We’re getting left out of health-care reform

Essay by Ellen Miller

Rural health – June 1994 – Colorado Central Magazine

The old Scout handbook included all kinds of instructions about surviving in rattlesnake country. It had instructions about carrying something for a tourniquet, a razor blade or sharp pocket knife for cutting, and a suction cup for getting the poison out. The thrust of it was that, as in the days of the frontier, once you get out to the big empty you’re on your own.

Well, it’s 1994. We now have telephones and USWest is promising to eliminate party lines any decade now. We’ve got cable television and satellite dishes and we’re being indoctrinated daily about the coming information superhighway. Rural America, they say, will have the same opportunities as the cities, but without the hassle.

But all is not rosy. It never can be with the feds involved.

Congress hasn’t even gotten serious about the big national health care reform stuff, but our not-to-be-trusted senators and representatives are already tinkering with Medicare cuts that will fall disproportionately on rural hospitals.

Medicare has become the monster that ate Chicago and several other large cities because doctors and hospitals keep raising their rates. Apparently there are doctors out there, particularly in cities, who believe they have a constitutional right to a half-million dollars every year. They justify this by telling patients, “Don’t worry. Your insurance will cover it.”

But in small western towns, most people are either self-employed or working for a very small outfit. There are no mass customer breaks on health insurance, despite efforts of many chambers of commerce to form insurance pools.

Nobody who lives out here is under any illusions about the pay scales and transportation costs that make most people hard-pressed to pay for any health insurance. And now the latest Medicare reduction could cost rural hospitals much more than their urban counterparts, according to state hospital associations.

Bill and Hillary Clinton talk of health care alliances. That’s easy in Denver or Albuquerque, where there are hundreds of thousands of people living relatively close to each other, but how do you link regions of the vast rural, small-town West into coherent alliances? Then there’s the fear, espoused by many, that people would lose their choice of doctors.

Give me a break. Most people living in small towns thank their lucky stars if they have a doctor, any doctor, in residence. That gives them a choice — they can go to the hometown doc, or drive to Durango, Alamosa, or Colorado Springs to pick from a few more.

There’s talk about the new national health care covering public transportation costs for doctor and hospital visits. Again, that’s a nice thought for the cities, but it’s no help at all for those of us whose only familiarity with public transportation is the occasional tour bus running through town.

BUT IF OUR SENATORS and representatives don’t start making that point in Congress, and soon, we’ll again end up paying more for less. Guys like Scott McInnis of Colorado, Bill Richardson of New Mexico, Craig Thomas of Wyoming, and Pat Williams of Montana need to start raising some serious hell about this.

They can get allies in Congress from the other big empties, like the Dakotas and Alaska and the Deep South. If everybody could afford the same health package as our congressman enjoy, at taxpayer expense, of course, there would be no health care debate.

Maybe it’s time to remind them. There’s a business research type in Grand Junction who figures that people in the rural West take a third of their salary in Scenery. Maybe we’d better dust off those rattlesnake kits, particularly when the feds come to town.

Based in Grand Junction, Ellen Miller once had a day job covering the Western Slope for Associated Press. Now she free-lances.