Improving lives and shaving margins
by Tom Sullivan
Arthur, Nebraska
The last time Democrats flipped a congressional seat in this largely rural district, they lost the reddest large county by just over 3,000 votes. “Losing” in that heavily Republican county by only ten percent was itself a huge victory. Sometimes winning is just about shaving the margins.
A friend (a former Republican) asked for messaging advice at a fundraiser over the weekend. When canvassing in such places, not for particular candidates but for voter engagement, what should volunteers say when asked what Democrats stand for?
A poll last fall by National Public Radio (NPR) and the Robert Wood Johnson Foundation found 55 percent of rural Americans rated their local economy only fair or poor. A follow-up poll just released examined economic insecurity and health:
Several findings stand out: A substantial number (40%) of rural Americans struggle with routine medical bills, food and housing. And about half (49%) say they could not afford to pay an unexpected $1,000 expense of any type.
One-quarter of respondents (26%) said they have not been able to get health care when they needed it at some point in recent years. That’s despite the fact that nearly 9 in 10 (87%) have health insurance of some sort — a level of coverage that is higher now than a decade ago, in large part owing to the Affordable Care Act and the expansion of Medicaid in many states.
The Affordable Care Act when combined with the Medicare expansion brought health care access to many who previously had none. But it is still not enough:
Of those not able to get health care when they needed it, the poll found that 45% could not afford it, 23% said the health care location was too far or difficult to get to, and 22% could not get an appointment during the hours needed.
Dee Davis, president and founder of the Center for Rural Strategies in Whitesburg, Ky., says poverty and ill health are endemic where he lives. “People in this congressional district have the shortest life span in the United States; we also are the poorest,” Davis says. “We’re poor and we’re sicker.”
What’s more, a second NPR report finds that of respondents who reported they could not get needed health care, one quarter said their communities were too remote from the nearest clinic:
Rural hospitals are in decline. Over 100 have closed since 2010 and hundreds more are vulnerable. As of December 2018, there were more than 7,000 areas in the U.S. with health professional shortages, nearly 60 percent of which were in rural areas.
Dave Mosely writes that 21 percent of the nation’s rural hospitals risk closure, and nearly half of rural hospitals in Alabama, Mississippi, and Alaska. The study by Navigant finds this amounts to “about 430 hospitals in 43 states that collectively provide care for millions of Americans and employ more than 150,000 people.” Lack of access and/or time and long distances involved to reach them can prove deadly.
The Tennessean inadvertently identifies why this is happening across the country (emphasis mine):
The closure of a local hospital is a very real possibility for the people of Greeneville, a hardscrabble Appalachian community of 15,000 about an hour east of Knoxville. The facilities here, Laughlin Memorial Hospital and Takoma Regional Hospital, have been half-empty and losing money at least four years in a row. New owners recently fused Laughlin and Takoma in a desperate effort to become profitable, and officials admit that both hospitals were likely to close in a few years without intervention.
For-profit health care is why. The United States operates hundreds of overseas military bases and thousands of installations on every continent except Antarctica. Getting accurate counts and costs is problematic. Like rural hospitals, most of them are out of sight and mind. All of them exist to protect American lives and interests. None of them are expected to operate at a profit. Yet somehow, they manage.
NPR reports the U.S. has approximately 1,860 rural hospitals.
What do Democrats stand for? Health care as available and no-deductible as our military, for one. Hospitals not required to operate at a profit need not close. Costs need not spiral out of control. This country’s archaic system of for-profit health care drives both. Obamacare was step one in remedying that. Step two must be some variety of universal care with no out-of-pocket cost and care accessible to rural as well as to urban communities.
The NPR polling also finds financial insecurity impacts many in rural America. Unexpected expenses of $1,000 or more for health care or a car repair send many families into a tailspin:
Overall, nearly half (49%) said they wouldn’t be able to afford that. And more than 6 in 10 rural black and Latinx Americans said they would have a problem paying that off (blacks, 68%; Latinx, 62%), compared with 45% of rural whites.
Lack of economic opportunity coexists with lack of health care availability:
In areas where higher-speed Internet access is available, people are turning to telehealth instead of going to a doctor or clinic. But broadband access is a perennial issue in many parts of rural America, with 1 in 5 (21%) saying that accessing high-speed Internet is a problem for their family. Among those who do use the Internet, a majority say they do so to obtain health information (68%).
What do Democrats stand for? Broadband expansion on the scale of rural electrification as an engine of economic development in rural America. Plus, as a support for thinly available health care, at least until they can deliver health care as universal as telephone and electrical service.
One of the NC state representatives at last weekend’s fundraiser was introduced as Representative Broadband. He gets it.
But the broader problem of financial stability involves addressing the wage gap and economic inequality.
Electing candidates focused on addressing that systemic problem rather than on finding ways to assign blame to voters for it might help.
When knocking those doors, I recommended listening first and talking later. Ask about people’s financial and health care concerns and insecurities. It is not stepping on any candidate’s message to suggest Democrats want, first, to perfect Obamacare or truly replace the current system with something available and accessible to everyone everywhere, and second, to work toward shrinking the wage/wealth gap that has left them feeling as though they serve the economy instead of the other way around.