many private doctors refuse to accept patients covered by either program.
It gets worse. Of the roughly 25 percent of Washington County Clinic patients not covered by Medicare and Medicaid, about 15 percent have no insurance and no ability to pay for their care, Hutcheson said.
All told, just one in 10 clinic patients has private health insurance.
That’s the kiss of death for making money.
It is also a way of life in rural
The challenge, said
Doing nothing is not an option, at least as far as public health is concerned, added Clint Cresawn, the work force programs manager at the
“There are places where access to care is so limited that some people don’t get care,†he explained.
“We focus on primary care, the sort of stuff we need day-to-day.â€
Hutcheson and other non-doctors have become the ones who deliver much of that care. They do a good job when the patients can actually get to them. But statistics from the Colorado Health Institute show that in rural counties there is not only a critical shortage of doctors, but of all kinds of advanced medical professionals, such as nurse practitioners and physician’s assistants.
The health institute reports that in 2006
None of this bodes well for the people living in rural areas.
“A really big issue is a lack of public transportation to get to care,†said
No access to health care means “no access to early detection of disease,†Cresawn added. No early detection means problems that “are a lot more expensive to treat.â€
“Mental health and dental care are both huge needs,†Cresawn said.
In sum, it adds up to an urgent problem with which
“Years ago, doctors would move to town, raise families and stay,†Hutcheson said of
Copyright 2007 by Jim Spencer. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.
6 users commented in " Painful Choices 2: Rural Care Pits Profits Against Access "
Follow-up comment rss or Leave a TrackbackThe rubber meets the road, so to speak, when it comes to medical care. The same people who argue strenuously against “socialized” medical care, line up to get it when it’s their own hides that are at stake. If our society ever had a legitimate debate - instead of political sound bites - perhaps the discussion would start with the issue of making a profit. Can health care be provided by practictioners, institutions and insurers who have a profit drive? Should it? This isn’t quite the issue in the urban areas because those without insurance are a minority of the population. In the rural areas, they are the large majority of the population and that seems to make all the difference in their attitudes toward “socialized” medicine. I do not begrudge those who live in rural areas their health care; I just happen to think all Americans should have access to health care, regardless of where they happent to reside.
If you live in the middle of nowhere, access to many things will be harder to come by. Are we comingling access and ability to pay? Or is the combination of inability to pay and the lack of population making medical care even more scarce? So we make health care totally free and subsidize the best facilities in the country in every rural area, what should the acceptable cost per capita be? If you are the only person living in a 50 mile radius, should we put a team of doctors in your living room waiting for you to get sick? Obviously tongue in cheek but I’m just asking the question. It’s not that I want people to go without health coverage. But people choose a lifestyle for a reason and there is a give and take.
Well said Lhkman, I couldn’t agree with you more. I imagine 90% of people in isolated rural areas vote Republican. Kind of like cutting their own throats isn’t it.
I don’t understand why people keep lumping insurance companies as part of the “profit” problem. Insurance is a tool, a method of sharing risk. When insurance paid only for the medical expenses related to illness and injury the cost was relatively lower. Today, “insurance” is no longer insurance. It is pre-paid medical care. The public demanded that health care plans cover expected expenses. Based on the concept of insurance, expected expenses are not insurable. To have them covered requires collecting 100% of the expected expenses plus enough to cover the cost of administering the plan. It is insurance that allows people to pay a few hundred dollars a month so that if they develop a serious medical problem, they don’t have to come up with tens or hundreds of thousands of dollars to pay for the treatment. Anyone with a brain insures their home. For a few hundred dollars a year they are assured that if there is serious damage to their home it can be repaired or rebuilt. (Flood insurance is a different topic which deserves its own book.) If you want homeowners insurance to cover the cost of repainting, fixing the toilet, replacing washers in sinks, replacing worn out carpet, etc., the cost will go up substantially, and it will look like the product the public had demanded for health care. Is there profit in selling health insurance? Yes, otherwise it wouldn’t be sold. And, if you have an HMO, you don’t have insurance, and they still want a profit.
Mandell: When you can predict precisely when an individual will become ill and precisely what treatment will make that person well again, your screed might have some validity. Until then, it reads like the usual conservative/populist pablum we always get here in Colorado.
noidea and Wildflower: Your comments both are interesting. Let’s make distinction, though, between availability of health care and the cost of that health care. Rural areas always will have issues of availability, just as they do with much of modern society’s trappings. It goes with being rural and not having sufficient population density to support many things we in urban America consider our right. As for the cost issues, let’s face it, insurance companies are in business to make a profit. I’m an unreconstructed capitalist, so I think that’s just fine. One way they can make that profit, though, is by cutting back on what they will pay for for policyholders. Like it or not, that’s about the only way an insurance company can make money — unless people suddenly were to stop dying or getting sick and houses did not burn or get blown three states away. I pose the following question as just that a question: Should health care (to say nothing about its availability) be subject to the decisions of a bureaucrat at an insurance company who can read the fine print of a policy and determine that the company will not pay? If the answer is yes, and I’m sure some, like Mandell, will say it is, then we’re back in the days of the Old West and the frontier; it’s every man and woman for him or herself.
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