The market has not worked to attract people to rural America to care for our rural citizens (a topic for another day). After doing some research for a talk, it turns out that health care professionals are actually responding appropriately to the market:

Rural residents seeking health care are (as a rule)

  • older than urban residents
  • in poorer health than urban residents
  • more likely to be disabled
  • more likely to be uninsured
  • more likely to face financial barriers in obtaining healthcare
  • more likely to incur travel burdens while seeking care
  • much less likely to receive services than are their urban counterparts if they suffer from serious mental illness. There are specific barriers to mental health access. These include
    • Service fragmentation
    • Lack of transportation
    • Lack of cultural and linguistic competency
    • Poor rates of Medicaid enrollment among people with mental illness
    • Stigma associated with mental illness
    • More poor immigrants

 The south offers more complex set of problems that make the market even less likely to be effective

  • Population is in decline and poverty is increasing in rural areas
  • Rural poverty tends to be persistent, historically complex, self-perpetuating, and psychologically and culturally oppressive
  • One third of the poor in the United States live in rural areas, and the rate of poverty in rural counties is increasing at a faster rate than it is in urban areas
  • Residents of rural counties in the south are more likely to be unemployed, less likely to be Medicaid eligible

All in all, President Obama’s vision, as articulated in his speech on Wednesday, said very well why we need to work to care for our fellow citizens despite there being no profit:

But there’s always been another thread running through our history – a belief that we’re all connected, and that there are some things we can only do together, as a nation.  We believe, in the words of our first Republican President, Abraham Lincoln, that through government, we should do together what we cannot do as well for ourselves. 

And specifically about healthcare:

We recognize that no matter how responsibly we live our lives, hard times or bad luck, a crippling illness or a layoff, may strike any one of us. “There but for the grace of God go I,” we say to ourselves, and so we contribute to programs like Medicare and Social Security, which guarantee us health care and a measure of basic income after a lifetime of hard work; unemployment insurance, which protects us against unexpected job loss; and Medicaid, which provides care for millions of seniors in nursing homes, poor children, and those with disabilities.