Rural America is not served well by the medical profession because there is a lack of family practice doctors, a problem that could be addressed somewhat in the health reform bills now before Congress. That’s the good news. The bad news is that the reform package, if passed, would extend insurance coverage to millions more in areas where there are a lack of doctors to attend their illnesses.
I have experienced the dilemma up front and personal having lived in rural Oregon for 13 years. What reminded me of that ordeal was a splendid article in today’s Washington Post about Dr. Ben Edwards, a family practitioner in Post, a tiny town in West Texas. I strongly recommend reading the article for it precisely outlines the Catch-22 dilemma in Washington because it won’t solve the doctor shortage nor improve care.
Several years before I moved to Oregon I was diagnosed with diabetes. The condition worsened as the years rolled by. I could afford the oral medication prescribed by a San Diego physician at the time but I could not afford insurance premiums or copay visits to a doctor. My teeth fell out. My vision deterioated. I developed numbness in all my extremities as nueropathy set in. Bad circulation in my legs made it painful to walk. These were symptoms I figured out on my own. What I didn’t realize that at the same time I developed kidney problems and congestive heart disease. More on that later.
In 1994, my third year living in Gold Beach, the Oregon state legislature enacted a universal health care plan (OHP) with coverage extended to some 700 types of illnesses. Premiums were based on a person’s income. My reported income was 0 for which the monthly premium was $7. I confess I was part of the shadow, underground earners who lived off of cash tips for cleaning fish and pumping propane gas for visiting fishermen and tourists at the RV park where I worked rent-free.
OHP saved my life.
The first thing I did was see a dentist. He was the only dentist participating in the state health plan beween Brookings and Coos Bay about 90 miles apart and serving about 7,000 residents. The waiting list was nine weeks for the first visit. He worked on four patients at the same time, each in separate rooms. His wife, who was his secretary, told me her husband attended to 90 patients a day, seven days a week. He did not have a dental hygenist. He pulled my six remaining teeth. By the end of the fourth visit I received complete upper and lower dentures I still wear today, some 15 years later.
There were two family practice doctors in Gold Beach, three if you count an old man who no longer took on new patients and specialized in herbal treatments for whatever causes. One of the doctors suffered from a personality disorder and insulted all of his patients for failing to follow his instructions.
I was fortunate to become a patient of Dr. Michael O’Gara who himself was a diabetic. He put me on a special diet, told me to get a diabetes monitor to test my blood sugars and changed my medication from oral to direct insulin injections. All that was new to me.
But, Dr. O’Gara was equipped to do little more to treat diabetes. The closest specialists were 100 miles inland in Medford. I had no car at that time.
Gold Beach had a public hospital supported by a district tax. It had no trauma unit and eight beds. As a result, most people in the Gold Beach area subscribed to a life flight service for $72 a year that would airlift patients to Medford. The number of flights per subscriber was limited to three per year, as I recall.
I moved to Nehalem, about 250 miles up the Oregon coast, in 2001. There, the nearest doctor was in Tillamook, about 30 miles to the south. Same situation. Specialists dealing with diabetes were non-existent. By then, I owned a 1982 Ford Ranger and had to drive 90 miles to Portland to see specialists dealing with my circulatory problems.
It wasn’t until I returned to San Diego in 2003 that the heart and kidney conditions were diagnosed. And, that discovery came accidentally. A hospital-run senior health clinic prescribed diuretics to battle a water-retention condition. Eventually, I became dehydrated, lowering my natural potassium level to nil. I was taken to the hospital where a battery of tests and an MRI finally determined my heart, kidney and lung malfunctions.
The point of my story and the one about Dr. Edwards of Texas illustrates how difficult it is for patients receiving adequate health care in rural areas of America. It is not a question of public options or stringent rules on health insurers denying coverage for pre-exiting conditions.
It is a system that makes it economically awkward to entice family doctors to practice medicine in rural America. The rural hospitals can treat broken limbs but rarely can afford the expensive diagnoses equipment to treat respiratory, heart, kidney and other diseases.
There was much amusement of the sardonic sign the Democratic congressman from Florida displayed when fighting the Republicans on the health care legislation. “Die Quickly,” it said, referring to the Republican plan.
By the same logic, the sign for rural America might be “Die Slowly Or Move To The City.”