We need to train certified nurse-midwives for home deliveries in these rural areas. A nation that put the people, instead of capitalism, first would do so.
(See "Call the Midwife," a British show about the beginnings of the National Health Service in a devastated post-World War II London. Some women received competent medical care for the first time in their lives.)
15
More is missing here than a hospital. Where is the father of the twins and 2 year old? Where is the father of their mother? Where is someone to coach the mom that birth control would help her focus on supporting the 2 year old on an $8.50 hourly income?
70
Where are all the pro lifers? Where are all the far right religious men and women that demand the say over a women's body ostensibly because the baby needs to be born?
Where are the anti-national health care folks?
Step right up. It's go time. Now comes the time to back up the phone rhetoric.
56
So many commenters are asking why people in rural communities keep voting Republican. It’s because they know the Democratic party no longer cares about middle class white people, blue-collar white people and poor white people.
The party cares about everyone else under the sun, everyone who identifies themselves with a hyphen, but not them.
8
Maybe people in these areas should consider voting for people who support their healthcare, education, and economic opportunities. It might also help if they encouraged learning useful skills. Just a thought.
36
Isn't Missouri one of the states which has forced the closing of most of its Planned Parenthoods, which at least would have provided low-cost or free pre-natal care? This gap in women's reproductive health care has been partly created by the push to defund Planned Parenthood. I understand, that does not cover the lack in birthing facilities, but at least more pre-natal care could have been offered. Please, let's take as much care of children before they are born AND after they are born!
42
Is ours also the only society where a twenty-one-year-old with no husband, no money, and who already has a two-year-old would be getting pregnant again?
Aside from figuring out how to get medical care for her and her three children, could we do something about helping her to make better choices when it comes to her life?
61
Not to belabor the obvious, but how many of these affected rural counties/areas have been voting Republican for the past 50 years?
Elections have consequences, from the local level to the national level...
35
I just went through this. We live about 15 miles outside of Bastrop. It's considered a suburb of Austin, and it's a decent sized town, but our home is 40 miles from the nearest hospital with obstetric services. That's a full hour's drive, if traffic cooperates. Unfortunately the only hospital in this county stopped offering obstetric services years ago.
My baby girl was born May 8th of this year. Of course I went into labor at night, and by the time my contractions were close enough together for me to be certain that I was in labor it was about 7am. We battled the city's rush hour traffic for 90 minutes while I went through active labor. I went into the transition phase of labor before we finished the hospital's paperwork (Why they have us pre-register is a mystery, they made us give all the same information again after our arrival.)
I'm thankful everything went well in the end. I went into labor the day after my baby's due date, I made it to the hospital in time, my baby was born quickly, easily, and in perfect health. However I know we were just lucky. The last few weeks of the pregnancy were particularly stressful, beyond the regular "we're about to have a baby" stress, because both my husband and I were terrified that I wouldn't make it to the hospital in time.
19
I hope rural voters will take these issues into consideration when voting in the next election. Health care delivery is inefficient in areas with low population density. Making health care dependent on high profits makes providers less likely to serve liw density (rural) communities.
18
And I hope rural voters understand they make up of all kinds/colors of people. It was appalling to read the racist comments on this thread. The interesting thing re: voting among rural white folks is many don’t realize how much each ethnicity helped to establish: higher wages, farm Maintainance, accessibility to jobs via public transportation, human rights. There were a handful or more of those who owned businesses on which the rural white folks depended. If no jobs were found, especially in the NE, traveling laborers worked side by side with Black workers. Every single person: Red, Black, White built this country.
8
Yes, having to drive for hours to reach a hospital is terrible, but it's more than just issues with capitalism.
The population shift from the countryside to cities and rural ageing is a worldwide trend. It's happening also in France. As a citizen, I can find it shocking that obstetric care is becoming more difficult to access. But as a MD working in public health I know that a hospital becomes a very dangerous place to deliver a baby if there are not enough deliveries per day, as this conditions staffing and equipment, sure, but also expertise and procedures. The same goes with surgery. What Ob-Gyn or surgeon in his/her right mind would want to take the chance in a lawsuit-driven system?
It's a tension between people rightly wanting the best care and their wanting care within a reasonable distance. In many depopulated areas. You have to choose, or 1/ move to the city, or 2/ accept c-sections, or 3/ deliver at home.
Instead of maintaining a near-empty obstetric ward, pay for pregnant women to take the last week off work and stay at a hotel near a competent and well-staffed hospital. It's less stressful and much cheaper and safer for the mother and child (and the health care workers).
21
So how does Europe do it?
How about the wilds of Scotland, the glens and the bens and the isolated islands?
Yes, there are large metropolitan cities, but what about the far-flung villages of Sweden, Norway, Finland?
Everyone lives in a city in Germany? France? Spain?
All of these places have medical needs - and their people are all covered.
So, how do they do it?
ARE there women making 200-mile round trip to have a child?
What's their "infant mortality"?
How much are their premiums?
How many are NOT covered?
We are the only industrialized country that does not have universal coverage for every man, woman and child.
That won't help Kela today.... but maybe someday this country will have what dozens of other countries already have.
38
Where is the father? Could he help with some of the $?
25
breaking news: humans are social animals and have better mental health and physical health care in cities.
7
If we cut taxes and Medicaid funding, the market will very quickly fix all these problems!!!!
Not!
11
Train more house wives to deliver the Baby like in many countries of the world where people can't even afford to go to hospital.One does not need hosp[ital for every possible birth.
7
Did she vote for Trump?? Something says YES
9
You know a lack of closeby hospitals isn't just a women's problem, right? Last I checked men need medical care too.
11
Hey, where did all the "pro-lifers" go?
27
So... why do these counties consistently vote to cut health care? Are they stupid? Suicidal? What is going on with these people?
15
This is yet another indicator of our apparent determination to reward the rich and penalize the poor, while applauding the rich as “go-getter, hands-on, get her done” types and demonizing the poor as “lazy, negligent, can’t do” takers. As we nurture that falsity, we are taking yet another step in our apparently determined effort to become a third world nation.
12
Why are women still having babies? Men don't respect us. And in the example in this article, they obviously don't stick around, either. 21 years old with a two year old and twins on the way? How will she support three kids? How will she ever develop her career? If American corporations will not pay women fairly, if men refuse to wear condoms and stick around, why do women allow this? The lack of hospitals is only perhaps the latest forced suffering put on women in America. Wake up!
38
It seems every day now I read a new news story that reminds me of how much this country hates women.
21
This article talks about several women with several children and zero fathers. Having children without a spouse or a dedicated partner is generally a recipe for a lifetime of hardship. The number one predictor of poverty in the United States is not race; it is being in a single parent home.
35
"Elections have consequences." I've heard this phrase thrown around a lot lately, largely by the smug republican crowd as they revel in their newly minted SC pick. So, to the left wingers here pleading that we don't jump to conclusions on this story, please stop ruining this story for the rest of us. It is nice to see the rural counties suffering a little pain from time to time. They, of the uber patriotic true American ilk, who scorn the federal government and liberalism as if it's a disease, welcome to the 21st century!!! Republican politicians have done much of what they told us they were going to do, and the incredibly naive flyover dwellers are finding out what that means today. I find it amazing how, seeing how much the right has RELISHED disparaging not just the left but anyone not firmly in their camp, how some commentators here still want to help these people. These rural states voted overwhelmingly for this. They cut their nose off to spite their face, and now cry for help when chickens come home to roost. As they will tell you, they're the freest people on this planet and no stuffy ivory tower aristocrat will tell them how to live their lives. So let them see how much aid their patriotism will give them. They have spent the last few generations denying women reproductive aid, cutting or refusing federal Medicaid, and this last decade defiling the mere idea of healthcare. Why not let them eat cake?
18
Do the Abernathys vote in every election? Which party have they been voting for?
11
Imagine screaming in pain with dental pain, having many dentists and hospitals close but unable to get care because dentists refuse to treat even deadly abceses.
4
A 4 hour trek to drive 100 miles?
3
@Bob Foreman It does seem long, but the local roads in many rural areas have not been kept properly repaired in decades. Poorer states such as this one are often just not able to pay for the work. With a woman in labor, they may also have had to drive much slower than usual. Three hours would not have surprised me; four, yes.
6
One question: for whom did she vote?
9
You can buy condoms, vaginal foams, spermicides,vaginal spermicide films and a host of other birth control methods across the counter with no prescription needed .
The women could learn to say 'No love without that glove".
Si quiere mi amore, un condon.
25
Lucky to he trom a great state....Elections have consequences...
3
Why do people in rural states keep voting for republicans? Honestly, I am so sick and tired of hearing about their thoughts, feelings and problems and why they voted for Trump. They have spent years ruining their own states and now they have voted to ruin our country.
22
As the song goes “you do it to yourself”. If healthcare matters. Then vote for representatives who support healthcare
9
To @Freedom
HRRP was passed as part of the ACA when both the House and Senate was controlled by the Democratic Party
Readmissions Reduction Program (HRRP)
Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012. The regulations that implement this provision are in subpart I of 42 CFR part 412 (§412.150 through §412.154).
And it scales with poverty
Christian Hospital says its costly difference of opinion with Medicare hinges on how to count the large number of poor people that the St. Louis hospital treats.
Medicare penalizes hospitals that readmit too many patients within 30 days of discharge, and Christian expects to lose almost $600,000 in reimbursements this year, hospital officials said. Christian is one of 14 hospitals in the BJC HealthCare System.
Medicare doesn’t play fair because its formula for setting penalties does not factor in patients with socioeconomic disadvantages — low-income, poor health habits and chronic illnesses for instance — that contribute to repeated hospitalizations.
If Medicare did that, Christian’s penalty would have been $140,000, Lipstein said.
https://khn.org/news/missouri-hospitals-seek-to-focus-readmission-penalt...
3
Midwives would be a good solution for these people until there is a better solution.
5
This is truly a bipartisan issue. In a country as large as the US, the cost to sustain a hospital at every rural outpost would be prohibitively high. No other country that is as geographically large as the US is able to sustain full service hospitals every 50 miles. Russia doesn't, China doesn't, India doesn't, Canada doesn't. Higher income nations such as Germany aren't able to bridge the rural urban healthcare divide and that country is a fraction of the size of the US. I'm not sure there is a solution that would enable all people equal access to all levels of healthcare irrespective of geography. Perhaps putting tools in place to enable people to move more easily to locations with healthcare and jobs.
http://www.unrisd.org/80256B3C005BCCF9/(httpAuxPages)/3C45C5A972BF063BC1...$file/Cook.pdf; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100192/; https://academic.oup.com/heapol/article/32/5/669/2999098; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426537/; https://www.oecd.org/germany/Health-Policy-in-Germany-July-2016.pdf
5
No profit = No mission
What did think was going to happen?
It will so much worse when single payer happens.
Single payer systems seem to be working in Canada, England, the European democratic socialist states, etc. depends on how you role it out. In the US once all of the special interest groups are through with any legislation you minds as well throw it in the garbage.
12
I see two issues here. 1. Not enough funds to run a hospital in a rural community mostly likely because their tax base is small. As a country, everyone needs to chip in to help out but of course for a set amount of time. bring High tech manufacturing, train residents for high paying jobs, higher education, etc...so there can be a tax base. If none of this work, stop being sentimental but practical and move to an urban big city.
2. Even if the hospital was right next door to your house you should not have had 3 children by the age of 21 if your income is basic and you cant afford gas. then you should have kids you cant afford.
Health care and a safety net should be in place because many people need help one time or another. However, there also needs to be some personal responsibility, some form of limit, some form of volunteering for entitlements received-medicaid or whatever
16
A clinic is an essential element of rural civil society, like an elementary school or grocery store. Losing it can cause an exodus of the middle class and young. The Republican federal and state assault on health care includes not just budget cuts but shutting down abortion clinics and cutting visas for foreign doctors who staff many rural clinics. In impoverished urban minority areas, clinics are often affiliated with hospitals with alternate sources of income, within a solid tax base area, and with progressive city governments. While Trump targets minorities and coastal liberals politically, rural America is in his economic crosshairs. Can white Christian rural Trump voters put their need for health, education, and social services above their racial fears next election?
27
So...what was the most lethal occupation in country 150 years ago? Soldier? Miner? Farmer? Construction worker?
Nope! It was MOTHER!
And that’s the kind of world we seem to be returning to,
30
If you are going to set me up for a joke, I will not pass it up:)
Amazon Prime Delivery anyone?
6
Barney Frank had it almost right when he said, "For conservatives, "Life begins at conception and ends at birth."
Evidently, it should be, "life begins at conception and ends JUST BEFORE birth."
24
Ob malpractice rates are high. Read Galileo's Revenge by Peter Huber published perhaps 20 years ago. It is not better. We need loser pays in negligence and malpractice cases.....if the lawyers knew they might be forking out 500,000 if they lose they might not be so eager to sue. And we need national health insurance to care for the long term care needs of kids who have had obstetrical bad outcomes and it should be no fault. That is a societal responsibility and a measure of our humanity. By the time it has reached the courtroom it is only about money.....for the lawyers.
13
So much winning, right, Dunklin County? (Voted for Trump by more than 70%.)
Thing is, they voted for Trump. They voted in politicians who turned down Medicaid expansion. I don't care what happens to these people anymore. Reap what you sow. Keep idolizing your beloved Donald.
Thing is, that hard heart is another horrible fallout of this 30-year GOP abomination. I don't even know myself at times.
35
Just wait. Us physicians are all fed up. When we quit, walk away, it won’t just be pregnant patients that are left out in the cold. And yes, Obamacare was a big part of why.
11
The US has the ignominy of seeing profit-care way more important than health-care.
7
Maybe this is besides the point, but how in the world is this young woman going to raise three children while earning $8.50 an hour?
34
I'm sorry to say this but a pregnant woman in Niger is not too likely to get any prenatal care, prenatal vitamins much less deliver her baby in a hospital with a doctor. That is, unless she has money or her husband has it. So Americans, especially those who want to have kids, must be willing to vote for single payer health care and recognize it could be much much worse.
10
I would ask these rural folks to please vote for candidates who are actually interested in helping them get affordable health care.
VOTE 11.6.18
11
Three things:
1. In my opinion medical care should never be “for profit” as we get, amongst others, this kind of awful thing that a hospital is closed even though it’s badly needed.
2. Can Planned Parenthood step in here? Open a clinic, an office, something?
3. Where is the father/are the fathers of Ms. Abernathy’s children?
14
Three kids at 21, while making $8.50 an hour? Am i the only one who sees something radically wrong? Where's the baby daddy (s). I guess the taxpayers will be rooting the bill for many years to come
41
Yes - let's close the clinics that provide birth control, sex education and help women plan their families. What could possibly go wrong?
49
A midwife is the way to go.
6
@Kathleen not with high risk pregnancies, such as hers.
11
One part of the problem with access to women's healthcare in rural areas is the relentless attacks on Planned Parenthood, which is sometimes the only nearby place women can go for the checkups and treatment that reduces how many women have complications during pregnancy or at birth.
Funding for clinics that provide abortion services is also under sustained, heavy attack by the "pro-life" types. Odd, since so many of them claim that it's the rural values that are under attack today. They claim to defend these values, while worsening the health outcomes of mothers and of babies brought to term. And they mostly are gravitating to the party that doesn't want increased access to healthcare. Providing health insurance to people whose employers don't is frowned on, too. Better to pretend anyone on government assistance is just a "taker".
The USA has an embarrassingly low rating on maternal and child health - to compare us to civilized nations is to see that our current system is not working.
42
76% of the voters in that district voted for Trump. 69% voted for a Republican governor. Those candidates are clear that they don't want Planned Parenthood - so there went that affordable option to the cities that can support them. The candidate for governor (and their state house & senate representatives) were all solidly against "Obama Care". Voting against their own interests is going to end with a lot of people dead because they can't get medical attention when they need it. But they'll keep voting Republican. So they can figure out what they are going to do without a hospital in their community.
36
My husband fell out of his wheelchair in March and was transported to a local hospital 15 miles away. After a MRI showed a bleed on his brain the ER doctor said he may need surgery to relieve pressure on the brain. A request for helicopter transport to the nearest trauma center 60 miles away was made (no neurosurgeon on staff so all head trauma had to transferred) because of a storm on weather radar the request was denied. He was transferred by ambulance which took a hour to reach...anyone who has ridden in an ambulance can tell you it’s like laying in the back of a pickup truck ...not good for head trauma. Once in trauma care I was informed my husband had a subdural hematoma with midline shift of his brain and there was nothing medically to be done ...he was brain dead. I was not expecting that diagnosis. After all the funeral stuff was over and grief turned to anger at my unexpected loss. I found many in my County agreeing with me the dismay of not having a Neurological staff at our local hospital. I lost my partner and best friend of 30 years because it was too “expensive” to have basic emergency care.
21
I am very sorry for your loss. Unfortunately, neurosurgery/neurology are not considered basic healthcare. These practices are two of the most difficult to complete - 12 to 14 years of school and residency. Rural hospitals don't have the volume of patients to make it worthwhile for a new physician to start a practice. And because the length of training time is so long, we don't have enough physicians practicing - even in larger areas. Many health systems have 6 to 12 month waits to be seen by neuro. God help anyone with a brain tumor or emergent neurological issues.
5
@Mary Dauby I am so very sorry.
5
This is another example how our elected govt is mistreating Americans big time.
“At least 85 rural hospitals have closed since 2010, and obstetric care has faced even starker cutbacks”
Related, per Vox News: “Southern states have closed down at least 868 polling places for the 2016 election. The shutdowns follow a Supreme Court decision that limited federal oversight of elections.”
People are forced to travel longer distances to vote, then stand in longer lines. Many who work long hours or have no transportation end up not voting. It’s a voter suppression technique.
The purpose of closing medical facilities or voting places is profit or political power. This has no place in a modern democracy.
Federal oversight is the key—in medical care and in voting rights. We the People deserve uniform, consistent standards across the country. But that’s off the table when profit rules politics.
In America they can define the Bill of Rights or Equal Protection of the Laws any way they want.
Question: How far must women travel in other modern democracies to get medical care and to vote?
They may be smaller countries, but they have rural areas too. That should be the next discussion.
23
A sense of entitlement without consequences is not what this country was built upon. To have the rights you do and the privileges this country affords you, you have to contribute equal effort. Some make more money and pay more taxes. We live off other people’s money (taxes). Therefore, let’s not forget to be grateful for that and try to contribute our fair share in whatever ways we can. If we are not doing this then we have no reason to demand equal treatment. The government runs on taxes, or other people’s money. It doesn’t owe us anything if we are not contributing enough. So before we demand let’s remember JFK’s words, ask not what the country can do for you but what you can do for your country.
9
It's all about decisions - political and personal. Hopefully, Ms. Abernathy will be an informed voter in the next round of elections - and an informed woman in her family decisions.
9
It's amazing how for-profit hospitals in states and regions that continually vote against tax increases and Medicaid expansions are forced to consolidate and then close, driving up the infant and maternal mortality rate and further increasing the economic costs associated with literally just staying alive
9
As long as for profit is the principle policy for medical care in the US rural populations will always suffer the worst consequences of our priorities. The argument that we have only limited resources falls on deaf ears - we seem to always have enough for defense spending and tax cuts. On the other hand someone has to pay for these hospitals in rural areas. There are real costs involved. So what are the representatives of these states doing to solve the problem? And not just the problem of not enough hospitals, but about jobs? The woman in the article has a low paying job, only her mother to depend on apparently, yet she is hardworking and responsible but her future looks hard at best. The problem is not just the lack of hospitals. The easy answer would be to move but that is not always realistic. To stay however sounds untenable.
5
Neither the Republican or the Democratic Party has the will to implement a Canadian style universal health care system because they know their constituents won't want to pay for it.
6
Do rural hospitals have difficulty recruiting doctors and support staff? Wondered if this is also an issue
15
Yes, they do. Rates of reimbursement in rural communities are set at lower rates than in suburban and urban hospitals. That results in lowered payments to doctors and facilities. On its face that seems fair, because the cost of living in these communities is lower, except for the fact that almost all doctors have huge loans to repay following graduation from medical school and residency no matter where they go. In addition, equipment and supplies are not cheaper in rural areas.
I believe the ACA had an incentive to encourage primary care and OB-Gyn doctors to go to rural areas and get their loans reimbursed or paid off by the government if they served a specified number of years in certain areas.
I am not sure, but I believe those programs are currently being eliminated or severely curtailed under our current HHS secretary.
18
Yes they do have problems getting new physicians. In OB where there are fewer deliveries and malpractice insurance is sky high and pediatric Neonatology not available it’s no surprise that rural obstetrics seems done by GP’s if at all. For the most part medical schools and post graduate training is in large cities and moving to a small town where the lifestyle is much more confined is not an easy sell even with hospital income support. What are the school systems like, what are the social opportunities like? I could go on and on but anyone can get the situation I’m relating.
10
I agree that health care is a priority and should extend to all, including the maintain of hospitals and clinics that do not run at profit. My other thought on reading this article was self responsibility for the pregnant mothers. Having babies is not a God given right, when you can not afford it.
10
@ELIZABETH; Or the self-responsibility of the Republicans who gut women's healthcare and family planning and who then want to whine that the woman kept the kids.
Pick a lane.
8
Yeah, we just lost our maternity services, in my little community. All we have left is lab services, and emergency room. If you're having a baby, you have at least 40 miles to drive, to a maternity facility, assuming no rush hour, or beach traffic. Then, who knows?
1
Let me try to shed a little light on a few memes that are showing up in the comments:
1- The you voted for Trump/Republicans and now you deserve what you get argument.
Not everyone in every state that went for Trump wanted that result. My Arkansas county voted for Obama, Obama & Clinton in the last 3 elections, yet we have a Republican Governor, AG, Assembly, & Congressional Delegation. Just as you are suffering under Republican government you did not vote for, we are as well. There are plenty of blue islands in the sea of red.
2- Greedy hospitals. These days, if a hospital does not do a significant number of deliveries, the insurance rates are almost prohibitive. Many hospitals are running on razor thin margins in a business where nobody can give you a concrete idea of what the market will be like next year, much less 5 years out. Those of you in business understand how hard it is to budget, plan and operate in such tough market conditions. Nobody knows what the makeup of Congress will be in January and nobody can guarantee what the Medicare, Medicaid, CHIP, & ACA will look like.
3-Greedy doctors. Most new Doctors finish Residency carrying debt measured in the hundreds of thousands of Dollars before they buy a home, open an office or anything else. Most are forced to join an existing practice and increasingly those are owned by for profit corporations or the for-profit arms of not for profit hospitals.
We need Universal, Federal, Not for Profit Health Insurance for all.
35
Dunklin County had a population of 45,300 in 1950. Today, 30,500 people live there.
When an area suffers long term population decline, all types of service providers close. Hospitals are no exception.
This story is about demographics, not health care.
8
Wayne T Smith, Chairman of the Board, Community Health Systems.
.
People wonder why there’s no civility any more. Stories like this are why. Healthcare and the wellbeing of loved ones is a hugely personal thing. When people like Wayne Smith make cold, calculated business decisions to shut down hospitals - making healthcare more difficult to get and putting our wellbeing at risk - it’s natural to take that personally. We’re not going to be civil if we see Wayne Smith and his wife and family out one day.
.
Same goes for Time Hingtgon (President at CEO), Thomas Aaron (CFO) and the rest of the mostly men who occupy Community Health Systems’ boardroom.
4
But these folks voted overwhelmingly for the policies that have led to the hospital closures! I feel very sad about their suffering, but how else will people learn to vote for commonsense measures that will make a difference in their lives. How's that tax cut working out for these families if that's what they voted for? How's the trade war? And the wall? Sheesh. It's very hard to feel sorry for these folks... but I hate to see this. We should all be living well in America. But we know it's only corporations and the CEOs who steward them who are really benefiting.
6
No worries; Trump will help his supporters on this issue.
4
Shameful! This is third world or worse, and right here in the good old U S of A. I am fortunate to live in a community with two full service hospitals - one public and one private. But the public one is struggling based on over use by the uninsured and the "deals" cut by insurance companies. The private one is struggling based on the "deals". Right now, we have sufficient cardiac, cancer, obstetric, and general medicine coverage. But for several years we have not had a Category I Trauma center. In case of severe trauma, patients have to be sent more than 100 miles away to San Antonio or Houston for care. Psychiatric care is all but non-existent, with traveling doctors coming in from Houston on a 1-2 day a week basis -for a community of 92,000+.
Where is our compassion, our acceptance of responsibility? I don't care if you're Rep, Dem, or Ind. We need to fix this NOW!
6
Medicare for all.
5
This plutocracy has billions more for the defense industry, billions for the fossil fuel industry, billions for corporate America and the richest of citizens, but not a dime for the rest of "us" .....whether it is funding for rural hospitals or affordable housing in California.
22
These people voted for Trump. Did they get the health care he promised them?
40
Yes. Every area should have a hospital with an obstetrics unit. Yes. There should be quality health care for all. Yes. We all want these babies to thrive. But, a question. Where is the father or fathers? This 21-year-old has a 2-year old. Why did she have more children? Just asking.
32
Would the father’s presence have changed any of these relevant facts? Or are you saying she and the babies deserved this outcome because they lacked the guiding hand of a man in their lives?
19
It's almost absurd that the fathers were not even mentioned. Men are increasingly viewed as disposable.
8
This situation could just as easily have happened to a 35-year-old woman.
8
Please NYTimes, more articles about how we are not taking care of real problems here at home what with this ongoing Trump circus of enablers pushing for giving tax cuts to the rich, trying to destroy the Affordable Care Act, and Trump's own very wasteful spending if full display.
9
Yet another example of the 'great' outcomes from your user pays "health" system. Here in New Zealand where there is a (OMG, gasp, quelle horreur) socialist medical system, nearly 100% of the pregnant population has access to and uses an excellently trained force of midwives for their comprehensive prenatal care. Referrral to an obstetrician when needed is prompt and also frree (and obstetricians don't refuse to see anyone).
Make any comparison you choose: comprehensive pre and post natal care, maternal morbidity and mortality, still birth/premature birth, infant mortality (especially at the poor end of the spectrum) and then decide which works best: a system where you can buy anything (or in many cases nothing) or a system that has been designed to safeguard the lives of all its citizens, starting before they are even born.
56
Comparing New Zealand to America is like comparing a T-Rex to an ant. Hardly relevant. If you are a bunch of ants, with plenty of food for you to survive, it doesn’t mean the T-Rex does too.
4
The Obstetrics ward at the hospital where I was born closed down years ago & it’s not a rural area. It’s an affluent suburban area. Our biggest problem was undocumented immigrants with no insurance who would suddenly pop up in the hospital, have a baby, not pay for it & have postpartum problems with babies & mothers due to lack of prenatal care. Even emergency Medicaid couldn’t solve that mess. The hospitals couldn’t afford the care of mothers & babies who had never seen a doctor & the state said they couldn’t accept the hospital’s poor obstetrical outcomes. Add to that the litigious society we live in. Lawyers advertise on tv to sue hospitals if your baby is born with a problem. No prenatal care? No problem!
The hospital said, “You know what? We’re done here. Let someone else deal with the non-reimbursed costs, the ambulance chasing lawyers and the low grades from the state which threatened the closure of the entire hospital” and shut down the OB floor.
But people don’t want to talk about illegal immigration when it comes to the costs of obstetrical care. They also don’t want to talk about the societal change of women having babies on their own without a second income. Back in the day, mothers were married & they or their partners had jobs with health insurance. Now there aren’t partners, there aren’t decent fulltime jobs for men or women, and there isn’t any health insurance.
Guess what comes next? Elder care. Nursing home & geriatric units will close.
16
@Hychkok Thank you for bringing up the health care costs of illegal immigration. A friend of mine who is a nurse here in NYC has witnesssed what you have stated. She has to help 14 and 15 year old illegals spell their babies’ name because not only do they not speak English, they are also illiterate in their own language.
12
This is the richest country that has ever existed. But we WON'T provide decent, affordable, accessible healthcare to all Americans.
Because it CAN be done. And we know how to do it. We just WON'T do it.
Why? Because the Koch brothers, the Waltons, the Mercers, the Adelsons, the TRUMPs, the Murdochs, and all the other 1 %-ers might have to pay their fair share of taxes if we did.
14
A consequence of a for-profit medical /healthcare system. Wrong wrong wrong.
10
American exceptionalism is just propaganda. I just spent two months in Canada, my other country of citizenship. What an eye opener. Vast distances between small towns in a huge country. Universal healthcare, and the system is by no means perfect. But they have a much lower infant mortality rate and people outlive Americans. The US system is predatory capitalism with at least 30 % of every healthcare dollar going to profiteering. it's a sick system, so Americans get sick and die or go bankrupt. It's sad watching the USA slide into such a diseased swamp. I am lucky I can work freely in both countries. Not a day goes by that I don't give thanks for my Canadian citizenship.
23
Greatness. Much Greatness. So Much Greatness !
34
Of course if we had a decent society with government help this situation wouldn’t be a problem, but our rural brothers vote against this
15
So many comments blame the people of this county of which 75 percent voted for Trump. Would there have been more sympathy if they had voted for Hillary? It’s not Trump’s or the Republican’s fault, nor is it the Dem’s as more enlightened and informed commenters have stated.
I thought the Democratics were the party of love for all. Hypocrites.
Someone please get 21 year old Kela, the mother of three, some birth control. Where is the father(s) in this story?
8
@Olivia
Trump’s policies have nothing to do with hospital closures as you stated.
This has been coming for along time and accelerated under Obama.
These places can not afford full service hospitals.
The country can not afford to pay for full service hospitals close to all rural folks.
6
It’s a question of priorities. A generation of increasing concentration of wealth at the top leaves less money for everyone else. For states, counties, cities and towns. I don’t believe that they need to have a hospital next door but 200 miles away is not sustainable. Sometimes things cost a lot of money but they’re worth it
2
When the 'granny midwives' were driven out by the medical establishment, the argument was everyone would have a higher level of care. Clearly this was false.
13
Keep voting for Republicans rural America, health care will improve as soon as we eliminate Obama care.
1
Good luck with that. Republicans have no plan or intention of offering ANY kind of healthcare legislation except to take away any of it that is left.
2
This wouldn't work for all cases, but traveling nurse midwives could really help out here. They could handle prenatal care and routine deliveries and catch high risk conditions early so patients could plan to travel to hospitals before their due dates. A while back the Times ran a story about Alaskan women who go to maternal homes a few weeks before they are due. Of course, cost is an issue and in our current environment it's not clear who would pay for such care.
6
This is also a growing problem in rural Sweden (see https://www.bloomberg.com/news/articles/2018-06-26/now-even-swedes-are-q..., so I don't think these closures are necessarily a symptom of capitalism. I'm wondering if out-of-hospital midwives might be a cost-effective solution both here in the United States and in Sweden. If Medicaid could be expanded to include midwifery care, that could get these rural families the maternity care they need.
10
It's all based on fear that a normal delivery could go "bad"; that a woman might end up needing an emergency C-section (even though with good prenatal care, this risk is small, as many high-risk pregnancies can be identified and referred ahead of time). In small towns like mine, the hospital is not equipped for surgeries and has no obstetricians, even though our community has 6-7 well-trained family practitioners who all know how to deliver babies and have done so for years (including 2 of mine) until a few years ago. But because of the risk of a possible bad outcome, insurance companies and hospital administrators, together with the American College of Obstetricians and Gynecologists (ACOG), have decided that deliveries in small towns are no longer acceptable. This is a shame and, in my opinion, a step backwards for our country and its healthcare for women and families.
12
PLEASE do further analysis on if the closing of rural hospitals (and access to all types of medical care) by states differ among those that expanded Medicaid under ACA and those who did not.
Many people highlight this could be due to ACA (or not be true). But we don't know based on the information presented. We just know it is since 2010.
6
As I understand it many of the states, which have hospitals that are closed/closing, are states which refused to expand Medicaid which they could have done (and still could do) under the ACA (aka Obamacare). Of course most of these states are controlled by republican legislatures and/or governors. They gave all sorts of reasons for not expanding Medicaid but it pretty much boiled down to not wanting to support anything proposed by President Obama.
At some point people have to make a choice and then live with it. If they don't want Medicaid expansion that is fine but not doing it has cost many rural communities in the form of medical care. Maybe the citizens of these states should take it up with their legislators and governors.
25
@Auubrey That is harsh but accurate.
That said, it is hard for cash-strapped, overwhelmed people to make the time to learn about campaigns and issues, much less skip a day to vote.
If we made Election Day a universal holiday and mandated public funds to pay for campaigns, we might fix things...
6
@TJ Thanks TJ. I have always believed that any system will work if the people involved want it to work. We would have a better system of elections and government if everyone wanted it to be better. But the truth is that there are many people who want to restrict voting, make it more difficult for some to vote, and make the system be less democratic. That is why everyone should vote at every election if at all possible.
2
The closing of rural hospitals is just a symptom of econommic contraction in these same areas. That these towns once had viable hospitals and clinics (and car dealers and schools and central shopping districts) proves they had a "critical mass" of economic activity in the past.
Blame who you like, but at least part of the cause has been a multi-decadal migration to urban areas. What we need is not artificial support of hospitals in empty counties, but to somehow convince people that living in small towns is trendy and hip.
14
@Bob Krantz: get a mobile health unit.
2
Part of this is self-selection. I write about 3 letters of recommendation every year for students seeking admittance to medical school every year. One of them once said a rural area, because that's the kind of area where her parents served as doctors, and she considers it a moral duty. Which is to say that even she considered it self-sacrificial. Doctors are well-educated and (mostly) liberal. They mostly don't want to live out in rural whatever.
The other part of the issue is that childbirth has become highly specialized and medicalized. Personally I don't think that's a bad thing, and it's partly simply the product of increased medical knowledge and technologies, though obviously also partly because of things like high obesity rates. But the point is that some of these towns may well have doctors (or midwives) who can provide less specialized care. Providing 2 months of NICU treatment to under three-pound twins, as in the story--that requires a major facility with very specialized equipment. I'm not saying those facilities *shouldn't* be all over, but... We live in a giant country. I'm not sure it's possible to have one of those every 30 miles.
Of course there should be SOMETHING in place to support Ms. Abernathy--it might literally be more economically sustainable to provide public support to house people like her near a major hospital for 3 months than to actually sustain hospitals like that near their homes.
17
@bess: The "something" is Planned Parenthood. If people get good prenatal care, have access to contraceptives, get educated, can plan their own families without politicians orthodox religious stuff in other people's lives, get screens and check-ups then you don't have to have as many people seeking emergency care hundreds of miles away while endangering the lives of the mother and child.
Ask Mike Pence. He was personally responsible for a public health emergency in Indiana when he closed clinics, rural opioid addicts began sharing needles in huge numbers and he suddenly had a third world situation with an HIV-Aids epidemic from shared dirty needles. But he felt great about closing PP. His forever-healthcare is gratis, thanks to US taxpayers.
7
While one hesitates to blame the victims, these rural hospital closures are the direct result of these states refusing additional Federal dollars to expand Medicaid availability.
But let us not overlook the toxic effect of for-profit hospital chains making decisions based in what’s best for their bottom lines, and not what is best for the public health.
24
In urban areas, particularly the less affluent sections, a very high % of the doctors (and nurses) come from third-world countries. I was under the impression that the same, at least for doctors, is true in rural areas as well. Is there any way to steer FMG OB-GYNs to underserved areas such as Missouri? Or is it impossible for the OB to practice without a hospital nearby. Of course, with enough OBs, it should be possible to have an OB department, unless the reimbursements are too low. BTW, about 15 years ago United Hospital in Port Chester closed. The triggering event was the exodus of the OB service.
3
It takes more than just doctors to serve in OB. A surgical team needs to available for emergent deliveries, the equipment, the drugs and the staff.
The cost of the liability insurance has to be calculated in as well.
2
The Republicans are delusional if they think not providing healthcare to the American people is cheaper than premature infants in hospitals for months, mothers with totally preventable maternal health problems that go bad, elderly people ending up too far away from care, reliance on an ER for care, etc.
There is a kind of madness in their politics right now that is going to take a generation to take out of their hands and exile them politically.
29
The article primarily addresses the profound shortage of obstetric resources in rural / underserved areas, but only briefly mentions a parallel issue -- the worsening shortage of both inpatient and outpatient pediatric care, addressed in this recent article in The Hospitalist: https://www.the-hospitalist.org/hospitalist/article/170115/pediatrics/ra...
6
It is the Medical Industrial Complex that no longer cares about patients or health care, but only money!
14
While distance is certainly a problem, families living in urban areas that appear 'close' to a hospital also have problems with access to OB/GYN services. Among the many problems is a callous approach to providing for others that is so pervasive in our society right now. The boot-strap, stand on your own two feet mentality belies the reality for so many people.
6
The party that backs legislation that will ensure that every fetus is carried until term cuts back on funding that will make childbirth safe both for the mother and the child. The Republicans really do have a war on women.
27
These rural voters rejected Barack Obama, rejected Obamacare, and drove intensely to "get government out of our lives". You have got what you wanted, congratulations. Now live with it.
67
"They don’t know what to do.”?? I know what they can do. They can vote for and put in office people who won't keep driving them deeper and deeper into the hole they are in, A political party that will spend the taxpayer's money on helping the taxpayer. There is an old saying "when you find yourself in a hole, the first thing is to stop digging". Stop voting for people who make your life worst. Vote for people who will make your life better. Stop listen to the lies.
33
Could have done that if Bernie was the candidate.
1
What kind of country allows a person who cares for the elderly to be paid so little that she has to spend nearly 25% of her pre-tax income on the gasoline she needs to drive to work?
32
Just before this I was reading David Brooks column (not necessary reading). The themes run through every story these days. The world for a handful of people is nirvana while the rest of the world unravels.
Jeff Bezos just broke $150 billion in assets and his workers can feed themselves.
Somewhere between stifling socialism and unbridled capitalism, there are tax rates that can redistribute earnings and assets that help lift the world out of war and desperation while allowing aspirations to thrive. If we can own that truth we can deliver babies not just packages.
17
Dare I try to spin this as an issue of personal responsibility? Isn’t that how conservatives always spin things? Clearly, just like we should do away with public education and homeschool our children, shouldn’t we all find our own hospitals? Thing is, resources like hospitals and health care - the things you don’t need until you very seriously do - are the sorts of things we all need to pitch in for, when we’re well AND where we’re sick, regardless of where we live or who we vote for.
11
What will be the tipping point where we as Americans demand better healthcare and vote out those politicians that won’t obtain it for us?
12
I don't understand why anyone, pregnant or not, would want to live so far from a hospital. All types of things can happen to people that warrant getting to a hospital within thirty minutes - accidents, heart attacks, strokes, kidney stones, etc. Unless you are emulating Unabomber (minus the bombs) or Little House on the Prairie lifestyles, you need to be closer to the creature comforts. However, these people are Trump's base so one can argue this is what they signed up for. The infants that died did not and it is very sad that they paid the ultimate price.
9
It appears as though you did not read the article thoroughly. These areas did have hospitals which suddenly closed. It is not as though these women asked for that to occur. I lived about an hour from a hospital for the births of two of my children (one of whom was born in the winter). It was not my choice to live that far away, but that’s where we could find jobs (my husband is an ecologist, and I’m a veterinarian). Rural areas in our country will probably always exist; many of them provide the food we consume, and contain much of our country’s natural resources. People have to live there. It’s important that we recognize that, and making a statement that people should just live closer to hospitals strikes me as rather uninformed, and isn’t actually a solution to the problem.
24
This makes you wonder about midwifery as another option. It's definitely not a replacement for a hospital and obstetrician for serious complications, but many women choose to hire a midwife to help them deliver at home. Perhaps a program to bring more midwifery training to rural areas?
10
Not twins. Typically.
1
@Kat
Sure! Let’s just stick poor people with inferior care delivered by people with inferior training!
No hospital? That’s OK, just deliver in a manger. It was good enough for Jesus.
Ditto for the recent surge of primary care delivered by non-physicians with scant clinical training. Yes, I’m talking about nurse practicioners and the like.
1
There are many reasons for the general decline in medical care and it is not just rural. Our system is broken and no one is willing to step up and fix it. Things will only get worse. The stories I could tell.
2
Don’t worry Trump will make hospitals great again, right?
The ACA helped keep rural and
community hospitals open. Now
what, GOP voters? The bad results of your decisions will keep coming.
Paul Ryan stated clearly that Medicaid and Medicare are on the
chopping block. Remember this in
November. They want a red wave
so that their plan to unleash the
power of the free market on the
sick, disabled, and elderly can
come to fruition. Though they’ll
use abortion/guns/immigrants as
cover, this is what they really
want. And it will crush you.
31
I do support universal healthcare but would like to play devil's advocate for a moment (and I do think there is some truth here). Many of these towns were created to support one industry, or one company. People flocked to these localities for that one reason. Now that the companies are going away, or the industries are no longer popular or profitable, is it America's job to subsidize areas that are not great places to live in anymore? In a sense, because of this, Americans need to emigrate to places where there is opportunity, to states or cities where there are jobs and resources. I do not think staying for more than one generation without any jobs, hospitals, stores or capital is sustainable. And to pretend it can go on like this is foolish.
14
@Meadow while your point about industry/company is valid, I question of you read the article. These women struggle to afford the cost of gas to make a doctor visit. How on earth would they be able to uproot their lives? Emigration is expensive, prohibitively so. If one moves, there is no guarantee that the cost of living will be affordable, a place of living is certainly not a sure thing, finding a job may take months.
Perhaps, instead of telling these individuals what they should do, you might instead ask why it is that they have not done so, already. You might have your answer.
4
Sorry but elections have consequences and these people are getting exactly what they voted for.
I'll save my empathy for people who don't vote Republican.
26
@Adrienne exercising the right to vote, in whatever way you choose, does not make one deserving of her own death and/or the death of her child.
4
So most rural Americans vote Republican. Medicaid not expanded in Missouri most likely by a republican. Do these rural folks make this connection? The Republican Party does not represent rural America’s economic interest.
Vote Democrat
20
*EVERY TIME* a story like this runs, I wish the reporter would have taken the time to ask "For whom did you vote?"
If the answer was "The Republican", then the reporter should press on and ask "Do you understand that you're now getting exactly what you voted for? Do you feel any different about your vote today now that you realize how it affects you personally as compared to just affecting 'those' people?"
And if the answer was "I didn't vote", then the reporter should press on and ask "Did you understand that people who did vote were going to be making the decisions that are now affecting you? Will you be behaving differently this November?"
I'd really like to understand the statistics around "Getting what I voted for"/"Getting what I voted against"/"Meh".
21
Eventually, you get exactly what you VOTE for. November.
16
Fat, sassy guys in places like the governor's mansion in Texas decided it was OK with them to gut Planned Parenthood in Texas, leaving rural women without good prenatal care and consequently a new maternal death rate right up there with 3rd world countries.
But they feel good about it.
Until people vote their interests and punish and I do mean punish the ideologues willing to kill off would-be moms with pitiful or non-existent care, then these guys are going to keep doing this to please their increasingly bizarre and elderly base to fundraise off of while endangering the next generation.
24
Why would someone making $8.50 an hour be having children at all, let alone 3?!? Absurd.
62
Good point. We barely make ends meet on six figures with two working parents in a moderately-priced city.
6
@A reader: it's her business but perhaps the Planned Parenthood was closed by the "absurd" GOP near by.
16
@A reader Have 3 kids making $8.50/hr? Pro-life, not pro-choice!
7
I have to read the paper again to make sure it is happening in the USA not in a third world (The NY Times being a family newspaper I will not use the words of President Trump) country.
4
Keep on voting for republicans, rural America, you won't even be able to raise a volunteer fire company. Your party want's you to be desperate wage slaves so you won't sass the overseers when they pay you a dollar an hour to make your labor competitive on the world market. Then you can eat your guns and ammo.
24
I could be overreacting, but it seems that we are intentionally marching toward what used to be called ‘third-world’ status.
Maybe one of the reasons why that term has grown out of favor is because it’s hitting too close to home on too many significant data points.
16
The crisis faced by those in rural areas regarding medicine is yet another reason that "market solutions" are not the answer to all problems.
Capitalism's objective is to make money. Pure and simple. Many figure that once we strip away all, or most government regulation, the wonders of the market will satisfy most people and efficiency will reign. But what happens when there is so little demand as to limit the motive for any investment, as is the case with many rural communities and medicine? Without any, or very little economic incentive to provide for these areas, doctors and insurers flee to larger markets, the big cities, leaving those in the country to fend for themselves. The solution to this is some type of government-run medical system, one that requires service. Leaving this to vagaries of the market is simplistic, and in this case, deadly.
10
Competition is great for controlling costs where there is sufficient demand and labor supply. Where there is not, there is a big difference between having one of something and zero of something. If it is cheaper to run a clinic with a subsidized helicopter and ground ambulance service, this might be a viable alternative to a full hospital in a sparse county. Whatever form it takes, there is plenty of precedent, and obligation, for government intervention in health care systems primarily based on competition.
Speaking of government intervention, instead of trying to depopulate regions of the country by shuttering expensive but necessary services, the government could instead allow a lot more people move here.
4
For those saying"move to where the healthcare is", consider that some have already done that, that there would be more people there, more other businesses, more jobs if those hospitals and clinics had remained opened, if instead of profit center consolidation they had remained independent, and planned parenthood clinics, which in many states don't perform abortions or refer women, had not been closed.
Consider also that rural America is where much of our food and other agricultural products come from.
7
@Me It is true that our food comes from there, but not from labor. Food is produced with significantly less labor now so the people are not needed for that.
1
@Me Rural America is where some of our food and agricultural products come from, but much of it also comes from abroad. However, the number of people required to work in the fields and orchards to products our food is much smaller than it used to be thanks to technology. The fact that food is grown in a place is not an argument for the government to work to keep dying towns alive. If there are no real opportunities in a place, people need to be encouraged and incentived to leave. (I am NOT saying this should be done by slowing taking away all their health care, before everyone piles on).
Keeping a hospital open in a dying town with no real industries only creates opportunities in health care, not in other businesses or industries. That would be a snake eating its tail.
3
None-the-less, people are required. Food simply does not grow its self. Ag can be a dangerous business; medical care needs to be available to the people who grow our food. Those who work in ag also would like to have lives and families. Take away the basic necessities those families need and see what happens to production. It is a very shortsighted view to say America can get its food from other countries. The USA is already importing more than we should be comfortable with. In the face of a world-wide catastrophe or war, the rationing we could face would be beyond austerity. Smart citizens support the people who grow their food.
1
The model is not working. The state hurt its own population by their legislative rant against Obamacare (not expanding medicaid) and their rant against 'abortion' (forcing planned parenthood clinics etc. to close even though in many states they don't even provide abortions or referrals for abortions).
Beyond that, the fallacy that the private sector can do everything better comes into play - healthcare, especially when insurance is involved, is about as far from a text book perfect competition model as one can get; it is rife with asymetries of information between doctor/patient/insurer, the patient has no bargaining power as there is little 'choice' when it is about life and death, pricing is opaque and extremely variable, and then there is the insurer which adds a third player to the setup. That is why lots of regulation is needed - to provide the right amount of care and keep the costs down. In the situation here, the profit motive pushes providers and hospitals towards where the concentration of money is and away from where it isn't. That is why public funds and incentives are needed to support healthcare in rural areas.
11
This is exactly what they voted for. The first story about Missouri - people here were against expanded Medicaid, the hospitals went broke.
There's nothing in these areas the federal gov't did not build. Rural Electric, telephone, the roads they must drive 100 miles down... these people now say they don't want any of it. Take it away and let them live how they demand.
26
How much can we afford to spend to have all types of medical care available to all of us everywhere? At some point is is incumbent upon each of us to make ourselves available to the care we need.
9
Every other first world nation does it. Why can’t the US, the richest nation the world has ever known.
5
Because we cover much more land area with varied terrain, unlike other first world nations.
3
@Doctor D:
Oh Lordy. Even our great-grandparents could put together a hospital in rural America for care of patients and mothers having kids. Do you actually want to lose a grandchild to something treatable like snakebite because you have no facilities anywhere??
5
As long as this administration goes unchecked and deregulation and big business runs this country no one who isn't one of the 1 % will be living under the same laws. This country no longer will take care of its people. Every aspect of this government is geared now to the Trumps, Kochs, McConnells, Ryan's, GOP, Republicans. They consider themselves the only true deserving citizens of this country.
7
Rural North Carolina counties are losing population to larger, urban dominated counties. For the rural hospitals, the loss of patients also means the loss of revenue to keep them open, resulting in some hospitals reduced to urgent care facilities. Meanwhile, our veto-proof Republican dominated legislature has steadfastly refused to expand Medicaid and obstructs ACA signup opportunities whenever they can, even with the knowledge that these actions harm public access to health care facilities.
8
Enough with the wailing "oh but hospitals closing is the red states' fault for not expanding Medicaid"
Medicaid ONLY Pays 22 -50% of what it costs to treat a patient.
That means the hospital eats 50-78% of the cost
They LOSE MONEY on all the Medicaid patients.
Medicaid patients will NOT keep a rural hospital open.
It merely reduces how badly that hospital is in the hole from catastrophically in the red to really badly in the red.
In both cases, it ends in the hospital CLOSING!
19
Well, their republican reps won’t be expanding their Medicaid benefits, will they? Yes, you get what you vote for.
11
@AnnS Those patients who are being shut out of the Medicaid expansion are too poor to afford even the subsidized ACA health plans. So they are uninsured, and when they finally need medical care, like for delivering a baby or seeking medical care, the hospital receives NOTHING for the healthcare provided. Medicaid would have at least helped the hospital recoup some of its costs, instead of NOTHING.
3
At least they have tax cuts, though, right? So it all evens out in the end. You get what you vote for.
6
Health care is a profit-making enterprise. Health care will be provided where there is money to be made, that is, in evil cities, run by evil Democrats, where no business can exist because taxes are too high, your guns will be taken away and there are too many regulations. Did it ever occur to people who choose to live as far away from any other people that if they did, they'd be far away from other people? The education system in this country needs as much improvement as the health care system. (But we can't afford it, they say.)
3
@Scottilla
> Health care is a profit-making enterprise.
Health care *IN AMERICA* is a profit-making enterprise. Other countries have made other, perhaps better choices. We could, too, but we don't.
6
Switch rural healthcare for another issue, such as stricter firearms regulations or opening the southern border to all Latinos. Watch all of rural America explode in protest (and worse).
It saddens me greatly to read these articles, but I know this is what most people there voted for. Elections have consequences, and rural America has had several of them.
NYT should do a series on the recent WaPo article where most Americans in thirty years will be living in 7 states, and the political implications of that.
5
@John W And all that will do is give the Electoral College an even greater impact on elections. Ugh.
Certified nurse-midwives, attending low-risk births at home or lost-cost birth centers, and higher risk births in hospitals as part of a team of that includes physicians, is the best and cheapest way to address this problem. I see no mention anywhere in the article about midwives. Mr. Healy, do your homework and follow-up with a story about whether the regulation of health professionals in the states featured create unnecessary barriers to midwifery care.
8
@Alyson Reed
Wee problem with that
Medical professionals - nurses etc - DO NOT WANT to live in that area
That area has struggled to get healthcare providers for over 15 years
Google it - lots of stories out of Missouri about the area's inability to attract and retain providers
5
@AnnS
People who already live in the area and want to stay there could be trained as nurse-midwives, nurse practitioners and physician's assistants.
@Freedom: I just wanted to add to my reply to you on “ shared responsibility “ with respect to out of wedlock children that in addition to Planned Parenthood we should substitute the aforementioned vasectomies for viagra under things covered by our ridiculous healthcare system, who would have thought the old guys passing our laws would be in such demand as to find viagra necessary, and covered, while birth control for men isn’t. In all seriousness it does take two to bring a child into this world and the twenty minute procedure for men is reversible: time for the guys to step up to the plate, it can’t always be women’s responsibility.
22
Complicated by the fact that many are Catholic-run hospitals in this state. Which means that if they offer obstetric services they must also offer other reproductive services. Like birth control. And legal abortions. So guess what gets cut? The War On Women is alive and well...
13
If Mitch McConnell and Paul Ryan get their way eliminating Medicaid for thousands of their constituents, watch the wave of hospital closures that will occur in their states as well as others. Of course, they, other GOP office holders and Trump will try to lie their way out of their responsibility for causing another crisis they have created blaming it on Mr. Obama, Hilary and Bill Clinton, CNN, the New York Times , etc.
10
There are a lot of comments here that are angry, frustrated and hurt. What we need is not invective but ideas. How about a corp of midwives or a partners in health program. Who cares who voted for what. More ideas and acknowledgement that sneering partisanism is just sadness and shock callused over with a thin tissue of political principles.
6
I agree with you Geno. We need to find solutions to problems like this. Unfortunately, the reason people whine about Republicans is that it seems like the republican representatives in our government object to solutions that are not in line with their dogma.
When the ACA passed, rather than modify it, or tweak it to work better, they just outright rejected it. They ran on repealing it and when confronted with doing so, had nothing to replace it.
Providing women with access to birth control and prenatal care in their private health care plan or via Medicaid seems like a no brainier to control costs. Unfortunately, many conservative donors and religious leaders don't agree and pressure republican representatives to follow that lead instead of using common sense and an accurate cost analysis.
The frustration of many who do not fall in line with this thinking is reflected in the comments.
7
Where are those “pro-life” activists who want to save babies? Surely this must concern them.
16
@C Many of those pro-lifers believe in tax cuts more than they believe in the quality of life after birth.
3
maybe 20 years ago, the Times ran a story about a couple in Wyoming , who lived 40 miles up a dirt road.
The local school district, rather then pay for sending a school bus up and down the road each day, paid for boarding school for the child
2
This is a great example of why we need to super-fund Planned Parenthood! (if we can’t figure out a universal healthcare system.) I went to PP when I was 21 and managed to not bring any unplanned children into poverty (and avoid abortion). And I went on to get married and have a comfortable family that ironically fits well into the Christian ideal.) I know I have little information, but I’m not feeling optimistic for the babies in the story. Hopefully I’m wrong.
And I have poor relatives in similar rural areas that support republicans but suffer from their policies. I don’t understand it! (Maybe it’s the fault of Fox News and other stupid tv?)
19
In the early 70s, I returned from Vietnam and worked to start a program under Intermountain Health Care (IHC) in Salt Lake City, UT where I would set up rural clinics, some 200 miles from an MD or hospital. New programs of Family Nurse Practitioners were graduating with Master’s Degrees from both Utah and BYU--the private Mormon University. These men and women got independent licensure and a year extra of pharmacology to write & use prescriptions.
I lobbied for a Rural Pharmacy Act where Pharm-Ds set up small locked areas in each clinic. The NPs could write scripts that patients could drive in & fill. Meds for chronic conditions--insulin to heart meds. But clinics needed meds for acute problems that needed to be used NOW.
These NPs were the top grads and it was a HARD job as they also had to do the x-rays--some still using wet dip-AWFUL chemicals. Did their own labs too. I worked with the NPs and was amazed what they could do with so little. We set up ground ambulances with volunteer EMTs to do initial care/transport. Contracted for Life Flight--both helicopters and fixed wing for the worst emergencies.
Each clinic needed access to curettes and a suction machine to do emergency D&Cs. Fairly simple procedure but absolutely necessary to keep a woman from bleeding to death from problems with some miscarriages. IHC, a Mormon institution refused-“Don’t want abortion clinics!”
Until the day a woman came in HEMORRHAGING and the clinic had the tools/know how! They saved her!
6
@Nuschler Just curious - what happened to this program? Does it still exist?
2
"It’s 4 A.M. The Baby’s Coming. But the Hospital Is 100 Miles Away."
I am confused by this headline.
Piggot Community Hospital is 16 miles from Kennett.
Pemiscot Memorial Hospital is 18 miles from Kennett.
Great River Medical Center is 29 miles from Kennett.
Dyersburg Regional Hospital is 44 miles from Kennett.
St. Bernards Medical Center is 55 miles from Kennett.
Lawrence Memorial Hospital is 60 miles from Kennett.
Searching for obstetricians near Kennett, MO will yield 5 within five minutes, and many other surrounding the area.
8
@Georgi: There is more to the story (did you read it) than being able to google "miles from Kennett".
4
Some doctors won’t see patients who are late term or high risk.
4
@Georgi Did you happen to check if those hospitals offered obstetric services? And that the obstetricians took high-risk, late-term patients?
2
And under Trump and this worthless GOP, it will only get worse. Remember voters, Trump and the GOP are about the donor class, not the middle class.
7
Rural (white) America overwhelmingly voted for this.
They have my thoughts and prayers.
20
Hospitals in rural area started failing in 2010. Yet the readers claim it's trump's fault. It's the fault of the aca, Obamacare. HHS and CMS are the implementers of this joke of a fix for the US healthcare system that purported to improve access and reduce costs. But most here are city dwellers who hate 'country folks.' Need midwives at this point, but shame on dc and their insurance companies
2
Did you read the part about Missouri’s “failure to expand state Medicaid” like other states? The states that sided with the GOP healthcare obstructionists back during Obama’s administration, surprise surprise, didn’t take the financing that was available to the states that opted to help their poor and needy citizens.
So hospitals in their communities failed. They got what they politicked for.
7
No ma’am, Republicans controlled Congress almost the whole time- don’t blame Obama, blame the reps and senators these people voted for.
13
When the now Republican governor of KY was running for office he pledged to eliminate the ACA and cut Medicaid. When asked how he could get elected with those policies the answer was 'People on Medicaid don't vote'. How true it is.
I guess there is no need to comment on the fact that the woman giving birth to twins did not have a partner or husband to take her to the hospital or help care for her after the C section.
4
All the more reason to support Planned Parenthood.
18
A major if not the major contributor for financial strain and eventual closing of hospitals that serve uninsured patients is the reduction of Disproportionate Share Hospital (DSH) funds which are meant to compensate for hospital care delivered to patients without insurance.
Over 3,100 hospitals receive this funding which has been reduced by $5 billion during 2018 alone.
This reduction is part of the Affordable Care Act (ACA) which the Democrats passed without a single Republican vote.
Inexplicable to me is why the Democrats claimed to want to offer care for more people, yet reduced the federal DSH funding instead of increasing it.
While emotionally comfortable to claim that it from lack of Medicaid funding, if the Democrats had only increased instead of decreased DSH funds to hospitals as part of the ACA, then it is less likely these hospitals would be in financial trouble and closing.
NYC public hospitals such as Bellevue and Harlem Hospital have been significantly underfunded as a result of DSH funding cuts.
I wish the NYT work with NYC business people to look at the balance sheets of the NYC hospitals and the rural hospitals and would interview Obama and leading Democrats who passed the ACA and ask them why they decreased the DSH funds.
Would some enterprising NYT journalist(s) please investigate this?
DSH:
https://en.wikipedia.org/wiki/Disproportionate_share_hospital
4
@David MD They reduced it because the expansion of Medicaid in all states was intended to shift the costs over.
When SCOTUS said that was optional, that went out the window.
2
@Seri
The Democrats and not the Republicans were the ones who reduced the DSH which was unwise in any case as these hospitals are typically underfunded anyway.
The DHS funds cover illegal aliens (of which, for example, NYC has about 500,000) which is not covered by Medicaid.
New York State Gov. Cuomo was critical of his fellow Democrats for instituting the cuts.
'“The irony and meanspirited nature of the cuts is breathtaking,” Gov. Andrew M. Cuomo, a Democrat, said in a statement on Friday. “These cuts are specifically targeted to our most stressed hospitals and neediest populations.”'
https://www.nytimes.com/2017/10/02/nyregion/federal-funds-hospitals-cuom...
Government so small you could drown it in a bathtub.
The Conservative utopia, endorsed by the citizens of Missouri.
Freedom for American citizens. What could be better than that?
9
This is just one example of how the real needs of people are being neglected more and more in this country, in favor of greater and greater profits. What is especially infuriating is that many people in rural areas, as well as cities, are simply unable to understand how the economic and political system (technically known as "capitalism") works, and therefore fall for completely unrealistic ideologies and the politicians who promote them.
8
One story after another: Over 14,000 wastewater (sewage) treatment plants need major repair/replacement. 54,000 bridges need fixing. Fresh water is becoming imperiled by fracking and overuse of aquifers. And rural hospitals?... Fawh; they are weak bottom liners. But the stock market is doing fine - for that narrow slice of us who own significant stox. Perhaps the strangest story is how those very folks most damaged by American decay cry "socialism" at every plan to fix the problems. We must be a dumb as Trump says we are.
10
Absolutely ridiculous. 30,000 people isn't even a small county, and should be big enough to sustain a hospital even with stagnant Medicare spending.
30,000 is pretty close to the median population of all US counties.
2
The Democrats made huge federal funding increases for Medicaid in rural regions keeping many clinics from closing in the great recession brought to us by the GOP, Democrats doubled families receiving food stamps and passed the Affordable Care Act which increased revenue for health care providers across the nation. Trumpublicans are cutting Medicaid, cutting food stamps, eviscerating the ACA and acting to bankrupt Medicare with their $1 1/2 trillion tax cuts for millionaires, billionaires and Wall Street. Uninsured levels are already going up, which means more closing of hospitals in rural areas. Stop voting Republican and demand action on your needs not more GOP exploitation of your fears, or their incessant stoking of racist bigotry.
11
@Winston Smith The number of families getting SNAP changed because of the Great Recession. More families became eligible.
Nothing like the invisible hand of the free market... strangling the life out of Americans to subsidize people like Elon Musk and Donald Trump.
12
We don't have health care in America. We have wealth care. And if you are poor, you will suffer and die, unnecessarily. Tha about sums up our medical system.
13
Missouri got what it voted for.
13
21, single mother, $8.50 an hour with 3 kids. Time to get birth control in place. Rural America or otherwise.
36
@Mensa Sorry - that got harder to do when the GOP fought a war against reproductive health care.
5
And where are the Planned Parenthood clinics in Missouri that would have provided family planning, birth control and women's health services to the rural poor? Driven out by the Missouri anti-abortionists, who must be happy to pay for critical neonatal services as the price to pay for another life, while they condemn the mother for her situation in this life.
7
Where are the Pro Life people? Why aren't they marching, waving pictures of dead 1 month old infants who died for want of healthcare?
42
Maybe more tax breaks to the rich will solve the problem... #satire
17
Yeah! Keep slashing those taxes!
For profit health care is killing us.
13
It's not just rural Midwestern communities facing this problem. Out West, the problem exists too. One in particular; Tulare Regional Medical Center- home to Trump "fixer" Rep Devin Nunes- closed its operations October of last year.
The sorry saga pitting the board against the staff and residents of the Farm-Rich and people-poor Tulare community doesn't appear to have moved Mr. Nunes. (just google "Tulare District Hospital") and the saga is splayed open for all to see:
("FBI, DA search home of former Tulare hospital CEO"-www.visaliatimesdelta.com April 23, 2018)
("Tulare hospital board approves RFP, faces financial hurdles"- May 24, 2018 by Tony Maldonado; www.ourvalleyvoice.com)
9
Go ahead and show us how you can stand on your own.
3
White, rural Missourians are part of the base that voted for DJT and voted to kill off Obamacare.
Well, they are getting exactly what they voted for.
(note to base: DJT traffics in resentment and hate, neither of which has a cash value or is going to get you decent medical care (or education for your kids or clean drinking water.))
He doesn't care a whit about the base, or the families of the base. He conned you all. (don't feel bad, he is really good at it- he's a fantastic con artist, and a six time (!) bankrupt)
Base - when you pull that lever in November- ask yourself - what is really in this for me and my family. (and do yourself a favor and stop listening to high school graduate, fact challenged, know-it-all billionaire Hannity tell you what's good for you.)
When you pull that lever in November, ask yourself- what is really in this for me and my family.
17
I wonder if there has been any research on the effect that the Regan Era 1986 Emergency Medical Treatment and Active Labor Act has had on the collapse of rural health care and emergency health care in general. With no Medicaid, no ACA and no paying patients I can understand why rural hospitals are closing in droves.
Also their myst be a whole slue of reasons (financial, social and economic ) why an unmarried 21 year old working part time and earning minimum wage is now saddled with 3 children. It can’t be just stupid!
8
@Sailorgirl It absolutely is part of this. That law wasn't changed. But they expected to shift the costs over when Medicaid was expanded under the ACA.
When the GOP fought this in SCOTUS and the expansion was made optional, now the hospitals still have to treat everyone, but are stuck with the bills instead of the feds.
2
I don't want my tax dollars going to pay for counties which voted for Trump to reduce access to medical care. That'll lurrn 'em!
7
I agree. Let them reap what they have sown.
4
@IfUAskdAManFromMars What a humane response - not. You should be ashamed. Trump is a disgrace, but withholding adequate medical care to those who might have voted for him is not the answer.
4
Leave to the NYT readers to turn this into more stupid rants about politics (like the Dems will hand out even more freebies with non-existent money)
Bottom line is that the demographics of the population in this part of Missouri can NOT cover the cost of a hospital
* 27.4% of the county are in poverty
* County median household income is $31,200 - 56% that of the rest of the US
* In Kennett -city - 25% are dropouts - not even HS diploma
* In SE MO, 70% + of the Latino/Hispanics are uninsured because they are illegal (MO School of Journalism article)
MedicaRE pays enough to cover the cost of a patient but not enough to cover shifted costs from the uninsured or too-low-paying Medicaid MedicaID doesn't pay enough to cover the cost of seeing the patient Uninsured (& uninsured illegals) = pay ZERO
Not enough higher income households to cover the difference between cost & under-paying Medicaid or the non-paying uninsured.
And the women they interviewed
* 21 year old with a kid having gotten pregnant at 18, an $8.50 an hour job, no husband - 3 kids & her income puts them at BELOW Poverty Level - 70% of poverty level & living off taxpayers
Typical. Over 50% of births are paid for by Medicaid - women who can't afford the kid keep breeding & Medicaid doesn't pay the full costs
* "Ms. Hernandez, who emigrated from Mexico a year ago, speaks almost no English." 70%++ odds she is here ILLEGALLY. Now breeding & no way to pay the bills.
So the hospital closes - well duh...
23
@AnnS Sometimes humanity has to "trump" statistics. I grew up in a town in the south where communities made sure this story couldn't be written about their town. You say that "the demographics of the population in this part of Missouri can NOT cover the cost of a hospital...". Well, that is true in many states that find a way to provide for their rural residents. Your rant comes off as anti-poor, anit-immigration, but you don't mention helping with birth control or supporting abortion. Are you anti-everything that helps the poor?
12
This is why healthcare should not be a for profit enterprise! Medicare for all!!!
The gist of your comment is that this county is not worth the investment of money into medical care because of the high drop out rate and the cost of providing care to young and poor women.
If that is true, why does the current leadership in Congress want to force her to give birth by supporting an anti abortion and anti birth control agenda?
12
Anyone feel good about our country right now, anyone? We would not stand with each other if aliens invaded us from the planet Kolob. But hey, the markets are up and abortion will soon be criminalized. Bin laden and Putin couldn’t be happier.
16
Can market fundamentalists not get through their apparently thick heads how wrong it is to say, "Well, if Ikea and Walmart don't find it profitable to open stores in certain areas, then why should hospitals?"
Health care and insurance aren't products on an Ikea or Walmart store shelf. What is wrong with the many Americans who are convinced that they are?
16
The biggest pressure on hospitals has been the need to maintain an emergency room that takes patients who show up without insurance.
5
I don't understand why healthcare is always on the chopping block but the military has no budget constraints at all, even as we "celebrate" our 17th year in Afghanistan.
34
This is going to sound really mean, but the majority of these people in rural areas consistently vote Republican, the political party actively trying to eliminate the Affordable Healthcare Act and who have been in cahoots for decades for the wealthy, the powerful, multinationals, and big pharma. They also don't care about the common man.
How can I be sympathetic towards people who live in rural red states who vote for people who don't care about them? One reaps what one sows, whether in a good or a bad sense.
As for me, I lived in an area of the country that didn't have good prospects and moved to another city that offered more economic and quality of life opportunities, including healthcare. That's what people do who want to survive and prosper.
16
This has happened a lot in rural Georgia which has lost hospitals, and the first department to go seems to be obstetrics.
It is because Georgia did not expand Medicaid.
Republicans truly don't care about babies or life, just their forcing their views of religion or healthcare on everyone else, especially on women.
22
Unfortunately, the people in these poor rural areas are victims of getting what the states' electorates voted for. Less government, reduced services, and more money for the higher income individuals.
Only after the fact do the working poor find that they are providing the higher income via lower taxes to the higher income segment of their states.
12
How in 2018 we have Health Care going down hill for people? I'm not against Rich people, but everytime i read a story like this it Always affects those on the lower rung. We spend Trillions to help other Countries, and I'm not against that, But How does America let this happen at home?
3
Important Tip: If you want to have a hospital nearby or a gas station or a grocery store, don't live in the sticks. Instead do what billions of people have done in the last 300 years: Move to a metropolitan area.
4
The irony of following conservative policies to cut or decline healthcare - fewer jobs, fewer services, ever-continuing contracting spiral in rural areas.
Consider the opposite - if critical medical services are available in rural areas, these areas might stabilize, even grow.
Republican health care policies - denial, cuts, no budget - not only kill jobs, they kill communities at every level.
4
The story does not mention a husband. If women in Republican America want to have children without one, they must face the consequences.
At any rate, women for millennia gave birth attended by midwives. The scarcity of obgyns may be a blessing in disguise, getting women to return to nature.
5
If men in rural America want to have sex they should invest in condoms.
14
@Inveterate Nature is cold and uncaring
It tried to kill me and my babies.
Until about 100 years ago, childbirth was the leading cause of death for women of childbearing age. In some places, it still is. Medicalization of childbirth is one of the best things to happen to women.
10
@Jane K Or let the once friendly Virginias be CLOSED. After all, Republicans love to preach abstinence.
I'm going to take a wild guess and assume that many of the underserved areas in rural America have Republican members of Congress who care only about the well being of their fatcat contributors. The author of the article would serve the reader better by connecting the political dots more.
7
Follow the money, and the politicians who pretend to care about "life". Look hard at what they DO. VOTE accordingly.
7
No husband or baby daddy mentioned and at $8.50 an hour, the young lady in this story is not supporting anyone. It’s magical thinking if anyone believes her financial situation will improve to the point where she will be able to support herself and three children, two that will likely have life long issues due to premature birth.
A serious talk about birth control should and the implementation thereof, have taken the place after her first child.
The fact that hospitals are closing has to do with the fact that the communities they’re located in can’t sustain them.
22
Same thing is happening in Canada, and the problem doesn't affect just babies and mothers. Some conditions such as heart attack and stroke depend upon rapid medical help. A study at the U. of California has linked emergency room closures with increased in-patient death rates at hospitals that receive the extra patients from closure areas. Increased driving time to emergency room and increased patient load at fewer hospitals are thought to be the cause. A separate study showed that patients with heart attack whose driving time to the nearest emergency room increased by 10 minutes or more had a significant increase in mortality. Those with increased driving time of 30 minutes or more had a 30% higher 90-day mortality and 21% higher 1-year mortality. Thus the longer driving time lessens one’s chance of survival after leaving the hospital and as much as a year later. People from areas with closures needed more intense treatment and suffered poorer health outcomes. Find out more at:
https://www.healthaffairs.org/doi/10.1377/hlthaff.2013.1203
http://www.nber.org/papers/w22861
https://www.ncbi.nlm.nih.gov/pubmed/27881498
4
My comment will not be politically correct -- I am a Liberal and I wonder why a woman, with a low income job that barely pays more than minimum wage, now has 3 young children. She clearly could barely take care of her first child - and now she has 2 more.
38
If she has limited to no access to healthcare, then her options for birth control are limited at best. If you think about it, this entire story is about a lack of healthcare from start to finish: a likely lack of adequate sex education, a lack of access to contraceptives besides condoms, a lack of access to abortion, and finally a lack of access to prenatal and obstetric care.
4
To clarify my previous comment, I am not saying that this woman would have or should have had an abortion, but if she is this far from a hospital that could provide the obstetric services she needed and she’s in Missouri, she very likely didn’t have that as a feasible option if she had wanted it.
1
This is a bipartisan issue and BOTH the Dems and the GOP has failed us. They're both one and the same two-headed snake when it comes to the medical industrial complex.
2
And after church on Sunday these poor citizens will likely discuss the pending loss of their freedoms by more government overreach. How they pay too much in taxes already and how a woman's right to choose is something she should not be given the right to do.
Prediction - its going to get worse friends. Buckle up and keep voting to cut your noses off to spite your face.
16
It would be informative to know the breakdown of Medicare, Medicaid, and "no insurance" for the exemplary hospital in the article. With what seems like a rather high 95% of all patients being in one of the 3 categories, it would not take a very large number of uninsured pts to tilt a hospital into the red.
3
If you live rural, you can't expect big city things.
The fact that the population keeps on growing, but nobody is moving to those towns suggests the market has already spoken. There cannot be a right to services. If there's a reasonable market, it will be provided. But don't expect we have to pay extra to coax doctors to work in rural areas where they don't want to be for too few patients.
13
At what point is it reasonable to rely on more local resources instead of assuming a hospital 200 miles away is the only option? Or building one closer is the only feasible means to have a baby. Midwives or duolas have existed far longer than hospitals.
4
@MH agree that midwifery care in the US needs to be explored and expanded, but no midwife or community hospital will be delivering and managing significantly premature twins. It’s a problem of not only local access but also reliable transport mechanisms to regional centers for those who need higher levels of care. The WHO and “district” care models utilized in many low resource countries could be considered for more prompt mobilization of high-needs patients.
7
In residency for ob/gyn our tertiary care system served 29 counties in our state. Folks would routinely drive 1-2 hours for prenatal visits and delivery, and this was 15 years ago. Whenever any woman is high risk, none of the smaller local groups would take them out of fear of litigation or bad outcomes. That's just one piece of the puzzle. The main issue I've seen working in healthcare is consolidation of smaller system into larger collectives. Smaller rural hospitals are bought by the larger systems which in turn buy out practices, and end up owning everything in a 3-5 county radius- sometimes more. The system shunts patients to their main facilities and either close, or cut back on services offered at the smaller hospitals. It's not surprising, because it is a balancing of limited resources in a for-profit system, but it does leave the most vulnerable without access to care. If you can't travel, you are out of luck. What's more, the access vans available to our medicaid patients are limited, and often don't travel out of county. I've had patients show up 4 hours before their appointments willing to wait because that was the only time the van could bring them. Maybe our CEO would be willing to take a pay cut to pour some resources back into our community...
17
Our maternal morbidity and mortality rates have increased/even doubled to the level of third world countries.
“Premature delivery and low birthweight have been consistently associated with poverty, which affects over 20% of U.S. children, the second highest percent among 35 developed nations.”
http://time.com/5090112/infant-mortality-rate-usa/
Moms increasingly don’t have insurance as the paperwork for Medicaid is ungodly under this administration. Many moms are illiterate-dropped out of school by the sixth grade as our failing schools can’t detect learning disabilities much less know how to work with them in a class of 40-45 kids.
Why is this happening in the world’s richest nation with the most expensive medical care? It’s the horrendous gap between impoverished women and wealthy mothers. Here in the USA poverty is considered to be the fault of the poor.
Every day Fox News and other far right wing sites such as Newsmax, blame these moms for being poor. “They don’t even try (Lou Dobbs)! They’d rather spend money on liquor, drugs, and a good time.” Women’s clinics are being defunded-“abortions!” No, birth control/prenatal care is being taken away.
I work for AmeriCorps and rotate to different areas. No public transportation to come in for pre-natal care. Mothers had WIC to provide protein and milk. FIRST program to go under Trump.
These are American citizens-not “illegals.”
We MUST get universal health care and a base income!
These moms are DESPERATE and do try!
54
@Nuschler I wish I could give you a thousand " thumbs up". Thank you.
3
This is just another example of the control of our country by the corporate super-wealthy. They have no need for public health, public education nor any of thre other services that should be the highest priorities of our government. Instead they tout military spending to further line the pockets of the exucutives of Haliburton and other defense contractors. Of course little of that money trickles down to the soldiers actually putting their lives on the line. Ironically the most ardent supporters of the current administration are also those most at risk from the systematic dismantling of the remaining programs of social welfare. And the present-day democrats feeding from the same corporate trough really provide little more in the way of support of these programs than republicans.
3
@Wk, Every state that did not expand Medicaid is a Republican state. There is no equivalence between the parties.
5
Finding a Doctor in a rural area is not a “ fly over state” only problem, it is a tremendous problem in Oregon outside of the major towns, in the south coast town I now reside I have tried for three years to get a G.P. I have Medicare and a supplement but if you have any issues you are not welcome, you must actually fill out an application to see if you are acceptable, I thought our insane system of high cost healthcare for profit was to create more competition and better service, neither is true, our system is just another means of fleecing the middle class and working class taxpayers(who pay at a higher rate than those clipping coupons, passive income), allowing enormous pay packages for health care honchos. BTW where are the fathers in this episode, Ms. Abernathy is having her third child as a single parent and Ms, Hernández, recently emigrated from Mexico, spends her days relaxing and praying; must be nice: my daughter was working fifty hour weeks to help pay for a $2,000/month medical premium for herself, her husband and other son until the week before she delivered her second son.
29
@Ted Maybe if there had been a Planned Parenthood clinic in the area, Ms. Abernathy would have been provided with birth control and family planning information, as well as prenatal care. But it seems that the anti-abortionists would rather drive PP out of their state rather than provide the needed care that would support healthy mothers and planned for babies. Where are those anti-abortionists when women need prenatal care?
18
@Freedom I agree totally, or for that matter where are the responsible men, when I knew I was no longer good parent material I had a painless twenty minute procedure that insured there would be no “surprises”.
Fret not, the invisible hand of the free market will surely fix this...
34
@Angry The free market has already spoken, and people with skills have left these rural areas behind despite population growth since humanity arose.
What next, city folks grumbling there's no peace and quiet among trees and wildlife?
2
@Angry : It already has.
Welcome to the real world where things like costs matter. It is literally impossible to have great medical care available in every small town in America. Choices have to be made. Anybody who says otherwise is selling snake oil.
17
@Amy
Yes, costs matter. That is why other developed countries focus on costs as well as access and quality, rather than just leaving it to 'the market', and why their healthcare tends to be better at a fraction of the price without driving people into bankruptcy, and available to all. The health industry is about as far from the textbook perfect competition model as one can get, rife with market imperfections, which is why it needs to be heavily regulated to provide access, quality, and at a reasonable cost.
Here are 5 examples that work better than here.
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/
8
States that did not expand Medicaid are showing the impact in these rural communities. Likewise, wonder if MO has cut back on Planned Parenthood.
Understand the difficulty of Ms. Abernathy's harrowing birth experience and the future prospects for her and her family at $8.50/hour.
Does she also bear some responsibility? At age 21 she now has three kids to raise and where was the father?
31
@Jim So if the father was there to drive her all that distance, that would make it better? They MIGHT have a little more money if he were around, but the basic problem still wouldn't change - profit motive sending providers to where the money is and away from where it isn't, giving the finger to Obama and planned parenthood (not expanding medicaid funding, closing clinics that did not even necessarily provide abortions or give referrals).
3
From the Kaiser Family Foundation 2016 report
1. There were 72 rural hospital closures between January 2010 and April 2016, compared to 42 closures between 2005 and 2009
2. Causes
High poverty and uninsured rates in rural communities, high rates of Medicare and Medicaid coverage, and declining populations.
Privately insured patients often went elsewhere for care, hurting the local hospital’s revenue base and contributing to perceived low quality of the local hospital
Rural hospitals built in neighboring communities under Hill-Burton now compete for limited patients, federal dollars, and health care resources
Corporate business decisions, rather than assessments of local needs or planning, drove the hospital closures . In all three sites, the large health systems that owned and managed the hospitals made the decision to close them based not on community needs, but on corporate business consideration
Changes in Medicare and Medicaid payment over the past few years have had an adverse effect on rural hospitals.
In recent years, Medicare cuts arising from budget sequestration and other federal policies14 have led to lower reimbursement rates overall, while specific provisions of the ACA, such as the Readmissions Reduction Program, under which CMS reduces PPS payments to inpatient hospitals with high readmission rates, have also resulted in lower Medicare reimbursements for many hospitals"
Note these cuts occurred during the Obama administration
7
@Gerhard Under a Republican-controlled Congress that created the budget sequestration problem, which was used by Mitch McConnell and backed by Paul Ryan. Don't forget the Republicans' hand in creating the Medicare cuts, which you have conveniently forgotten.
8
@Gerhard "Note these cuts occurred during the Obama administration"
So things are getting better? Please explain.
1
@Gerhard
And who was controlling the purse strings? The GOP. Who has been trying to destroy Obamacare, making things harder for everyone, since before it was even passed? The GOP. And who came up with and supported (as recently as February 2009) the very measures that were screamed about the loudest - insurance mandate, subsidy, penalty, federal guidelines? Conservatives (heritage foundation, grassley, graham, corker, alexander etc.).
Here is evidence of my last statement:
https://healthcarereform.procon.org/view.resource.php?resourceID=004182
If you don't believe it, google the documents it refers to from the Heritage foundation, from health affairs, from the senate.
3
"Today, researchers estimate that fewer than half of the country’s rural counties still have a hospital that offers obstetric care, an absence that adds to the obstacles rural women face in getting health care. Specialists are increasingly clustered in bigger cities. Clinics that provide abortions, long-term birth control and other reproductive services have been forced to close in many smaller towns."
So wait - we also have rural counties in places in big states like California, Washington, even upstate New York. Do these states, where people voted the "right" way in a compassionate and progressive manner, have these same problems? Most likely in many cases. California, for example, is huge, with many non-urban counties. Should we care about residents in THOSE areas if they're in states that didn't "vote against their own self-interest"? Should we enact a policy of double standard?
Many in these comments routinely sneer at inhabitants of anything other than large metropolitan areas. Yet aside from the fact that we still have personal choice (you remember that) or choose to live in more rural settings for any number of reasons, are we, as a nation, to basically say that if you don't live in a city you're on your own? Sounds silly when stated directly, but the tone of many comments in the Times makes you think that such attitudes are actually out there.
8
@George S In California, which embraced the expansion of Medicaid to all its residents, there is a network of care, including air ambulance if necessary, to take patients to Level 1 trauma hospitals that provide adult, neonatal and pediatric emergency care. Yes, California does try to take care of their most vulnerable, even if they cannot pay. Medicaid expansion threw a financial help line to many rural hospitals; and while some needed to be converted to emergency centers to stay open, there are still options to provide care to save lives.
9
@George S You wrote of "personal choice" but then demand that others come to your rescue?
The GREAT IDEA behind Liberty is that we all choose and deal with the consequences of those choices.
You get what you vote for. I have spent the past two years studying access to health care, medical debt burden, insurance status, and untreated conditions in several states including Missouri and its neighbor Kansas. They are two states which seem to aim to perfect the model of cutting taxes and services to the point of almost absolute failure. Stingy Medicaid eligibility requirements, failure to expand Medicaid for nonsensical political reasons, failure to fund safety net programs that serve the neediest, etc., this is unfortunately a deliberate consequence of policies enacted without regard to the well-being of the poor, including the working poor (as if that distinction matters). Thank your politicians, thank the Roberts court for allowing states to refuse Medicaid expansion, and thank yourselves for continuing to allow these policies to win at the ballot box. And we don't even have to talk about the epidemic of gun violence in that gun-friendly state, which is just off the charts.
80
@Tom
You pretty much summed it up. Red states suffer the most because they don't make the connection between Republican policies and their own hardships. Well said Tom.
6
@Tom They can move...that's the beauty of America's 50 states plus it's territories. If your government isn't providing, move. If free markets don't care about your small markets, move. But don't expect the world to adjust to your choices, and that's what we get when the Federal government steps in with its one-size-fits-few solutions, inadequately taxed to pay for them, with no choice or ability to move to get something better.
1
@David I wish she could move, I would accept her here in New York where we would actually take care of her and her children (those "New York values" that the red staters hate). But she probably can't. It isn't that easy for the poorest among us.
As I’ve mentioned elsewhere, several years ago I witnessed a flotilla of speedboats arriving in the main port of a remote Greek island. Glitterati? Rotary Club members out for jaunt? No. They were cardiologists and obstetricians making their monthly visit to Patmos — and clearly enjoying themselves in the process. (It was a majestic sight: there must have been nine boats coming in in delta formation.) If a poor, rather chaotic country like Greece can manage something like this, I seen no reason why America couldn’t have mobile medical teams too.
4
@Richard Janssen
> I seen no reason why America couldn’t have
> mobile medical teams too.
Red America is unwilling to pay for these things and they prove that every time they vote (or sit out a vote and let others make choices for them).
3
Has the very high legal risk doctors in the US face with childbirth now come home to roost?
My impression is that many of the checks that will be done in the community in the UK by midwife are requiring ladies to drive hundreds of miles to a hospital due to the (legal) risk adverse culture of the US medical system
10
America, you must be so proud of yourself - with your vulture insurance companies obstructing care and CEOs earning 15 million dollars a year to start, your for-profit hospitals "systems," minimum wage jobs no one can live on, and abject idiots in Washington wreaking havoc.
And don't forget the way you have flaunted your greatness around the globe as some shining example of "democracy." Yes, things are particularly awful now with that evil treasonous moron in The White House, but stories such as this one -- and worse -- with citizens bankrupted into lost homes, lost livelihoods and their own lives due to America's disgraceful "Health care system" -- are nothing new. The U.S. is an empire in steep decline.
24
@NoScreenName
People around the world aren't impressed with how poorly we treat our citizens. Good point!
1
If the AMA and other physicians would stop insisting that they are the only ones who can truly treat sick people we could manage this sort of problem. But MDs don't want to admit that they aren't needed when it comes to simple things like the common cold, hangnails, most sore throats and other issues. A nurse midwife can handle an uncomplicated delivery at home or in a hospital. The same nurse midwife can, if the circumstances warrant it, call in an ob-gyn when problems arise. There's no reason not to use qualified nurses with the interest and aptitude for dealing with patients outside the hospital or away from a doctor as long as there is a doctor available when needed. In fact, nurses might be a better choice because they aren't as intimidating as doctors and they aren't conditioned to stop caring about the whole patient the way doctors are.
While we're at it perhaps we should start having social workers help patients too. The patient who has no relatives or friends but is in need of assistance and is unable to organize it. The new mother who isn't certain about what to expect from her infant. The family overwhelmed by the illness of a child or parent. We need to start to do a better job by all Americans,rural or not, because when we don't we let people die alone, become much sicker than they need to be, and we send the unmistakeable message that money counts more than humanity.
8
In Virginia good Emergency Medical Services and good highways put many rural residents within an hour of excellent hospital that offer excellent treatment that a small hospital is neither staffed, equipped, or experienced to treat.
Now the question is: How do size effective medical services to a small community? Unfortunately that's going to look a lot like Cost Effective.
The presence of a hospital in a county is an an unambiguous measure of available services. The story is based on facts.
1
The medical marketplace says that it is more efficient and cheaper for people of childbearing age (and people with medical problems) to move to a city or suburb. Peoples' roots and heritage usually have no economic value except for the tourism industry.
We are not into subsidizing people, directly or indirectly, so they can live where their ancestors lived (or as their ancestors lived). If the rest of us were being honest with these people or with ourselves, we would tell them that they will encounter pressures to move and that we have decided not to spend resources fighting these pressures. But it is much more comfortable to see either the hand of God or the evilness of money.
Hospitals are run or closed for money because we want low taxes, small government, and a society structured by the market rather than government action. It is foolish and hypocritical to blame those who run the hospitals, who are just doing their job of following the bottom line and protecting their investors. It is not up to them to put their jobs at risk by being charitable; it is up to us to make giving care their main job and using resources efficiently subordinate to that.
16
If those who run hospitals are just doing their job, does that mean that opaque billing, deliberate padding of bills, subverting in-network and out-network compensation, incentivizing admittance, performing unnecessary tests and proscribing unnecessary drugs, creating quasi regional monopoly providers, and all the other elements of racketeering almost unique to the pseudo free market healthcare system are something we the public should accept as normal?
3
Maybe these people live in rural places because they are the farmers providing the food we all eat, or the workers on the oil rigs that provide the energy we use or they can't afford to live in the suburbs or cities you think we should all be in.
I'm sure if you were traveling across the country through one of these rural places and fell ill or had an accident, you would have a better appreciation for an accessible hospital.
These communities are in the "fly over" states we keep hearing about. We should care that they aren't left behind in any aspect of what all Americans deserve, including adequate healthcare, education and infrastructure.
Much of the divisiveness in the country has been created by the fact that people in these areas have felt left out of the economic recovery that cities and suburbs have enjoyed.
Ignoring their needs does not make our country stronger. Ignoring the needs of these communities is part of what has divided us as a country.
8
@Jane K The reason the economic recovery is occurring in cities and suburbs and not in rural areas is pure economics. In order for an economic recovery to occur, there has to be a working economy. Rural areas simply cannot support a working economy. Hence the corporatization of farms and the thriving of cities.
"In a statement announcing the closing, the hospital’s local chief executive, Christian H. Jones, called it the “most sustainable plan for the future.”"
In other words the health care system, aka the wealth care system, has told another rural area that their health is less important than the company's bottom line. If this were a regular business that decision would make sense. Health care is not a regular business. People cannot get up and move to the next town, county, or state when the hospital, practice, or doctors they need relocate, shut down, or stop accepting their insurance.
America needs a real health care system not the wealth care system we're currently dealing with. Unless there's a better reason than the bottom line people in rural areas or any area should not have to travel over 50 miles to receive basic care and in this case having access to an ob-gyn, a place to deliver the babies, and an OR or a bed in the hospital is basic care. That the babies needed far more care is understandable along with the fact that they might have needed to go to a different facility. But not having basic care available in the community is disgraceful.
18
@Honeybee, maybe if people could afford the care they need the clinics would not sit empty all day. At the very least we could manage to cover rural areas better than we do now. Part of it involves getting doctors into rural areas, forgiving debt if they become family practitioners and locate in rural areas, and changing how we look at health care (i.e. it's a human right now, not a privilege.)
@Honeybee Yeah, just seems impossible, doesn't it? Other countries seem to have figured it out, to some degree even some other states, but just seems impossible. Hey, I know, let's trash Obama.
@Honeybee: Texas closed women's clinics in West Texas - maybe even your own representative- knowing that indeed they would put Texas women at risk because of these huge rural counties. Lots of people there have been there for generations, farming and ranching- I guess you could call that "choosing to move to remote rural places to have no healthcare" even you are cynical to the bone.
You might not like Obama's solution but having no clinics is even worse/ not a solution.
People in Dallas used to know this stuff, but I grew up in Ft. Worth, so maybe I am giving Dallasites too much credit.
"What is our community coming to?” asks Ms Abernathy.
Here's the answer. The community and others like it are the victims of ideologies like "less government", "lower taxes" (especially for the wealthy) and "health care is not a right".
91
Every state that refused to accept or expand Medicaid is complicit in the failing health and deaths of its residents, and particularly the ones who are least able to afford any medical care at all.
60
Rural hospitals are closing mostly in states that
refused to expand Medicaid. Killing these areas was done on purpose with he goal that these poor people would eventually self deport or move to a place that did expand Medicaid - like Arkansas
That’s the republican plan- drive them out
32
I actually met a political scientist, so my first question was, "Why do people vote against their interests?"
Her answer was that people don't vote their interests. They vote their identity.
87
@Norman
What does that mean? Why would you accept and then publish a statement that does not make sense unless one tremendously amplifies the meaning of "identity".
2
@Norman Perhaps that's what comes from pretending that one's "identity", however that is defined, trumps everything else. Don't think of yourself as an American, no, think of yourself as [X] first and foremost"! Look what that creates.
1
If it were men's lives, not women's and babies on the line, that hospital would remain open.
21
@Nancy Rockford yes, no doubt that was THE deciding factor.
1
I wonder whether the subject of the article voted? If not, does she realize that her vote counts?
12
@mary Even if she did vote, there are few political leaders that support Medicare for All. Most places don't have a politician to vote for that would help in this case. We need to push for a wide embrace of the idea that healthcare is a human right.
4
It is not simply the quantity of medical facilities, but their quality. Funding low utilization hospitals does not mean that they will have the level of expertise needed. It would be preferable to facilitate rapid transportation for those requiring medical services. Standard of care cannot be provided in rural hospitals for stroke, heart attack, trauma, difficult obstetrical cases, and other acute medical conditions.
11
@W. Ogilvie
But it is unreasonable to expect someone to make a 200 mile round trip for weekly medical checks.
2
A local hospital with a lower level of care may not have had the expertise that the woman and babies in this story required. However, as an RN who works in a community hospital, I can tell you without a doubt, having a local hospital 10 minutes away can make a huge difference.
In the time it took her to get to the hospital 100 miles away, she could have been stabilized, received the antibiotics and steroids she needed to prevent breathing and infectious complications in the twins, and delayed the delivery by hours and possibly days. Those days and hours are invaluable to the development of fetal brains.
Even if she was transported to another hospital for delivery, the team could mobilize the resources required to deal with a preterm birth with longer and better preparation than the crash surgery allowed.
In addition, at some point those babies could possibly be transported back to her local hospital to complete their care close to the home of their family, sparing the travel back and forth for a woman who has just had major surgery. That may contribute to preventing surgical complications for her.
Closing rural hospitals is short sighted. Despite their limitations, they are an important link in the chain. The short term losses the hospital was able to avoid does not make up for the long term losses of the community. Profit does not belong in healthcare.
8
There is just so much wrongness in this story it is hard to know where to begin.
The "market" strikes again
No Medicaid expansion
Shuttering women's health clinics
No aid for familes
This story really sums up the GOP in a nutshell. We don't care..do you?
27
This is what market driven medicine gets you. Capitalism just doesn't work for some things.
26
No civilized person
wants rural residents to suffer. They do not “deserve” it. But it is a sadly predictable outcome when 75 percent of Dunklin County voters supported Trump
45
@Walker77 It's not just Trump, and it's not just the Republican party. Many Democrats have also not embraced the idea that healthcare is a human right. Nothing will change until the country as a whole supports these policies.
How much more "Third World" does this country have to get?
Flint, Michigan's water is still toxic after 3 years.
Puerto Rico has never recovered, even a year later.
There are cuts, cuts, cuts in every support program.
The poorest are being told, "Work it off, you pikers!"
Meanwhile, Mitch McConnell and Paul Ryan, and, yes, all the other Republican boys and girls, feverishly work behind the scenes to give the wealthiest massive cuts in their tax bill, even to the tune of over $1.5+ TRILLION, of which the rich get a cool 80%.
The military budget is almost ONE TRILLION.
Look, this is the hallmark of a Banana Republic: That money is shoveled by the bucketful into the hands of the already-rich and the military, and ripped away from programs that assist women - usually poor women, but really, any women and children at all.
This is all very simple: If you hear of funding being cut, say to yourself (very quietly), "Banana Republic, Banana Republic, Banana Republic."
You can also say the same thing when you hear the cute names that Republicans specialize in: Religious Right, Moral Majority, Tea Party, Freedom Caucus, Heritage Foundation and Federalist Society - don't they sound great? My, what a country we sound like on paper!
These sound like groups of men that will help all law-abiding citizens...... don't they?
But they are not.
For over 40 years this country has been dismantled, bit by bit.
It's called a "Banana Republic".
Creating them is what the US does best.
76
@rosa Well said. As a life-long liberal Democrat senior I am aghast at what has happened in this country in my life time. This article illustrates so well the results of the strangle hold of the Republican Party in the US, and especially in red states such as MO. We all need to work to get out the vote to bring about lasting change to reverse the course we are on. VOTE BLUE!!
12
@rosa except that "Banana Republics" were usually tropical countries that could grow bananas.... Never mind with the GOP's disastrous environmental policies, Alabama and Georgia will be growing bananas by the 2100 (Florida could have by 2100, except that state will be underwater.)
2
Hard to believe how health care is given the short shrift. Meanwhile, resources by force limited, even in a country as rich as these United States, are being wasted in a bloated military, and in disproportionately burning money in politicians, so that even those incompetent to carry out governmental functions get elected with the power of an indiscriminate amount of 'dirty money', just by loyalty to party, party before country. We can do better; but is there the will?
11
Excuse me but ... where did Missouri's electoral votes go in the last presidential election? Next time, the "show me" state might want to give a little deeper thought as to what it stands to be shown.
30
@Jerry Farnsworth That’s right Jerry, they all deserve to suffer, watching their children die, because slightly over half their electorate voted for not your candidate. Unfortunately, your attitude - condemnation and scorn rather than empathy and solutions - is exactly what allows outsider candidates like DT to prevail.
3
@BlueNorth It's not just the presidential elections. It's also state-level and local elections. The Republican-controlled state legislature chose not to expand Medicaid, chose to enact anti-abortion legislation, chose to cut funding for programs to help its residents. So Missouri chooses to blame the residents' lifestyle instead of helping them to get better lives? They reap what they have sown.
1
According to the 2018 survey by the American Hospital Association - 73% of the short-term acute care community hospitals are non-profit. That number excludes 956 government and state/county hospitals.
Non-profit providers are still the bulk of our system - but there are fewer of them as insurers prefer to work with tight networks of hospital systems - where costs can be leveraged over a number of facilities - and where the tax laws make it increasingly difficult to maintain non-profit status.
7
Non profit is a near meaningless term applied to hospitals. As documented in the NYT, many non profits drive the highest revenues thru the most egregious business practices, in order to provide the highest executive compensation.
4
@Xoxarle Agreed. As a colleague used to say: not-for-profits often have a large amount of not-profits.
The closing of the hospital in Kennett, Mo. is emblematic of the plight of many of Missouri's rural hospitals. These hospitals often operate in the red or on a razor thin margin.
As the article exposes, OB services are becoming more difficult to access in rural areas. However, medical deserts are becoming more common in all areas of Missouri as rural hospitals struggle to afford expensive service lines while balancing the need to provide appropriate access to the communities they serve.
The Missouri Department of Health and Senior Services last week briefly had a brown-out of access to certification on trauma, stroke and heart attack certification, with the burden largely falling on rural hospitals that must seek state certification for their status. Two weeks ago, The Missouri Department of Social Services amended the state's contract with its Medicaid managed care insurance companies, allowing them to cut payments to hospitals by 10 percent if the hospital does not contract with the insurer.
Hospitals already carry the burden of most of the state's share of Medicaid funding through a provider tax. In 2017 hospitals in the state had an unpaid cost of more than half a billion dollars for treating Medicaid enrollees. This is in addition to $1.25 billion in uncompensated care.
The state's hospitals need a partner in their state government. Evidence suggests that the partnership is fraying.
Dave Dillon, Missouri Hospital Association
19
I live in rural SC and it has only been in the last 5 years that my town even had a doctor. The closest hospitals are 30 miles away.
4
When you vote on November 6, 2018 remember which party has continually worked to gut health care funding.
116
@Dr--Bob Since when? 2016? Or 2010 or 2004 as it says in the article? Both parties have continually worked to gut health care funding for rural and underserved communities for decades. Absent from this article is a discussion of the impact of increasing regulatory costs on these small providers, costs that are minimal for large (eg urban) providers but crushing for small (eg rural) providers.
4
I just checked the NYT election results for Dunklin County. It was a loud and clear 75% victory for Trump. You can't force health care on people who don't want it. It's sad for this county, and other places in poor rural America, but they voted for market-driven health care and not 'socialism.' And they got exactly what they voted for.
427
Oh, it's that simple, is it? I could've sworn there was a decades-long trend of doctors abandoning rural areas for higher salaries and more cultural options in big cities, and that this trend was unaffected by Obamacare, or the election of any particular president. Who knew simple partisan politics we to blame?
5
@Expatico
> Oh, it's that simple, is it?
Yes, it as simple as that. In the end, it *ALL* comes down to money. If the problem is doctors leaving rural areas for big-city salaries, that certainly sounds to me like a question of money. If the problem is that there's no emergency transport to get patients highly-equipped, highly-capable regional hospitals in a timely fashion, then a billion or two diverted from our $715 Billion/year military budget could easily buy, maintain, and staff the necessary MedFlight helicopters.
But America has been voting to cut spending for decades and the chickens not only came home to roost, they died of starvation. This is the endgame.
1
Yes it's bully for them, but they injured me. Nothing impersonal, but I greatly dislike them.
2
You can't vote reliably for people who gut social services and healthcare and then complain when there are no social services or healthcare.
148
If we shut down healthcare systems because we are jealous of "undeserving" people (meaning strangers) getting good stuff, if we terrorize schools and universities because we resent others being educated, if we support a power shift away from majority rule and over to an oligarchy and advertise the move as "an end to mob rule", then we will not have health care, doctors, nor a population with the power to control their lives. No one is surprised and most of us are heartbroken. The answer is not mocking the first round of victims, and the answer is not lashing out at other commenters. Nott unless you thought this was fun in the first place.
19
@TH As someone who lives in Trumpland, I think part of the problem is that the rural population have no idea that life can be better for them, themselves, not a TV family.
They don't know what it is to just generally live in comfort and have a rich intellectual life. If you are reading this comment, you are automatically more privileged than most of the people who live where I live.
These voters (the ones who voted, which may not include young mom of the story) felt angry, they lashed out, and they shot themselves in the foot. Now we know they have something to say - let's pay attention.
Let's wake up. Don't batter them further. Try to find a way to redirect that rage toward the most appropriate target: the GOP. Let's also find a way to tie CEO compensation to the well-being of workers, not just the profits made off their backs. That would reduce that rage, I feel sure.
12
Where is the money supposed to come from to support the rural hospitals? As the article said, dwindling birthrates, declining availability of doctors and nurses and let's face it, GE, Philips Hill-Rom, Epic, Cerner, AllScripts don't give their products away for free. I had proposed a solution to someone in the Obama administration that got me a nice thank you letter and little else. Instead of pumping money into a runaway cost model it is based on targeted incentives to health care deficient areas such as government underwriting of medical school loan payments for each year spent in an at-risk/deficient region, government underwritten malpractice insurance for providers that operate within these health care deficient areas, tax deferment on the first $65K of income for nursing and medical arts/lab personnel, $95k for MD providers, FDA requirements for major manufacturers to "adopt" at risk healthcare facilities and networks in return for federal tax and import incentives, etc. Make it attractive to provide competitive care to at risk communities and the problem starts to resolve itself.
11
@Paul Cush providers don't need incentives so much as they need compensation. This hospital closed because Missouri Medicaid is extremely stingy, the state didn't expand, and the burden of uncompensated care is just too great. Medicaid expansion has been a life-saver for providers in some other underserved parts of the country.
20
@Paul Cush There's something sickening about relying on competive incentives and the free market to solve every problem in this country including health care--the obsession with money and profit over the humane principle of caring about others. Canada, Australia, UK, and Europe spend less per capita on health care and have longer life expectancies than the US. This is not the result of private enterprise. We have been brainwashed here to believe the free market will magically solve problems, despite an abundance of evidence to the contrary. It's time to accept a single-payer system and follow the lead of other nations.
18
As someone who works in the business, let me put it plainly:
The reason so many ERs and Hospitals are closing is because money is more important than human lives. Administrators, politicians, the Joint Commission, healthcare conglomerates, etc. are run by people whose job is to create and process regulation - they don't want to lose their jobs, so they always create more layers of red tape, more strategies for profit that need to be discovered and presented at meetings, and more frills to be trimmed. That means closing hospitals and emergency rooms. The name of the game is staying in the game, not "helping people."
Ordinary people? The stork brings an endless supply of those. Bonuses, support from lobbyists, a solid committee position with 6 figures are much rarer. Of course, it's in terribly poor taste to openly say such things, but that's where we are. Don't waste your time asking such people to respect your life and health and needs as valuable things. They will never see it that way while there is money on the table.
69
Correct. And political affiliation has little to do with love of money. Plenty of medical professionals leaving for higher-paid jobs in cities are staunch Democrats. Yet commenters here think voting Dem will somehow stanch the outflow of doctors from the countryside. Who knew public policy was so simple?
3
It is telling that the vocal "pro-life" minority stands silent as America's rural obstetrics units and hospitals close, resulting in life-threatening results for wanted/chosen pregnancies.
155
@Jennifer Hoult, J.D. Exactly!!!
3
@Jennifer Hoult, J.D. It's not "pro-life", it's "anti-abortion." They never care about funding programs to help the living lead better lives. How many of those anti-abortionists are complaining about cuts to the SNAP program? No one except the food companies who are going to lose business.
1
This is very upsetting, but since the citizens voted for this, they should live with the consequences of their actions. If residents don't like it, they should move to places with jobs and opportunities and live twenty to an apartment like the Central American migrants. Those are our choices in this political system.
14
@landless There is nowhere in the country that you can move an be guaranteed access to health care. These problems play out across the country, sometimes on a less extreme scale, but there is no escape until we embrace universal healthcare.
Additionally, since 58% of people did not vote at all in the last election it's not true at all that people voted for this. Blaming people for not voting isn't fair either because restrictive voter ID laws, which the state of Missouri has, create a huge barrier. Healthcare is a human right no matter who you are, no matter how you vote.
4
@landless The preemie twins did not vote for this.
3
@landless The citizens didn't vote for this--at least knowingly. They voted for the razzmatazz of a television entertainer who made them feel part of the group. The withdrawal of health care from rural America has been ongoing for decades now. The for profits left due to the bottom line and the county/state supported facilities are disappearing as state budgets are cut to allow for big tax cuts. Looking at you, Kansas!
3
The market has spoken. Rural counties are unprofitable in terms of healthcare provisioning. Who are red state conservative voters to question such orthodoxies? Do they not believe in the free market and reject socialism? Do they expect private businesses be run at a loss just so that babies can be born safely? This is about shareholder profits and executive salaries. These two considerations drive the entirety of our healthcare debate.
If rural Americans want an adequate first world healthcare system, one that does not require propping up by charities active in the third world (Remote Area Medical), they need to move to Canada. Or Europe. Or the Far East. Or Cuba. Or basically anywhere other than here.
61
Ninety five percent Medicare/Medicaid or self- pay i.e. no insurance is a fatal payor mix. Medicare pays at cost at least but Medicaid doesn't, good luck collecting on the self-pays.
Even if the state expanded Medicaid these hospitals would still be hard pressed to stay open.
9
...and we sneer at the elective surgery waits in Canada, and the word socialized medicine in Europe. At least they make it easier foe a woman giving birth to twins!!!
34
If you were an OB/GYN would you want to work in the rural area of an anti-woman red state?
80
This is what conservative “freedom” and “individualism” looks like. You voted for it, you got it.
170
''Ms. Abernathy had to make regular 200-mile round trips to the hospital to see the twins and then back to Kennett to be with her 2-year-old.''
Where are the fathers, and why wasn't she using birth control?
70
@Lawrence As the article said, the family planning clinic that dispensed long term and other forms of birth control (along with education to prevent unwanted pregnancies) closed. In fact, lots of Planned Parenthood clinics have been FORCED to shutter around the country. When communities lose these clinics, unplanned pregnancy rates soar. And when conservative governors block Medicaid expansion money, the hospitals close, too, and maternal and infant mortality soars. This is what the Republican "pro-life" policies yield.
44
@Lawrence, In many or most rural areas there are no women's reproductive clinics or support. No Planned Parenthoods. No private abortion providers either.
12
@Lawrence
Maybe the father works... (with a none understanding employer, military for example)
Maybe the hospital does not provide a suitable free room for the mother to stay in with a 2 year old...
Maybe children have basic rights regardless of the actions of the parents.......
5
Is this a story about a third world country?
Couldn't posssibly be about the US, could it?
21
@mjbarr: It is a manipulated story to make you think that the current administration has turned the US into a 3rd world country.
The closest obstetrician from my home in Newcomb, NY is 1.5 hours away in Vermont, or 1.5 hours away in Saranac Lake, NY.
This is not a conspiracy, it's just a fact of life. In an emergency and EMT can deliver a baby. That is about 30 minutes away on a slow day in the area.
Don't fret. There is no conspiracy to remove medical services from Americans. That would not be profitable.
@Georgi I can assure you that while the majority of babies are able to be delivered without consequence, that is not true for many deliveries.
This story in particular illustrates a pregnancy that challenged a trained OB-Gyn and pediatric staff at a high level of care.
If the risk of pregnancy and delivery were so low, there would not be rising rates of morbidity and mortality in pregnancy and childbirth in this country.
2
@Georgi What would that EMT do if it was a breech birth? Maybe you should research the maternal/ fetal mortality rates in your community or county. Might not be a pretty number.
Reading of the 2 one month old babies who died gave me the chills.
"About 95% of the the hospital's patients were on Medicaid, Medicare or had no insurance."
"Rural hospitals like Kennett's are being battered financially by several factors : Cuts to to public health insurance programs, struggles with debt and sharply worsening financing in STATES THAT DID NOT EXPAND MEDICAID."
Many of those who can not get care are the same people who voted the politicians into office who did not support the expansion of Medicaid.
I recall reading quotes in this paper of individuals of individuals who would have benefitted from the expansion of Medicaid in their states, yet voted for candidates who opposed the expansion, which baffled me.
While I am greatly pained to learn of the death of babies, and of people who can't get needed medical care, those individuals who opposed the expansion of Medicaid doomed not only themselves, but their own helpless, innocent babies, those of others, and other people who are suffering as a result.
Dooming themselves to illness and death was a bad decision. Dooming helpless babies was unconscionable.
33
No surprise here. Rural America is being written off.
9
@Mark Dobias. I have to say it again. Unlike the inner cities? There are two Americas alright, but the divide is all about money. The average poor rural American has more in common with his inner city compatriot than the urban rich guy down the street no matter what color. The inner city guy may have access to an ER after he gets shot doing a drug deal or just by a ricochet but otherwise they have much in common.
21
Rural America is writing itself off by voting Republican. I have been blessed in my life with many advantages and have always been willing to pay taxes to help those with less. I also feel to some extent that if people choose to vote for Republicans because of their anti-gay, anti-immigrant and racist beliefs, they shouldn’t go around whining if they don’t have healthcare or decent jobs. At this point it’s not exactly a secret that Republicans only care about making the rich richer.
Rural America has made its bed; now it gets to lie in it.
20
This is what happens when rural American keeps voting against themselves then blaming the "City" liberals for all their problems.
That said, if they get their local news from a Sinclair station, talk radio, evangelical churches, and Fox then how are they to know any better?
97
Why does this woman have 3 babies at 21? Nobody seems to have mentioned this. Surely she had other options.
81
@Anna
If this woman had had access to a hospital that provided not only OB/GYN services but also access to childbirth education and birth control, she might have had other options.
18
Where are they supposed to learn about these options from?
Planned Parenthood? School classes on sex education? Church?
8
@Anna Options for women are increasingly limited in Missouri. It’s an anti-woman state.
6
Is it any wonder why the maternal and child mortality rates are on the rise in two populations within the USA: rural American and African-American women. Such a sad state of affairs.
10
every day i read something new that makes me eternally grateful to have won the birth lottery - i was born in Australia. Universal healthcare means my state funds maternal healthcare 100% in top quality public hospitals with excellent specialists FOR FREE.
the United States is sick with racism and caste-ism.
it is not the land of the free.
it is the land of abject poverty.
you get better health access in developing countries.
how can politicians be so cold blooded that they're ok with month old babies dying because they defund maternal and child health but they constantly fight against allowing abortion and contraception. it absolutely boggles the mind.
why do these conservatives love punishing women so much?
108
@Phillipa The problem is these people in rural areas for decades have voted for people who did this to them. The voted for people who refused to expand Medicare coverage and who hate the Affordable Healthcare Act.
4
When these people end up calling 911, do they also get slapped with a bill ($2000 in many areas) for the ambulance?
16
People need to realize that this failure of healthcare should be laid mostly at the feet of the Republicans who have made a conscious decision that healthcare is just a commodity and that they want to downsize FED - except to help the wealthiest Americans. Everyone, we don't matter.
51
Democrats and republicans alike take blood money from the unholy for-profit healthcare racketeers: hospitals, doctors, Pharma and insurers. Hillary Clinton was the largest recipient of donations from insurers while a senator. The public option was killed by Lieberman and Bayh when Democrats controlled Congress. Both voted their pockets: their wives were on the boards of healthcare companies.
13
@Xoxarle, as a registered Democrat I must sadly agree that the Democrats and Republicans are both responsible for the failure of the health care system as the Republicans.
Obama adopted the Heritage Foundation's free-market health plan, rather than expanding Medicare, even though single payer was popular with their voters and they had a Congressional majority.
The difference is that all the Republicans oppose a rational health care plan, whereas only the majority of Democrats do. Bernie Sanders demonstrated that single payer was popular and respectable, and Democratic candidates will now have to reach that standard.
Who knows? Bernie might even win.
These people continue to elect Republicans, who are the enemies of any kind of social services. So, they are getting what they asked for. Hard to feel sorry for them.
41
Can they vote?
Republicans are doing all they can to disenfranchise those who would vote against them. Especially in these deep Red states.
10
Like the hospitals that left, many of these communities need to shut down as well and send there residents to more sustainable towns.
10
@Jeff, Like to Falmouth Maine?
4
Missouri is among the states that have chosen not to expand Medicaid. Might this not say something about how Missouri values health care?
24
As with some other articles of late, no small number of commenters are gloatingly rubbing their hands and happily talking about "choices" made int he 2016 election. So basically our sensitivity, caring and compassion - which gets doled out generously to prisoners, terrorists, and whomever - is almost gleefully set aside if some poor person lives in an area that voted contrary to to way these commenters approve of, even if the actual person in question either didn't vote at all (what if they're immigrants ineligible to vote?) or voted for the "correct" person.
The closing of these hospitals and clinics in rural or remote areas is a serious and complex problem that didn't suddenly emerge on on January 20, 2017. This has been declining for decades for reasons besides "mean" Republicans - toss in medical personnel who simply don't want to live in those places, litigation, cost of modern equipment, changes in certification standards, etc. And simply waving a magic wand and saying "single-payer for all" will not magically fix those problems, even with a big infusion of money.
What a sad statement about America in 2018 that a lot of people are willing to shun their fellow citizens (even non-citizens whom they otherwise claim to care about) based on petty partisanship and hatred of one man. Aren't we better than this? Shouldn't we at least try to be rather than just dismiss such serious matters as if it were a political game?
32
"toss in medical personnel who simply don't want to live in those places".
Question is WHY they don't want to live in such Conservative, Freedom Caucus, MAGA places.
14
@WendyLou14 Of course that is the assumption, but is that really the case? Are all medical personnel Liberal, Democratic/Socialist, or whatever this weeks terminology is? What if they are conservative but simply have other financial or social wants or needs, preferring to live elsewhere for their own reasons? Are those professionals supposed to be altruistic and set they family needs aside, while progressive professionals can merely sneer and say "well they voted wrong, let them die"? Are you totally defined, in the tribalistic mode of some, by where you live rather than who you are? It may come as a shock but people can have divergent political views and yet still be caring and compassionate.
Yes. It is my fault that people in rural America voted for their own destruction.
5
It is not only rural areas which are having difficulty with health care. Many physicians in major cities are closing their practices due to their loss of income and so-called penalties placed upon them by the ACA and government intervention and regulation in the delivery of healthcare services. Medicare patients in major cities are having difficulty in finding physicians who accept Medicare and as a result are going without the medical care they need.
The ACA also included large payment deals with health insurance companies which have rendered payments to physicians a minimum and made premium payments by subscribers unaffordable.
10
Medical systems failure is ubiquitous but in many forms. It is creeping into every form of care delivery. If you think you are immune, you will discover you are not tho it may not be an emergency baby delivery. Doctors are leaving practice everywhere and access to care thinning. Frogs in slow boiling water. It does not have to be this way.
4
This was preventable. Closure of rural hospitals was predicted when red states refused to expand Medicaid. Blame Republican governors and legislators who refuse to accept responsibility because rejecting anything originating from Obama was more important than the health of their constituents. People should be demanding Medicaid expansion in states without it and voting Democratic.
46
Yes another day and another horror health story. So that's right keep voting for the right wingers or the centrists who think everything is going along fine and just needs a tweeking or slow change.
Health care in this country only works for a few people. The whole system is shear insanity and it's getting worse by the second.
13
Rural hospitals,especially those with fewer than 30 acute care beds as opposed to long term care have been struggling since 1989. Often these facilities are sold to mammoth healthcare organizations. Some survive many don't.
This is not a political problem.The problem is a matter of the savage economics which control the US healthcare "business". It is compounded by a community's unwillingness and financial inability to maintain a hospital,even though the hospital may be the largest employer in the smallest towns.
As another commented ( Douglas McNeill
Chesapeake, VA) said "Health services need to be part of any town's plan just as vital as police, fire protection, schools and water. "
Our system itself is the problem.It can only be solved by a united will to accept responsibilities for both us AND our neighbors. Don't hold your breath.
15
Mentioned, but not really emphasized is the fact that the vast majority of rural hospital closures have occurred in republican controlled states that declined Medicaid expansion. This adversely affects rural Healthcare in ways outlined in this article. Often these hospitals are the largest employers in their communities.
Combined with the trump tariffs, rural America is being devastated. Will rural voters ever figure out where their interests lie?
92
Can we please not forget the role that certified nurse-midwives play in providing care to women in rural areas? This is a critical piece of this challenge that is not addressed. By collaborating with only one or two physicians, a large group of CNMs are able to provide evidence-based, high quality, comprehensive well-woman pregnancy and delivery care, alleviating the burden on both patient and provider. States like mine, NC, lack any OB providers in half the counties, yet will not pass any legislation that would help CNMs and MDs work more collaboratively to ensure access to care.
21
In this case the adage about success having a thousand fathers while failure is an orphan is backwards. This failure of our system has a thousand fathers, and mothers.
The combination of factors includes:
- shifts from non-profit to for-profit hospitals that cherry pick their populations to avoid the high risk and the poor;
- incredibly low reimbursement for Medicaid making it hard for practices and institutions to cover their overhead;
- short-sighted and politically motivated refusals of red states to accept Medicaid expansion money available via the ACA;
- increasing costs for professional liability insurance premiums that must be paid before anyone in the office gets a cent;
- and possibly in the story told here, issues with crossing state lines when on Medicaid (the story implies there is a closer hospital in Arkansas).
Another story in the Times today details the high overhead administrative costs of US medical care to get payment from insurance companies.
The cleanest solution to all this is universal health care, which I believe would be less expensive than current care due to reduced administrative costs. The money is there, in the private insurance premiums and current state and federal spending.
I am biased as a specialist in high risk obstetrics, and though I work for a large university, our salaries come from our practice, which is >40% Medicaid.
Remember this: every dollar NOT spent on prenatal care comes back as far greater costs for sick babies,
31
The milliion-dollar question is, how are people going to afford a proper raising for a baby if they can barely afford gas for a 50 mile drive to a hospital? Even that drive, a 100 mile round trip, involves, say, five gallons, or about $15.00.
What people really need to think about individually is how they can maintain a decent lifestyle, for themselves and those thrust into their lives. And society needs to find a way to employ people productively. Reducing single parenthood would go a long way on both.
22
So, how can people keeps jobs when they have to spend a day traveling to and from a hospital or clinic to receive care?
Having 2 parents btw doesn't guarantee that there are jobs to be had either.
4
As a physician, I once spent two years in a very rural part of California as part of the National Health Care Service. We had a small 10 bed hospital, now out of business. I was a family practitioner who also did obstetrics. Malpractice for delivering babies back then was reasonable, it has since become very costly. It is economically infeasible nowadays to practice obstetrics in rural areas. One needs a large practice to compensate for the high malpractice premiums. Among all the other problems of American healthcare, the litigious nature of our culture also affects the cost of health care.
49
I can't help but notice that a number of the folks in this article ended going to hospitals in Arkansas to get care. Arkansas expanded Medicaid; Missouri did not. As the 2018 Health Affairs report that's linked in this article notes, there's an association between Medicaid expansion and rural hospitals closing.
I lived in Arkansas for a number of years and remember the Medicaid expansion debates well. There were counties in northeast Arkansas where over a third of working age adults did not have insurance. You cannot operate a business where a third of your clients are unable to pay. After the ACA expansion, the percentage of uninsured at the university hospital in Little Rock dropped from 14% to 3%. Paragould and Piggott are not big communities but they clearly have kept their hospitals open. Arkansas politics are extremely conservative but the state legislators recognize the ACA impact on hospitals and rural care and have continued to reauthorize the Medicaid expansion year after year.
Rural hospital closings like the one in Kennett, MO are not inevitable. That hospital was busy. Decisions were made by the state government and this is the result.
144
Life in the Missouri Bootheel has never been easy. I know because I served as a VISTA Volunteer there in 1965-66 and lived in Kennett. I actually spent time in the local hospital with a serious asthma attack. The loss of the local hospital is one more piece of evidence that corporate controlled health system that puts profit ahead of the people it is supposed to serve. The fact that the state of Missouri has not voted to expand Medicaid as authorized by the Affordable Care Act very likely contributed to this decision, but leaving people bereft of health care is simply shameful. Rural hospitals close, rural schools close, town centers are decimated by Walmart; no wonder so many Americans are angry. There is a great documentary about the Bootheel entitled ::Oh Freedom Afterwhile."
24
Kennett is in the Republican Missouri 8th district, represented by Jason Smith, on the payroll of insurance companies, big Pharma, healthcare, lobbyists and lawyers. Smith pushed hard for Trumpcare in 2017, and his major contribution to the national healthcare debate was opposing the taxation of tanning beds, speculating that we might as well go ahead and tax the sun. Here and elsewhere voters get the best representation money can buy and consistently vote against their own self interest. I wish Ms. Abernathy’s twins the best in life and hope by the time they’re 18 they’ll vote the bums out. At least they got a 2 month head start.
80
For a myriad of reasons, successful and growing businesses recognize that red states are becoming difficult environments in which to exist. As these businesses choose not to invest in red states, those areas will become steadily poorer and the quality of education, health care and other human services will decline. Over the next twenty years, I anticipate a shocking bifurcation of America. Red states generally will not fare well, and blue states will be very disinclined to bail them out. Tragic for women like the one featured in this article.
30
I'm sorry to hear this. But who did these folks vote for? What did they think was going to happen? These are conservative people of whom many voted against the first beginnings of a universal healthcare system. They are making CHOICES. The choices we make in life have repercussions.
194
@Jon Mario they probably didn't get to vote at all - same issue with polling stations.
20
The problem is compounded by the fact that many of these rural communities are very conservative and politically controlled by fundamentalist christians, so sex education is minimal and knowledge of and access to birth control is discouraged. In more advanced countries, sex education begins in grade school, with the result that teenage pregnancies are far less common.
222
@Eric. Not only is access to birth control discouraged, sex education programs place an irrational emphasis on abstinence education.
7
Direct entry midwives would be an excellent source to do home births for those who are healthy and to do referrals when needed. A midwife will have more contact with pregnant woman and could intervene when high risk is determined. This would help greatly.
41
There are so many solutions to this problem ranging from itinerant pre-natal care to midwives to universal healthcare.
Nevertheless, Fox News and Republicans persist in survival of the wealthiest when it comes to healthcare and the United States.
It is unforgivable and completely, totally unnecessary in a country with as much wealth as ours.
69
In my professional career, I struggled for over fifteen years to provide health care to several locations in exurbia and rural parts of the country with only limited success.
Victory has a hundred fathers and defeat is an orphan. Reasons for my personal difficulties were numerous but mostly out of my control. Local civic leaders lacked vision and local citizens often lacked resources to pay for and support medical services.
I ultimately chose to jump ship to a medical system with deep financial backing and a supreme transportation infrastructure, ending my medical career in service to the US Navy for my final twenty-three years.
Health services need to be part of any town's plan just as vital as police, fire protection, schools and water. When governments fail to provide essential services, they sound the death knell to the communities they purport to serve.
48
It amazes me that so many of our fellow citizens that call our country "the greatest in the world" do not have a passport and have never spent time overseas. If one goes to Western Europe you will see well run and well equipped hospitals serving in the less populated areas, unlike much of this country.
If millions of common working and middle class people who keep voting for Republicans saw how bad this country really is compared to what it could be, there would be a revolution- a political revolution. The press is not helping with the way they report on Social Democrats like Bernie Sanders or Jeremy Corbyn as if they were Cold War Communists taking orders from the Kremlin. Last I checked, the Republican in the White House was the BFF with Putin- who was a Communist KGB Officer back in the day.
The press always ask about how we are going to pay for Universal Healthcare, but nobody in the media asked if we could afford to bail out Wall Street. Same for Bush's 2 wars in SW Asia.
319
@David Gregory
If you go overseas to Europe then you are never really two hours drive from anywhere - geography and population density is the problem in many areas of the USA.
If you look at Canada's universal system then you will see the same complaints about rural hospitals and Emerg departments closing in dying communities.
Universal healthcare is not a magical solution to these problems. Taxpayers are the solution and I do wonder how many people in Kennett do not pay taxes while consuming all manner of local and state services.
13
@SteveRR Australia and it's National Health Care System struggle with the challenges or rural and dispersed populations. Some of the solutions they are implementing include premium pay for medical personnel who work in county seats and rural freestanding clinics and providing transportation to medical appointments as part of the national medical insurance. They certainly are doing well controlling costs. I had to pay full freight for an in office drainage procedure in the very rural outback town of Coober Pedy. It was $80.00 AUS about $60.00 USD including antibiotics.
1
@David Gregory Thanks for drawing attention to one of the glaring omissions in any critique on US healthcare, how peer countries provide thorough services, where needed, for far less money than the U.S. And corporations aren't suffering for it, they are getting rich off this debasement, patients suffer.
1
Back in the proverbial day almost everyone was born either at home or someplace that was not a hospital. Including my dad and everyone in his family, all of whom lived in the rural South where a voodoo woman was more likely to attend a birth than a new-age doula, midwife or OBGYN. Those babies that couldn't make it, well, we don't know anything about them unless their births were recorded. Inordinate amounts of money and extraordinary medical measures were not expended on people 80 years ago and further back...and somehow the human race multiplied.
5
So do you suggest that we forgo all modern medical care? People multiplied in spite of smallpox, polio, bubonic plague, endemic cholera, sepsis from minor injuries, etc. Infant mortality was so common that children weren’t named until they were over a year old, and maternal mortality was a major killer of women.
Should we all forgo the modern advances that have for decades facilitated longer, healthier lives, or just those who live in disadvantaged areas or who can’t afford it on their own? Do parents in rural Missouri deserve to suffer the deaths of their children because of where they live and how much money they earn? Do women in the rural US deserve to be at higher risk of death during childbirth than women living in cities?
43
@Lauren, you totally missed my point. We are so much further advanced medically now, yes. But should people have babies when it is not advantageous economically to do so, let alone logistically? What about the increasing lack of availability of alternatives to pregnancy, like abortion, because of the political right-wing's agenda?
@Tournachardanar I agree that a massive part of the problem is that a huge swath of our population has limited access to the knowledge of those medical advances that allow for things like family planning safely and effectively. In my experience with teens and twenty-somethings in my home state which is not so dissimilar from MO, that very lack of access to family planning resources tends to lead to having children at economically disadvantageous times.
And the question of what’s logistically available should not have a profit-driven answer. It should be driven by the needs of the population. Certainly cost is a factor, and not every small town can or should have a full-service hospital, but the shuttering of community hospitals and clinics for the profits of a few and to appease social conservatives is unacceptable.
Please read the story about how Medicare has for years under paid hospitals and then wonder why many closed. They have shifted the costs to private insurance companies and others and are still fighting in the courts to perpetuate this formula which they know to be flawed. This story is elsewhere in today’s paper. Stop trying to blame current politicians for something that’s been ongoing for decades.
18
@James Krause,MD
And don't ignore the cost of all those insurance company executives making millions per year in salary. Get rid of them and there is a lot more money for the medical care when less is spent on high paid deniers.
16
That makes it ok for the current politicians not to do anything?
7
Let us not forget the ambulance-chasing lawyers who have essentially driven doctors out of OB care. Many doctors now only accept GYN patients. Giving birth to a healthy baby is not a given. Short of screaming negligence, doctors cannot be held accountable to the tune of millions because of what can be simply a twist of fate. The expense of covering yourself with medical malpractice insurance for doctors in general but obstetrics in particular(as well as the ER where doctors do their best with zero knowledge of pre-existing medical conditions) is pushing doctors into early retirement -- who also strongly urge their own children not to go into medicine.
Medical school sets students back hundreds of thousands of dollars. Everyone get together and sponsor students for rural care. That would be a start.
29
@JPRP- Your point that giving birth to a healthy baby is not a given is a good one and increased liability costs are clearly a factor in reduced access to care. However, how is a mother making $8.50 an hour supposed to pay for a special needs infant? These lawsuits arise because there is an inadequate public safety net to fund the care and people must sue to get the resources they need. The private sector (tort system) provides the means for support that the state has not. Universal health care is a more humane way and would cut out the need for the tort lawyers and their 30 percent.
10
@Absurd SImple; by not having babies she cannot afford. It's not my problem that she decided to get pregnant without consideration as to how she was going to take care of her children. Love only goes so far, and won't pay the mom's bills.
As for education, sounds like the mom's mom is there for her. I'm sure she could have provided a little education about birth control and responsibility.
Taxpayers are there to provide healthcare, but cannot afford to pay for all of life's mistakes.
The pro-choice answer is OK, as long as the mom doesn't use it as an excuse for bad choices.
Just where is "dad"?
Let's remember folks. Medical care is now a business. The market place has precedence over anything else, including patient care. It's like Walmart. Why would you open one (or keep one open) in a poor area with few people. No money in that.
36
"officials have put a tax increase onto August ballots to raise money to build a hospital."
Don't build, acquire the existing facility and reopen it as a non-profit.
And to me, a more interesting story is how a facility with 22,000 ED visits per year, closed.
Someone mismanaged the hospital.
15
22,000 ED visits from patients who are underinsured or uninsured means a lot of care that isn’t paid for. A typical hospital functions partly like an income redistributer because they can’t (and shouldn’t) refuse emergency care to anyone regardless of ability to pay, so the sticker cost of say an X-ray inherently includes the extra they need to give emergency X-rays to patients who can’t pay for them. If you have 75% paying/25% unpaying patients, this system is sustainable. If you have 10% paying/50% underpaying/40% unpaying patients, it’s impossible to raise prices enough to cover the costs of providing care to everyone.
26
@Lauren I agree with your point that hospitals should not turn away life-threatening cases from the emergency room.
But the government should pay the cost, not just the insurance companies paid by others or the private-pay patients - least able to pay.
And the ER should not be required to provide non-emergency care. For indigent non-insured people it's often the minor emergency clinic for sinus infections since it's the only place they can go that doesn't charge.
@Gandolf the White. EDs used to make money for hospitals, but the changing demographics of the u.s. and pay models mean for profit hospitals often close EDs. An ED full of poor people, immigrants (legal and illegal), single, unemployed moms to be, and old folks, and mostly people with no or public insurance which pays nothing will be busy but will losers when it comes to even keeping the lights on. It's like having a grocery store that has to give out food to hungry people with no money. Busy place that looses $.
1
Why are hospitals for-profit institutions?
When the fiscal responsibility of a Board of Directors is to the share holders rather than to the people they serve, compassion, empathy and goodwill are left 100 miles away.
The same can be said for the corporate ownership of our prisons and ICE detention centers.
I hope those corporate owners are enjoying their tax break.
80
Our national hospital infrastructure was mostly built by counties, cities, community hospital districts, and churches as non-profits. They were not expected to make money and were funded by donations, volunteer labor and taxes as well as fees. A generation ago they began coming under for-profit corporate ownership which consolidated into national chains that close hospitals when they don’t earn money.
22
@KBronson It should not be assumed that hospitals operated by religious orders are "lacking in profit", far from it. I worked for a large Catholic hospital group and their net profit after all operating expenses was impressive.
5
@Roberta. You are of course correct, now. With Medicare making a profit running general hospitals became possible and big business. Before the 60’s that was not the case except for a very exclusive few. It is now as profitable for the Sisters as for it is for shareholders. But the reason the Sisters got into the “business” was that historically there was no money to be made, only a need to be met.
2
I too have been in that ambulance with a laboring patient flying down snowy country roads towards the closest obstetric center, and reading this story brought back some harrowing memories. Unfortunately, that is a reality of rural life in North America, the hollowing out of communities, and the migration of the rural young to cities. How many times have I heard someone tell me, "they used to have a nursery here (now a waiting room)" or "in the 80s there was actually a small surgical practice here (now a storage room with an old gas blender as a witness)". However, in Canada, where hospitals and health networks are coordinated by the provinces, at least critical transports and referrals to tertiary centers occur in a comparatively timely fashion. The key to this system are the true heroes: the rural family physicians. They are still practicing in the mould of their forebearers, servicing their community members in their towns from birth to grave, house calls not unheard of. I would say that it is vital for rural communities to recruit and retain, compassionate, smart and motivated primary care doctors (a problem everywhere). But just as importantly, from a policy perspective, states need to take over and manage medical assets in rural counties in a similar vein as the Tennessee Valley Authority (for power and land management). A patchwork of competing health networks, spurring innovation, may work in the cities, but clearly does not serve rural counties.
20
It is not at all clear that moving to a single-payer system will solve the problems of rural hospitals.
The physician reimbursement rates established by Medicaid and Medicare are so low that small towns and rural areas already cannot provide enough volume of patients for young doctors to repay their school loans or for older doctors to send their children to college.
Consolidation of hospitals is already taking place, causing the kinds of problems noted in this article, so that does not help rural areas and small towns.
This is why many young people--and physicians--are moving to larger cities and metropolitan areas that can support physicians and hospitals.
No, I am not a physician; I am on Medicare and can only offer my sympathy when I see the low reimbursements my various doctors get from Medicare. (Same problem with Medicaid, of course.)
14
@Mon Ray Medicare is based on a system of patients sharing in the cost of their care, which is why there are deductibles, copays, insurance premiums, and private sector supplemental plans. The combination of this does work more effectively than anything else we have in this country to provide decent care, with an administrative cost of 6%, as opposed to the 15 to 20% in the private sector.
3
@Mon Ray
I appreciate your comments, but respectfully disagree regarding the impact a single payer system could have.
With our current system, especially when for-profit entities are involved, resources will follow reimbursement. Populations with high numbers of uninsured or medicaid patients clearly get left behind when investor preferences have to be followed, and investor returns paid. Of course, if the reimbursements under a single payer system are too low, we will have difficulty getting providers to work in those areas, but if all patients are within the same system, it follows that there will be a political impetus to make sure that providers are adequately compensated.
The movement towards consolidation is a partially a result of the complexity of our multi-payer system. A small practice has little negotiating leverage with insurers, and limited resources to interact with multiple payers. Having a simpler system with one payer will make small practices viable again.
Single payer provides a means of helping to ensure that there are resources allocated to previously underserved areas, by adjusting reimbursements in a way that rewards working in these areas.
Finally, everyone is covered under such a system. Time for the United States to join the rest of the developed world.
3
NICU babies whose families live far from the hospital can go days at a time without a visit from mothers or other family members. Nurses are busy with medical care and charting, as well as feeding, changing, etc.
NICU volunteers, often known as “rockers” or “cuddlers”, provide hours of comfort and verbal interaction, helping infants start life with mothering as well as medicine - both needed for good health. I encourage anyone with patience and love to give to look for an opportunity for this important and rewarding volunteer activity.
19
"Drop dead, America !"
GOP 2018
November 6 2018
104
@Socrates. Right. None of this would have happened if HRC had been elected.
7
@Al IF HRC was in the WH, we'd at least be talking about solutions to this problem. Instead, we are watching a complicit GOP let the president throw away everything that is decent and just about this nation.
The right has allowed healthcare to become a for-profit business and this will not change anytime soon as long as the GOP has control of all three branches of the fed. We are all on our own. Vote wisely this November.
@Al She would have waved a magic wand and decades of the development of these issues would have instantly vanished with the stroke of a pen?
I love the ACA. They made sure that uncovered individuals couldn't opt out of buying in without penalty, but made sure that their donor providers and insurers can.
Single payer now. Won't vote for any candidates who don't support it, and with more than convenient lip service.
22
These rural hospitals will likely never reopen — consolidation combined with lack of government and charitable support have closed that door.
Eventually, rural health care will probably be provided by nurse practitioners supported by remote tech-based support. Bare bones, and woe to anyone that needs specialist emergency care.
With proper resources, though, such a system COULD work reasonably well. A robust transport network. On-site residence options. A sort of hub-and-spoke medical center and specialist concept. But none of this is likely in our current system.
15
@Elizabeth A US isn't even repairing its basic transportation infrastructure, look at the bridges which are unsafe. Sounds like the road to the hospital is sketchy for this community at best.
3
I wouldn't necessarily limit this story to rural Missouri. What about the closing of St. Vincent's and other hospitals in Manhattan? Obamacare didn't go far enough: it pushed people into the insurance net but still allows the middleman to hold sway over the doctor/patient relationship. Healthcare is a huge percent of the GNP, and as long as it remains a for-profit business, things that happened in this story will continue to happen. We've been able as a country to create a strong public school system despite some of the problems with it; why not a strong public health system? But that would be up to our legislature, which also, like Trump, has too much vested in the money to be made from illness.
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Even after the St Vincent closing, all data shows New York City has a large surplus of under used hospital beds. Some New Yorkers merely have to travel a few more blocks! Contrast that with rural America where travel to a hospital requires hours and many miles! We need a National Health Care system where the government can assign doctors (and pay for) doctors in under served areas!
13
"sharply worsening finances in states that did not expand Medicaid"
These states made the deliberate decision not to expand Medicaid - it was on offer from the Federal government but they chose to turn it down in a show of political malice.
353
The people in those states voted in the candidates who were against the expansion of Medicaid in their states.
9
Where is the twins' father? Ms. Abernathy's father? Where are the fathers?
145
How would that make the hospital closer?
89
@Jennifer
It opens the possibility of moving to an area with needed services rather than living with mom.
@JenniferA note- there are hospitals closer than 100 miles.
Great River Medical Center is located in Blytheville Arkansas and lists full OB/Gyn services.
http://www.mchsys.org/getpage.php?name=greatriver
By Apple Maps, it is 29 miles away from Kennett.
What could be an issue here is many times when states pay for services, they want to keep them captive to facilities in that state.
The lack of health care in the rural areas is scary but I can't help but think the people in these areas in particular voted for this. They voted for republicans who have told them over and over again that they will cut medicare and medicaid and that tax dollars won't be spent on "those people" generally meaning poor people - cuts to SNAP, housing assistance, heating assistance, etc. That is the republican platform and it's not like they're hiding that agenda. They have also voted out or never had unions. They don't seem interested in forming any so they have little chance of their wages rising. Honestly, it makes me wonder what it will take to get people to learn some facts and vote for the best interests of themselves and their communities and society at large.
404
@debbie doyle The *old* people in these areas voted for this. Don't get confused.
1
I agree on this point that these communities voted for their own demises. Many Trump and Republican voters vote for reduced government participation in their lives, are against taxation - all for self-interests instead of voting for common good. It’s now such a surprise to them that these voters too are also at the receiving end of the common good but alas, the tap to them has been turned off at their own behest. Meanwhile, Make America Great Again = MAKE RUSSIA GREAT AGAIN! Trump’s agenda is finally revealed: the heck with America, let’s rob her blind! As is evident in all his policies, he seeks only to enrich his coffers and his own power. In Trump we trust...?
12
What will it take to even get people to vote in the first place?
4
Just ask the Republicans how many rural hospitals they're planning to rebuild. This is what a government is for. They're completely selfish and cynical and the hospital closures in non Obama Care states isn't an accident. It's profitable. They haven't lifted a finger to rebuild or refund these vital institutions.
Even if you have health care, too often you can't get it in Republican states. Do take care on vacation, America.
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The Hippocratic Oath, one of the oldest binding documents in history, ostensibly still held sacred by physicians, states that doctors will “... treat the ill to the best of one's ability.” It doesnt say anything about earning vast sums of money for doing so. Sadly, medicine is a “calling” to only a small percentage of doctors. To the large majority, it’s just a well-paying job. They will sell their services to the highest bidder, and thus exclude the rural poor.
15
@Charley
As a practicing obstetrician I can say without a doubt very few people went into this field for "vast sums of money." Anyone in medicine will tell you that the practice of obstetrics is one of the most grueling and demanding fields that depending on one's practice style demands 24 hour/7 days a week of on call, ready to be woken up at a moments notice to rush in to the hospital for emergencies. It is also one of the most highly litigious areas of medicine with malpractice rates in cook county in the 100,000 per year for a premium with liability occurring for 18 years after the birth f a child. Doctors are not saints-we are people too and to expect a healthcare system be founded on such an idea of a "calling" is not going to be reasonable or sustainable.
Where's the real money-look at insurance and hospital administrators.
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@Charley
How exactly do you propose that an OB/GYN, especially one who sees high-risk patients, practice without a hospital? Even normal risk pregnancies can end up requiring c-sections, sometimes emergently.
18
It is naive to put the blame on doctors. Doctors can’t fight the system, doctors have their own families, student loans and house loans, to take care of. Doctors did not sign up to deal with the mountain-loads of insurance and medicaid claims and processes; if their practices can’t survive, if hospitals and healthcare support aren’t available/accessible, they cannot provide basic efficient healthcare to their communities. Stop blaming the doctors, blame those who voted for politicians and the party who withdrew and reduced America to such a lamentable state!
32
Without an acceptance of healthcare as a right rather than a privilege, and without acceptance of the basic notion that taxes are the price we pay for a civilized society, this primitive situation will only get worse. In the case of obstetrics, in particular, you can add misogyny to the toxic mix. The general lack of a sense of responsibility to our fellow citizens has to stop if we are going to survive as a society. If you have read this story and don't identify with it, then just give yourself some time. Because, absent any significant change in our approach to governance (rather than power), you will soon have your own opportunity to be the subject of such a story.
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@Frank
The misogynists should be reminded that everybody has/had a mother. And women don't get pregnant by themselves.
It could be informative to revisit one aspect of Ernesto 'Che' Guevara's personality through Steven Soderbergh's massive work with Benicio Del Toro who made clear that Che was a medical doctor who passionately believed children should be within a reasonable reach of medical care wherever they lived. And any government that did not make such a goal a top priority, should be replaced.
22
Venceremos!
@Albert Yokum
a bit off point, but interesting that Benicio's is a gifted pediatric doctor- who gave up clinical practice to run hospital is a poor urban area...
This is what the voters in MO want, this is what they vote for, this is what they get.
265
@Kam Dog This is what old voters in MO want, and male voters in MO want. They're not the ones giving birth.
2
So, yeah, I take your point. Part of me wants to agree. Not least because Missouri is responsible for Mitch McConnell, and Mitch McConnell is responsible for Neil Gorsuch.
But I ask you this: Why? Why is Missouri Republican?
Before you say they're stupid, I'll remind you that half the country is below average, and Missouri is no different.
I suggest to you that Democrats have offered Missouri precious little since Jimmy Carter. Yeah, Obamacare, sure. But also globalization, wage suppression, and media concentration. That combination,making with the advent of the Internet, has impoverished Missouri and all but extinguished its local news gathering. Guaranteed, most of their news comes from corporations based on the coasts. Is it any wonder they speak of "coastal elites"?
If Democrats want Missouri to vote "intelligently", they have to put something on offer. It can't be Hillary Clinton's neoliberal stay-the-course, it's-all-good, stronger-together, yay-paid-family-leave brand of nothing. That's what got them where they are. If the government's going to do basically nothing, isn't it rational to favor making it cheaper? If wages never go up, doesn't a tax cut start to sound like a raise?
The whole country has been voting for "change" for years. Obama was change. So was Trump. By and large, the electorate doesn't understand the titanic forces that have been remaking American life since 1980. Democrats have to offer real change, now.
2
Am I missing something here? Where is the husband? Maybe no husband, so there has to be a man who is the Father of this expected Mother. Why is she pregnant if there is no husband. Sex education needs to be on the agenda and why isn't the man/husband/boyfriend using condoms. Take responsibility.
38
@John B
I'm not sure the presences or absence of a male in this scenario would help get this women the medical care she needs. Indeed-as is noted in the article family planning services are few and far in between as well.
63
Take a breath. Are you suggesting a responsible father could have kept the hospital open?
Use your imagination. Any number of things could have happened. The father could be dead. He could be working for Exxon in Texas or Wyoming. He could have been abusive or a drunk, or a playboy. If so, he wouldn't be the first man to be dishonest with a woman he found attractive.
It's easier to be judgmental than judicious. The story isn't about out-of-wedlock birth. It's about a for-profit hospital corporation making a financial decision with no regard for the community it serves. It's about a system that puts life-and-death decisions, effectively, in corporate hands, and imposes no liability or duty on the corporation to care for the people who live there.
It doesn't have to be this way. It didn't used to be this way. It could be radically better. Healthcare could be universal, and cheaper. The example of every other industrialized nation proves that.
If anything, the personal details are annoying. A hospital 100 away will be slow to treat anything: heart attack, stroke, chainsaw accident. The size and number of these corporations, an analysis of the trend, and the response of state officials would have been more interesting than knowing mom lay awake on the couch.
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Let’s assume there is a man in the picture - a boyfriend or husband who took responsibility for fathering the child, and let’s assume that these were planned pregnancies , would that have changed the lack of proper obstetrics healthcare services and access that these women living in the rural areas are denied to? Next you’d be blaming them for living in such rural areas? What about the pro-life movement refusing birth-control services and accessibility to all women, making women go through their pregnancies at all cost no matter their personal circumstances? Stop taking the lowest convenient pretexts of blaming it on the choice of people’s poor decisions, it just hadn’t happened to you yet.
22
Our infant mortality rate is a shame.
http://time.com/5090112/infant-mortality-rate-usa/
20
It appears that the for-profit model of health care in this community, has failed those who need it most.
13
I have empathy for this woman, and rural areas need clearly need more accessible and better health care. Can’t help but wonder, however, if she and her Mom voted for Trump. Surely this administration will do nothing to help ....Also curious no mention of father at all.....
30
@honeybluestar Bizarre, these "where is the dad?" comments, as though that has anything to do with the distance to the hospital. Are you part of some "men's rights/men must stand in front of every single story about anyone" campaign?
7
This is the result of having a healthcare system that is based on profits alone. Do you really believe that hospitals actually care about your health anymore? That may have been true when hospitals were non-profits run by the Catholic church or some other benevolent group. Now the majority of hospitals are run by hedge funds for the sole purpose of squeezing as much money out of you as possible. This is obvious as we watch the costs of a hospital stay skyrocket. Profiteers looked at the demographics of an aging society and decided to profit from it. But then what do we expect when we promote a society that bases itself on monetary worth instead of self-worth?
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@Mike L
Religiously run hospital congolomerates are large and no different than any other hospital group -don't be fooled. Catholic hospital groups have the added difficult of instituting their belief system in regards to contraception onto both the patients they treat along with any physician that works for them.
17
One of the major benefits of single-payer health care will be the much needed trimming of surplus hospital beds in urban areas such as NYC and Boston, and the reassigning of those government paid doctors to under served, rural, "medical deserts"! How care we provide equitable medical care for all American when there are no doctors or facilities in much of the nation?
13
@Donna Gray And that is EXACTLY what the H1B visa was supposed to do before it was co-opted and abused by bankers in New York for there I.T. Departments. Suggest anyone interested read about the H1B visa , then write your congressmen about ending the abuse by limited it to availability ONLY in places where the population density falls below either 100PPl Per Sq Mile or 300 ppl.
8
We need single payer National Health Care!
There are two issues worth commenting one, one obvious and one so pervasive it surrounds us without notice.
First, as hospitals and providers are squeezed financial through all sorts of abusive means, fewer hospitals can survive and fewer skilled doctors are willing to care for poor patients.
Secondly, the issue of decreased access to health care is viewed solely through the prism of women's health care. What about health care for men? Noteworthy fact: Twice as many health care dollars in the US are spent on women as men. And women already live several years longer on average than men do!
2
MHW, your second point on this doesn’t hold. If as you’ve mentioned, women live several years longer than men, then surely it’s only logical that women’s healthcare is entitled to “twice as many healthcare dollars in the US are spent on women as in men”
(in this age of “fake news” kindly enlighten us the source of your statistics comparison). Women’s healthcare spending also takes into consideration women’s reproductive health, childbirth, birth controls that men who are anatomically different have little use for. Would your mother have given birth in a healthy “you” if women’s healthcare spending had been reduced from the privileges that she was at the receiving end of? Would you have had just as many opportunities in life if as a result of reduced birth-controls she ended up having more babies hence crowding your childhood with more siblings and having less for you? Please think about this - just because it hadn’t happened to you doesn’t mean you haven’t been a recipient of what one considers “privileged healthcare spending on women”.
14
@MHW
Men don't get pregnant!
7
In this case, “women’s care” was provided to 3 lives, that is the main difference between women’s and men’s care!
8
People ask why America is the only first-world country in the world where the maternal mortality rate is rising, and this is the answer. These circumstances are preventable as soon as they are made a priority. People want fiscal conservatism but limiting social benefit programs for the sake of individual income can have life or death consequences. It's time for us to actually Make America Great Again and look out for our most vulnerable.
43
When will these voters understand that their choices at the polls have these sorts of consequences? We need a national healthcare system. The concept of for-profit hospitals is not working and is in humane.
69
Thank you for shining a light on the difficult obstacles these women and children are facing. Both of my children were born in small hospitals primarily serving low-income women and joined our family through adoption as infants. One of the hospitals has since closed and consolidated with another hospital. My youngest child’s biological mother received very little prenatal care—reliable transportation is a real obstacle to low income women. I understand it is not economically feasible to keep open all rural hospitals, but we must do better and seek a solution that values the lives of women and children in rural areas. It is unacceptable to have infant mortality rates in the US higher than countries in the developing world.
13
These are the same places that consistently vote for Federal cost-cutting measures, not realizing that almost all of the services that the government provides them, e. g. mail, are subsidized by the big bad urban areas. Sorry folks, no government, no doctor or hospital.
120
In the Netherlands, most births are at home, with an ambulance ready. The idea that every birth needs to be in a hospital, and hence there is a big problem when hospitals close, is outdated. The US should learn from bringing the doctor more to homes. Nowadays, this can be even more readily done by bringing mobile health care to the rural communities. However, the example, an early twin birth - would probably be exempted from the concept.
17
@Margalit
Two of my three children were born at home, but in each case a hospital was within reasonable driving distance if we needed to go in. As these rural hospitals close, the risk to anyone needing quick medical attention for anything serious goes way up. You can't do an emergency c-section safely at home, and a two-hour drive is 110 minutes too long.
3
@Margalit
Not a bad idea but remember, the Netherlands is the size of Maryland, a postage-size state, so distances are not on the same scale for an ambulance, etc.
17
@Margalit both my children were not breathing on their own when they were born and needed assistance. I was very happy to be at a hospital when the pediatricians appeared in seconds. A scary scenario had I been at home.
16
In Ontario, the previous government followed a strategy of cost reduction through consolidation. So rural health centers and hospitals were closed down or severely cut back. With an aging population, beds were cut back and the wait for retirement homes is now many years. In some places, helicopters were used for patient transport, but in many it was self-service. More people died as a result -- and it is unclear as to what the new government will do to address the issue.
But to manage the situation a whole new bureaucracy was created with regional management boards -- so front line costs reduced but overall costs soared.
One suspects the US model is similar... cost containment by service reductions where only the institutions dollar costs matter, the costs to the population are irrelevant. Management thinks of themselves and their shareholders -- as though they were selling burgers instead of community services.
At one point in our history, religious orders ran many of the hospitals and provided a measure of compassion. Growing up around Chicago I remember a few. It seems as the business mindset took over and displaced the old guard these institutions shifted from servicing the needs of the community to focus on their own. So abandoning some areas became an easy choice.
In a 'whats in it for me' era where private benefits are the only thing that matters (look at the government) the ultimate cost is the loss of social resiliency. This may be regretted.
45
@Greg Latiak The costs of running medical care along with schools is getting beyond many local religious organizations. Even large hospitals in large cities with a big customer base are doing poorly. Many way under that red line. Hospitals rarely have stockholders, most are not privately or stock companies. Who would buy stock in a hospital knowing most do not make their own costs and have to rely on government money. The money received back from medicare does not cover the cost of the care given. And when you have a large population without insurance brings even more problems as the money received from government does not cover them either. As to government, its been operating poorly for a long time paying out way more than it receives, hence huge deficits. Medicare alone, set up on the concept those working at any one time, pays for those collecting Medicare at that time. The government only takes in 50% of what it pays out for Medicare at this time and that percentage is going to grow as to being a deficit.
4
@JDSept it is true that Medicare does not cover costs, but I am not sure why that is the case. US health care is more expensive than any other country's, often significantly more. Yet we cover fewer people and our outcomes are worse. Something is wrong with our system, but it is so complicated and entrenched that it is going to be hard to fix.
@JDSept
"Medicare alone, set up on the concept those working at any one time, pays for those collecting Medicare at that time"....
That's interesting to know since my wife and I, as retirees, pay more than $500 a month in Medicare premiums.
1
The GOP war on women's health care and their concurrent war on the poor, takes its toll on the obvious victims, young mother and babies and every rural poor person. How ironic for the party that prides itself on "family values". Because it is poor rural American families from the "heartland" that are suffering.
Even here in NY we have seen necessary hospitals shuttered to make way for more luxury condos, even as the city's population strains existing services.
Midwives and nurse practitioners can relieve some of the strain, but when will true family values be truly valued, and government recognize that both health care and education are too critically important to be left strictly to market forces and shareholders' pocketbooks?
162
@Ellen Rural poor and women are not the only ones this hits. That long distance for care is the same for the wealthy or middle class and males that live in rural areas. That wealthy rural woman is no closer to care than that poor rural woman. This has been growing for a long time and not just under the GOP. The costs for care are growing no matter who is in office. The distance to care is not effected by which party controlling government.
7
@JDSept For emergencies, I agree, the rural wealthy are equally affected. But for non-emergency situations, they are not. They can much more easily afford the extra gas and time off from work and are more likely to have reliable vehicles to get them to more distant medical appointments.
@Ellen
A good number of these poor, rural Americans are the very people who votes in the people who voted against the expansion of Medicaid in their states.
That incredibly poor choice is completely unrelated to "market forces and shareholders' pocketbooks."
6
Truly scary. It’s not just obstetrics that these folks have lost, they have lost their entire safety net. Even if the hospital and Emergency Department had remained open the lack of consultant help would still jeapordize care. As long as money is more important than the lives of our citizens, this will continue to play out across rural America. It is true that making ends meet at Medicare/Medicaid rates is almost impossible for hospitals. The only solution is a single payer overhaul which would reduce overall cost and improve care for our patients as a whole.
461
@H. Sethi, MD
Medicare and Medicaid ARE single payers. With horrendous rates that are unsustainable. The answer is competition, and you get that by getting rid of government monopolies. We need to stop promising care (medicaid) to every illegal that crosses our border, and every American who refuses to get a job and pay for their own care.
4
No one is going to compete for poor, sick patients.
28
Medicare and Medicaid are two things, not one. You left out the VA and a few dozen private insurance companies. They are payers. Each is a single payer. It's not a single-payer system until there's only one payer, period.
Across the globe, there's not one example of cheap, effective medical care provided by a private market. Not one. On the contrary, every other industrialized nation has some form of government-run universal healthcare. Their costs are demonstrably lower — half, on average — and outcomes better. What are you going to believe? The lived reality of a billion people for decades, or a libertarian fantasy?
"Illegals", you say. I wonder, if someone enters the country illegally and is run over by a car, what do recommend? Leave him by the road like a deer, and let the vultures deal with him?
Interesting fact: in France, tourists are treated regardless of insurance. They are billed for the service, though, not having paid into the system. You want to know their #1 deadbeat? Americans.
The illegal immigrant population in the US is some 12,000,000. In a country of over 300,000,000, that's something like 4%, many of whom pay for their healthcare somehow. Meanwhile, our Byzantine private healthcare system absconds with 1/3 of medical spending, 6% of GDP, $1 trillion a year. Based on the numbers, which would you say is the greater problem?
13
The social philosophy behind socialized care is to think of ourselves as one community where we all bear the costs of caring for each other. When we hunker down and only take care of our own the lucky survive and the unlucky become ghost towns of despair. The local cost is tragic, the larger cost is to all of us, each failed community dead tissue in our collective body.
295
Studies have shown that heterogeneous societies do not exhibit these group characteristics. That is one of the costs of changing the US from a majority white, largely Anglo Saxon, European culture to a new world integrated societal structure. Witness the low rate of transplant donorship in the New York area. Everybody is in their little community or tribe.
1
I’ve served in healthcare for 50 years. Now a retired RN, thank goodness.
I was overjoyed when on March 23, 2010 President Barack Obama signed the Affordable Care Act. I had been going into patient rooms as an RN Case Manager through the depths of recession, and heard story upon story of job loss, insurance loss, and uncertain futures due to health needs.
None of that has meant a thing to Republicans. They have not cared about healthcare, about healthcare insurance, about rural healthcare, or city healthcare either. I serve on a rural Community Quality Council for our local healthcare provider. The ACA did help these rural hospitals financially. But for some reason Republicans didn’t and don’t care.
Republicans have denied funds for women’s reproductive health, which includes prenatal care. Republicans have opposed the Affordable Care Act and have done everything in their power to decimate it. Republicans are defunding Medicaid and Republican governors have not accepted Medicaid expansion.
When we have a group of legislators who give no care to children at borders, lost from their parents, who do not care about providing healthcare insurance means, in fact who totally oppose it, and legislators who do not even want to fund food stamps or WIC to the poor, do we really think they will care about babies being safely born?
This will only get worse. Republicans scream they are pro life - but whose lives?
756
@MIMA Trump has been President for only 18 months and the ACA is still in place. What you are seeing in healthcare is the direct result of 8 years of Obama policies.
1
@MIMA I hope everyone who replied that this isn't about Republicans reads this comment. I am an Independent, but I know both Democrates and Republicans who are good people. Yet, it is the Republicans who are in power (and have been even during the Obama years,) and they don't seem to care about anyone who isn't one of them.
7
@MIMA
It is unfortunate that despite being a nurse, you are as blind to the law as you are.
Medicaid reimbursements have never covered cost of care. As a consequence, hospitals that serve a high proportion of Medicaid participants, and/or had a high proportion of the uninsured, always received supplemental Medicaid payments.
In addition, uninsured patients who had no assets and ran up big hospital bills were eligible for Medicaid retroactively. [If you were uninsured and had assets, you had to pay your bill, but if you had nothing, or not enough to cover your bill, Medicaid is available after you incur the costs.]
The sacred law you were so thrilled with stripped funding for: the supplemental Medicaid payments that had always been made to rural and inner city hospitals; defunded SCHIP, a bipartisan program that provided health insurance for children; and stripped the Medicaid funds for middle class families with children who had high costs not generally covered by health insurance, like home health care and physical, occupational, developmental therapy.
As a consequence, the profoundly ill and disabled children of middle class families as well as elderly patients are on waiting lists for home health care and other supplemental services. Rural hospitals have closed.
1
This article reveals just one more way that US healthcare is failing its people. As the article succinctly cites, the hospital closed for financial reasons and is owned by a for-profit hospital group. Two infants have already died in this community, how many more must die before we reform our healthcare system to reflect patient needs before profits? I live in a community of 40,000 near Seattle and the publicly built hospital in my city was acquired by a national Catholic hospital chain, which developed a plan to close the hospital and move services to an unincorporated area with fewer low income patients. Having worked in hospital finance I can assure you it is about the money. We need national healthcare which will put patients first and establish budgets for necessary services, not just lucrative ones.
281
This is crazy and frightening. I wonder how many women in this area are giving birth alone at home or in cars along the side of the road. I have very fast labors and barely make it to the hospital 10 minutes from me in New Jersey (one of my kids was even born at home accidentally!). I can’t even imagine the terror and anxiety these new mothers must experience while in labor.
Hospitals are shutting down in poor areas when a large percentage of the population is too poor to be able to pay for services. This is what happens in a backwards country like this one where healthcare is considered a privilege for the elite rather than a basic human right. When will people start caring about the suffering of others more than their own pocketbooks?
197
Earlier this year a member of the Virginia House of Delegates tried to facilitate the reopening of a rural hospital that had closed by waiving certain regulatory impediments. He couldn't get it passed when large blocks of Democrats invoked procedural hurdles on the basis that this lawmaker (and most rural lawmakers) had been impeding Medicaid expansion for going on 8 years. Outrage ensued, but I look back at this maneuver and see it as one of the actions that finally spurred some Republicans to change course and vote for renewed Medicaid expansion efforts in Virginia. None of us works for free. Yes, of course, local and state government should consider subsidizing rural hospitals because there is an impending catastrophe but this article more than highlights why refusing to expand Medicaid was self-destructive. Poor people will be hurt he most, but if your child has allergies or asthma or if you are in a car accident, whether you are wealthy or poor, you are at risk from the lack of timely access to medical care.
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@Barbara Rural hospitals closed at the same rate in Medicaid expansion states as in non expansion states. Democrats in Virginia held out for expansion while allowing rural hospitals to fail out of spite, not out of a desire to improve healthcare availability.
1
First off, this is not on the Republicans, as many commenters here suggest, knee-jerk style. It is very much a bipartisan issue.
It costs a lot of money to run a hospital, and it therefore costs a lot of money to be an inpatient in a hospital. Private insurance covers the cost for most of us. Both Medicare and especially Medicaid do not. A hospital with a majority of patients who are on Medicaid, Medicare, or uninsuranced cannot stay afloat financially.
Because inpatient care is so expensive, there is a major shift nationally to outpatient care, which is far cheaper. So, hospitals close. This may be good thing in urban areas with many hospitals, but not so much in rural areas where there's only one hospital.
The problem is especially bad, as this article notes, for obstetric care. The lawyers don't help any; malpractice liability (which usually means bad outcomes, not bad care) is a major reason why it's so expensive to provide obstetric services. Next time you read about a $4.5 billion verdict in a jury trial claiming that baby powder causes cancer (which is not supported by evidence), remember that the costs of such verdicts have consequences.
Ultimately, governments and society will have to decide if they wish to subsidize rural hospitals. It won't be cheap, but it may be the right thing to do. But remember: there's a limited number of resources, and we have to make hard choices. Pretending resources are unlimited is a fool's errand.
123
@Alex - I live in a big, densely populated city and am happy to spend tax dollars to provide healthcare in less-populated areas of our country, and try to provide coverage - in areas where for-profit would mean the doors would close.
Why do people think healthcare should be a profit center? "Public good" means providing things that don't generate profit, and that's what government is able to provide.
Don't forget that parts of the country - the sparsely-populated areas - were last to get electricity, and it was the Rural Electrification Act that funded the power co-ops in areas where for-profit groups would never go. For-profit isn't bringing broadband to the hinterlands, either.
But the common good means things like that should be funded by all of us. Not to make someone a nice profit, but to provide the benefit of our mutual wealth in areas where distance nibbles away any profitability.
6
@Alex I think we are reaching the tipping point in this country when it would be far more economical and sensible to pay people to move out of rural communities to more dense areas where the economies of scale allow for better healthcare, schools, and more job opportunities. Pouring money into very rural communities does not make good use of scarce resources, especially when there are few jobs there to begin with.
1
Can you tell us the Missouri politician or politicians that refused to expand Medicare. Republican or Democrat?
1
Before jumping to partisan conclusions by deciding that only Republicans are to blame, notice that most of this decline has occurred since 2010: that is to say, under Mr. Obama. This trend, in fact, goes back decades. It does not matter who is in office. Doctors and nurses, no matter what their political affiliation, are more attracted to high paying jobs in big cities. In other words, they're just like you and me. The least greedy people are the ones who actually stay behind in these rural areas, yet commenters here seem to hate them the most.
61
@Expatico The cuts to DSH payments and lack of Medicaid expansion are 100% the fault of the right wing GOP.
2
@Expatico Except that rural hospitals aren't closing because of lack of staff. They are closing because, without medicaid expansion, they are deluged with extremely sick, indigent patients.
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@Expatico I grew up in a depressed, rust belt community. In order to ensure that I remained self-sufficient (not rich!) throughout my lifetime, my only option was to leave for the "big cities." My relatives who stayed behind, quite honestly, are unmotivated to help themselves, are uneducated, frequently engage in poor behaviors (drinking excessively, smoke), and blame others for their problems. I know not all rural folks are like this, but a certain amount of self-selection is occurring. Those that are motivated, hard working and open minded will leave rural, poor areas; leaving the poor, unhealthy, old, and less self-reliant folks behind.
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This is what happens when the most important aspect of healthcare is profit. Corporations do not care about a community's health care needs, they care about the money to be squeezed out of someone's health care tragedy.
Look at who owns your local hospital. It may be called Anywhere Community Hospital, which will lead you to believe it is locally owned and controlled. Companies like Community Health Services want you to think that. Your local hospital may have been bought and sold between corporations many times, but the original name of the hospital stays the same to make you think it locally owned and run.
What is truly sad is that the corporate business model for these companies is to buy rural hospitals all over this country and profit off them. The idea is that the only hospital in the area will have a monopoly on the health business of the community. Huge fees are charged to uninsured patients who cannot afford them. Local jobs in the billing offices get outsourced to save money. This makes it more difficult to dispute bills.
Eventually, when a hospital is not profitable enough for the corporation, the corporation directs the hospital to quit providing expensive emergency room care, cancer treatment, or obstetric care. If the profit margin is still not adequate the hospital is closed, like the one in this article. This hits a community two fold. One is the lack of health care available to the community, and the other is the loss of jobs.
This is wrong.
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@Jane K I wish I could hit the Recommend button 10 times on this comment. You are hitting the nail on the head.
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@Jane K..... "This is what happens when the most important aspect of healthcare is profit."
And also which is not regulated by democratically elected govts for the benefit of the people that elect them to get representation. Democracy 101 is ignored in the USA.
This happens because the profit of health care is identified as a positive, that it preserves American freedom and liberty. Politicians convety this message over our media.
We're so thankful for ACA, but it subsidizes insurance profits with our tax money.
This has to be contrasted with other democracies, also capitalist, that put citizen health above profits. Here, that's off the table politically.
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Your analysis is beyond eye opening. It is news to me and yes it makes total sense. But regardless of whether capitalism is injected I to the equation there are other profound issues such as the volume required to have good to excellent obstetric care. Low monthly delivery rates spell trouble to me as an anesthesiologist. Like anything else practice makes perfect. I don't have the solution but one thing g is sure: if resources are centralized then a.pregnant woman NEEDS to spend the weeks before if there is any indication ( the above patient had twins ) adjacent to the appropriate facilities. Yea go figure that out. It's not impossible.
The greatest nation in the modern world. Look at us.
Look at the end of us. What do we need to do? We need to do it. Why aren't we doing it? Capitalism. Recognize that.
If there is no financial reason to help people, they don't get help. That cannot go on. Leaders, make some decisions, voters make some decisions. Is this the way you want the country to be -- Dystopia? We have the means for a better society. It's in our hands, but we have to use it. There is so much money and it's not being used for good.
Wake up! We all do better when we all do better! That should be the USA motto from now on.
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@Eyes Open. great points, very well said. However the
republicans control all three branches of government,
and immediately under Donald Trump they undid every aspect of obamacare. People love obamacare .... except
republicans have undone most features of obamacare.
Moreover, the republicans have inserted their ideas in all
other healthcare options. After they ripped out important features of obamacare --and you go to hospital, you will
pay huge hospital bills if you're injured or sick. All the rest
of the money goes back to the republican party CEO's.
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Of course, most everyone in these red states considers themselves "pro-life" but of course, it's pretty apparent that living children are of zero interest to the pro-life movement.
My guess is most of these pro-life folks would prefer that the govement spend the money that could keep these hospitals open on tax cuts for rich people. I'm sure they can find a Bible verse to justify their greed. Same way they can find a Bible verse to justify their misogny.
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The farce of the 'noble businessman' and capitalism spread by....capitalists. Capitalism is great but our old blend of socialism and capitalism is what made us great. The success got to our heads and the capitalists got greedier and whispered and slanted and stroked and now education, healthcare and the prison system are privatized...and here we are. Ironically, this article describes best that those who are getting hurt the worst are the ones that keep voting to keep this condition upon themselves. Wake up, rural america. the GOP is not your friend.
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@Kipa Cathez
thanks Kipa - you are right when you say 'old blend of capitalism and socialism' - I try to explain that to people, but ignorance prevails so I hear : "socialism ? - that's --- communism isn't it? " Tho economists the world over have said our social security system works quite well ... Until they raid it or everybody is a 'private contractor' and the 20 somethings are told they are supporting all these oldies who have lived too long - same old game - pit one group against the other ... I would revise one thing you said: This is NOT capitalism anymore, but OLIGARCHY.
Be well and keep the faith !
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Thank you Obama. His signature law defunded hospitals that served a high proportion of the poor and Medicaid patients. Before Obamacare, hospitals, particularly rural hospitals, received supplemental Medicaid payment to compensate for the fact that Medicaid payments do not cover the cost of care.
Since those hospitals did not have anyone ate the bargaining table when the goodies were being divvied up to big medicine, their payments got cut.
This article would like to pretend that it is only in states that did not expand Medicaid in which rural hospitals are closing, but the closure of rural hospitals in all states expanded under Obamacare. Republicans restored the funding in 2015 when they gained a majority in the Senate, along with restoring funding for SCHIP which Obamacare cancelled.
The irony is that Democrats defunded rural areas out of spite, figuring they didn't vote for Democrats, so who cared if they had to travel 80 miles to the hospital. They didn't care about even the Democrat voters.
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Truth of the matter is that Medicare/Medicaid reimbursement coupled with low population numbers has created a situation where doctors are not willing to work and hospitals are not financially viable.
Blame Obamacare if you want. But it isn’t Obama’s fault or the fault of healthcare reform. It is simple economic reality.
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@ebmem this is misleading. First of all, the ACA intended for reduced Medicaid payments to be offset by more compensated care through Medicaid expansion. So thank the Roberts court for giving red states an out on that. Second, it is not true that the ACA has "expanded" the closure of rural hospitals in all states. The data from Urban Institute and others indicate that rural hospitals have done much better in expansion states and have not closed at the rates they have in non-expansion states. Finally, "Democrat" is not an adjective, no matter how hard you try.
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@ebmem The democrats didn't defund anything in Missouri. The state house has been solidly Republican for decades. And yes, that Republican state house voted against Medicaid expansion in Missouri.
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