Saving rural hospitals is key to Health Care for All : Retirees for Single Payer Health Care Blog
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Saving rural hospitals is key to Health Care for All

by 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.

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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  . . .  every year.

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 profitable.

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 serves.

Rita Valenti, RN, Atlanta, GA and health care advocates in the Washington DC area

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Medicare For All 
(HR 676)

Everybody In, Nobody Out Health Care - Gives every resident of the United States and the U.S. Territories access to all medically necessary health care services, including vision and dental as well long term care with no copays or deductibles regardless of employment, income or health status.  Private insurance companies may not duplicate coverage under this bill.

Non-Profit Health Care - Converts all healthcare providers to a not-for-profit service where illness is no longer a source of wealth for a few.

Single Payer Health Care – Medicare today is a social insurance program for those 65 or older and the disabled under 65.  Medicare for All improves and extends that social insurance program to all of us. This gives us all the collective ability to control the out of control costs of the healthcare industry in this country.  Pays for that expanded coverage by maintaining the present level of federal government revenues for Health Care as well as increasing personal income taxes on the top 5 percent income earners, instituting a modest and progressive tax on payroll and self-employment income, on unearned income, and on stock and bond transactions.


“People need to believe that social change is possible.  If they think their only option is to exchange one oppressor for another, they will usually choose to accept their victimization and try to make the best of it.  That is why counter institutions are so important, because they are living demonstrations that better social relationships are possible and within our grasp.  They are possible because, besides the seeds of the oppressor within us, we also have the seeds of mutual liberation within us, the instincts of cooperation, of sharing, democracy, equality, extended family.”  John Curl, Poet
‘There was no formal interview like I imagined but the day turned out to be even better.  There was lots of gumbo ya-ya about politics then (60s) and now with a bunch of us sitting around a conference table eating what had to be KFC.  There were a few people there from a group called Retirees for Single Payer Healthcare, most of whom were north of 60.  They spent a good 15 minutes arguing what commerce would look like in a post capitalist society as if this new arrangement was coming next month and they were teenagers planning out the rest of their lives.  It was a freedom dream in motion with General Baker at the helm – a powerful lesson in hope.’  Robyn Spencer, from “Rest in Power, General Baker”