Those were the good old days: Doctors would make house calls, even in the most remote parts of rural Rappahannock County. And if the patient couldn’t afford to pay in cash or with a check, the doctor would accept barter as payment — eggs, a Thanksgiving turkey, whatever the farmer could afford.
I know because I grew up in then small-town Warrenton a half century ago and my father was one of those doctors. Come Thanksgiving, Christmas and Easter, we always had more turkeys and hams than we knew what to do with. And he never had to waste a lot of paperwork time on insurance claims.
As my father was dying, about 10 years ago, he laughed and remarked that, were he coming of age now, he would never go into medicine. It’s become such a mess.
So-called Obamacare was meant to help ameliorate this mess, but it appears that the implementation of the new health-care law has become a mess itself. It’s much easier to criticize, of course, than come up with solutions; and the sad fact remains that the United States, of all the most developed countries, spends more on healthcare per capita but gets worse patient outcomes.
And within the United States, patients in rural counties fare the very worst of all. The explanation is partly demographic: Rural residents tend to be older and less educated than their urban counterparts.
But limited access to care explains even more: While about 25 percent of the U.S. population lives in rural areas, they’re served by only 10 percent of the country’s physicians. They are also less likely to have private health insurance, prescription drug coverage or be covered by Medicaid, according to the nonprofit National Rural Health Association.
Unhealthy habits start early. Rural children aged 2 to 5 are nearly twice as likely as urban kids to consume more than 24 ounces of sweetened beverages a day. From ages 6 to 11, rural kids consume on average 80 grams of fat a day, compared to 73 grams for their urban counterparts. So it’s no surprise that rural children are much more likely to be obese or overweight.
What’s to be done? Who knows? But even if we did know, given the unhealthy, messy governmental dysfunction in Big Washington, it’s doubtful we’d have the political will to do anything.