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Rural America Needs Medicare for All, and Fast

I'm a registered nurse from rural Iowa. In communities like mine, privatized care is an extractive industry—and it’s drying up

Rural American hospitals are closing at an alarming rate. (Photo: Shutterstock)

Rural American hospitals are closing at an alarming rate. (Photo: Shutterstock)

We’ve got a rural health care emergency on the horizon.

Rural hospitals are closing or teetering on the brink of closure at an alarming rate. More than a hundred have closed since 2005 and hundreds more are on life support. Long-term care facilities are vanishing across rural America or being bought up by large corporations who care about profit, not the care of our loved ones.

Most rural hospitals have even stopped delivering babies — you’ll need to go to the city for that, so plan ahead.

I know firsthand. I’m a registered nurse and lifelong Iowan from the country. I’ve kept a close eye on where we’ve been with health care, and where it appears we’re headed. It’s not looking too good for my community and others if we stay on our current failed path.

Medicaid expansion was supposed to help here in Iowa. It sure didn’t — because we handed the program over to private, for-profit “managed care organizations.” What we got in return was less care — and more services denied, facilities shuttered, and lives lost to corporate greed.

Hospitals that were already struggling now have to submit and re-submit claims to these private companies and wait months, if not years, to get paid. Even without privatized Medicaid, we’d still be facing an impending rural healthcare emergency. Privatization merely hastened what was already happening.

Americans spend about twice as much on health care than any other developed country, but we live shorter lives — even as we create “health care billionaires” that get profiles in magazines like Forbes.

Americans spend about twice as much on health care than any other developed country, but we live shorter lives — even as we create “health care billionaires” that get profiles in magazines like Forbes.

The for-profit healthcare system is an extractive industry, helping to suck the wealth and life out of communities, especially in rural areas. We’re being left behind because the for-profit insurance industry doesn’t see us as worth their time.

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Rural hospitals, local nursing homes, and care facilities are the lifeblood of our small towns across the heartland. We’re watching our farms and small towns wither away as the countryside empties out and our health declines.

But it doesn’t have to be this way. A system that puts the wellbeing of our community ahead of the bottom line of a select few can and will deliver the care we need, where and when we need it, and keep our rural communities alive and vibrant.

Which brings us to the Medicare for All Act of 2019 introduced by Rep. Pramila Jayapal of Washington state. Instead of allowing private corporations to decide who pays for health care and how much, we would put our financing back into public hands — and our health care decisions back into the hands of patients and their care provider.

Under Medicare for All, virtually all aspects of our health care will be covered. This includes, but isn’t limited to, medical, dental, vision, hearing, prescription drugs, mental health, addiction treatment, and much more.

Medicare for All also covers long-term and in-home care as well. What a gift to our families, especially those that often go unseen by an industry dominated by profit: the elderly and people with disabilities. Long-term and in-home care allows people to stay near their families or in their homes, rooted in the communities we call home.

Perhaps most importantly for Iowa and other rural communities, Jayapal’s bill includes a special projects budget for capital expenditures and staffing needs of providers in rural or medically underserved areas.

Will this cost money? Of course it will. But we’ll actually spend less overall than we’re currently spending in our broken health care system, and we’ll get better and more comprehensive coverage.

For all these reasons, Medicare for All is the prescription America and our rural communities need.

Barb Kalbach

Barb Kalbach is a fourth-generation family farmer and registered nurse, who is board president of Iowa Citizens for Community Improvement, part of the People's Action national network of grassroots groups.

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