Saving rural hospitals is key to Health Care for Allby In My Opinion on 06/13/15
Saving rural hospitals is key to Health Care for All
June 1, 2015
Rural hospitals everywhere are fighting for
their existence. Fifty have closed since
2010, affecting the jobs, health, and lives of over 800,000 people. When the critical access hospital in Belhaven,
North Carolina, closed last summer, the town’s Republican mayor knew his town’s
fate was connected to a broader fight.
With support from the state’s Moral Mondays campaign, a 2014 walk to
Washington, DC was organized to address the hospital’s future.
Now 283 more rural hospitals are likely to close. A second walk from Belhaven to Washington, June 1 to June 15, will petition Congress to keep hospitals open and help spark national attention and debate.
www.thewalknctodc.com and http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/)
Planned closures will mean up to 85,000 jobs
lost in health care and communities.
Rural areas will lose $10.6 billion in economic activity to support
people’s lives. Children, family
members, and neighbors die when emergency rooms close. Just ten needless deaths per closed hospital
each year will kill as many Americans as died in the 9/11 attack . . .
All this reflects an upheaval in the
financing and delivery system of healthcare.
The Affordable Care Act (ACA) and recent changes in Medicare
reimbursement encouraged the growth of Accountable Care Organizations —large
corporate integrated health systems. Profiting from economies of scale and
heavily dependent on technologies, their business model doesn’t work in smaller
rural settings. Most rural hospital
closures are in states where governors have refused to expand Medicaid and are
concentrated in the historic Black Belt of the South. This area’s rich black soil fed the
plantations and the brutal slave system that defined and expanded American
capitalism. The closings will intensify
the extreme poverty and poor health of the area.
Rural health suffered a blow in the early
1980’s when fixed Medicare reimbursements were introduced. Today Electronic Health Record (EHR)
technologies are needed to insure billing, payments and complex data collection
under Medicare’s new reimbursement policy.
Almost no rural hospitals could afford to implement EHRs four years
ago. Medicare’s “outcome based
reimbursement” ignores the devastating effects of poverty like lack of
transportation, food deserts and lack of money for medications. So closures are
accelerating, paving the way for the market to serve only those who are most
Each rural hospital closing is a story of
people and communities dying and under attack. Medicare and Medicaid are a
half-century old this July, won on the wave of the Civil Rights Movement. Today partial solutions are going to be
temporary at best and, at worse, will only make healthcare easier to privatize
and harder to afford. Only when
healthcare for those in the poorest communities is secure will we be able to
win healthcare for all.
The “NC to DC Walk” is an example of working
people, Black and white, working across party lines to make health care for all
a national moral issue. Its vision of
saving and improving rural healthcare points toward a federal guarantee for a
publicly-owned healthcare delivery system that is accountable to those it
Rita Valenti, RN, Atlanta, GA and health care advocates in the Washington DC area