The people who need these rural programs the most, the ones who leave church to go into a bar, come home drunk and beat up their own kids, really don't care about getting them health care.

I'm not sure if the folks in rural Oregon are dumber than the rest of us, but they sure seem so at times.

How about focusing on a health care system designed for a particular outcome, like perfect health for everyone (or some other goal you deem to be better)?

So let's see who's smart enough to grasp that concept, urban or rural folks? Maybe both?

Well since trial lawyers, like Edwards, are part of the problem I can't really see the Dems doing anything to fix this problem. There isn't much that the Dems love more than trial lawyer money so they aren't about to do anything that would limit the tort awards.

Tort reform redux! There are ample studies [google them] showing that trial lawyers and their suits are not the problem in our healthcare system. They reamain a target of Republicans who embrace their own lawyers - the ones who work for corporations. Tort reform is code for "screw the little guy."

In Oregon, rural = poor. The median household annual income in Lake County is about $30K, or $12K lower than the Oregon average. With Medicare and Medicaid reimbursement rates low and falling lower every year, it is not surprising that very few medical professionals want to work in remote rural counties. Try running a medical practice and paying your overhead (let alone paying yourself) with a patient base that is 80 - 90% Medicare or Medicaid. It is impossible.

As far as Dems attracting political support in Lake or Union or Grant Counties, I would not hold your breath. There are a few exceptions, but for the most part, Dems are disliked and held in very low esteem in rural areas of the Northwest. My mother barely talks to me at election time. Not sure why, and until the Reagan era the Repub - Dem divide was not nearly as sharp and unfriendly as it is now. And of course Mr. Clinton did not help the Dem cause in rural God's country Oregon by letting Monica L service his needs in the oval office.

Over in the Second Congressional District, Greg Walden's seat in Congress, Grant County is fairly typical.

Carol Voisin's campaign this last election cycle had a major focus upon health care. Yet, Walden only lost about 8% of the ground compared to 2004. Truth of the matter is that Voisin was out spent severely. Walden put in well over $1,000,000, and Voisin had around $50,000 if my memory serves me right (and it often doesn't).

So, talk about health care all you want, if the word cannot get out to the voters for lack of money for mailers, newspaper ads, etc. - it just doesn't matter. The local papers over here print anything Walden writes, and very little from the other side. There is not a level playing field and even issues like health care don't get played correctly. Walden claims to the people here that he is a real rural health care advocate. The papers never mention that he votes against health care in budget bills. So, the impression is left (uncorrected for lack of funds) that Walden is the health care hero, and if anything the Democrats just don't follow through on helping rural people.

It's a mess over here in terms of communicating any issue to the voters.

TomC-

While malpractice lawsuits are only a fraction of a percent of money spent on health care, the resulting defensive medicine practiced by doctors because Oregon lacks any protection for its medical professionals is between 10-20% of health care dollars. I would encourage you and Jack R to visit an earlier thread to see a lengthy discussion of this (OMG! by Democrats no less). While medical liability reform is not a panacea for health care access and affordability in Oregon, it is a part of the solution.

OB/GYN care in rural Oregon is in crisis, but so is family practice and dematology, and I'm sure other specialties will follow shortly if we don't take action and soon. Some of the good rural health care solutions that Democrats have profered in Salem are unfortunately like a slow blood transfusion for a patient that continues to bleed out. We need fundamental health care reform for the entire state, but as Kristin aptly illustrates...we need it especially for rural Oregon.

Insurance costs are up for doctors, hmmm. With no claims, ever, my liability insurance has increased by 1000% over 5 years for construction. I certainly don't like it and it makes my life more difficult, so which one of these tort reformists is on my side?

What is wrong in the 2nd CD for Democrats is considerably more complicated than could be covered in a comment. There are elements of it in each of the seriously considered comments.

JTT,

Medical malpractice insurance IS expensive. Perhaps that is because a small percentage of practitioners are allowed to keep making expensive, life-destroying mistakes because of lax oversight, and because medical decisions are made by providers based more on economic outcomes than on health outcomes.

The system is pretty simple. Attorneys take cases on contingency, so they earn only if they win [or get a settlement]. Weak cases are dismissed early on. Overly generous rewards are routinely reduced on appeal. I don't see the "reform" unless it's making it even more difficult for injured patients to seek remedy. from what I've read, the problem is with the medical establishment and the insurance industry, not with lawyers representing injured patients.

A few thoughts here... If health care in rural Oregon is so awful, isn't that an indictment of sorts against the Oregon Health Plan, which was supposed to cover poor people all over this state? Also, nowhere in any of these discussions about health care have I heard anything about making it easier for small businesses to voluntarily provide health care to their employees. Most of the people in this state who don't work for the government work for small businesses. How about creating incentives for their employers? The way this issue has been framed is borderline ridiculous. It seems to consist of liberal telling those small business employees, "You guys are jerks because you don't want your taxes raised to provide health care for poor people." But what gets lost in that argument is that these people pay taxes to provide those services for poor people, as well as Cadillac benefits for government employees. The problem is, they make too much money to qualify for those programs for poor people, yet can't afford health care. Is there any way, or any willingness, to change OHP to where solidly middle-class people could pay a set rate every month to be included in it? Because until that happens, or until employers can afford to provide health care, the only people that will have health care will be the indigent and government employees. That needs to change.

Kristin writes: "In this huge land mass, there is -- because of the cost of malpractice insurance -- just one doctor and one midwife who can deliver babies. There are only a handful of family physicians. One tragic result of this is that in 2005, Grant County had the highest rate of infant mortality in the state. It had the highest rate of child abuse and the second highest rate of teen alcohol abuse."

With only 7,000 people in the county I think we first need to ask how many infants are born there on average in a year? Is it enough for the resident physicians to keep up there skills?

Now I don't know who to blame for the high cost of malpractice insurance, but the last time I looked something like 60% of the medical malpractice insurance companies were owned or operated by doctors.

A partial solution may be to repeal the 1945 McCarran-Ferguson Act which allowed the states to regulate insurance companies. The way it is today each state is its own market. Imagine if you will how the computer industry would look if each state set the standards for computers. I am not suggesting that we do not need regulations by any means.

MW

Rural Oregonians need access to health care.

Scott Jorgensen's comment makes a good case for a single payer system. Everyone gets the "Cadillac" benefits he mentions. Everyone pays according to their ability to pay. Wahoo! Problem solved!

Those darn Canadians are so smart.

Tom-

A single payer system may be feasible, as long as it can be framed accordingly. To the extent that it could be labeled as "socialized medicine," it is politically unfeasible. But I would like to think that a common sense, bipartisan solution is within the realm of possibility. The main problem with anything that sounds like socialized medicine is that many people are simply uncomfortable with the idea of government having a monopoly on health care (death and taxes, wow, they've really got us by the short hairs now). The argument could easily be made that the reason the health care situation has gotten out of control is because big insurance corporations and big government have been having a money-drenched orgy at the expense of the average dude, which is simply unacceptable.

M.W. writes:

"N"ow I don't know who to blame for the high cost of malpractice insurance, but the last time I looked something like 60% of the medical malpractice insurance companies were owned or operated by doctors.

Please provide a source for this blatant piece of hogwash. Aetna, Travellers, and the like are hardly owned by doctors.

Scott says the specter of "socialized medicine" would doom any single payer plan.

In a health policy class at Oregon State University, our analysis of the state of health care politics was that single payer plans were the "boogy man" of health care reform -- single payer would not happen for a very very long time, but other reforms could be much more feasible in the short term.

Second, what other public services or utilities are "socialized"?

Phone service (we all pay the same basic charge.) Electricity... sewer treatment (in cities) water...

what else?

It might make sense to consider mandatory, no-fault malpractice insurance along the lines of the worker's comp system, however. Risk-rating doctors based on claims would still tend to reward good doctors and punish bad ones but at least such a system would direct a greater percentage of the resources toward compensating the victims and less toward the system of allocating blame.

I think that makes sense. What are the arguments against it?

The argument that higher costs for malpractice insurance are responsible for the lack of rural health care is hard to understand. What is it about Grant County that makes malpractice insurance more expensive there?

Second, what other public services or utilities are "socialized"? Phone service (we all pay the same basic charge.) Electricity... sewer treatment (in cities) water... what else?

Schools, parks, police, fire, roads, transit, courts, retirement, workers compensation, unemployment to name a few.

Jack Roberts,

No-fault malpractice insurance may warrant discussion, but the system would need to work a lot better than Oregon's workers comp system, which seldom performs for injured workers unless body parts are visibly missing.

Injured Workers' Alliance

Scott Jorgensen wrote:

"To the extent that it could be labeled as "socialized medicine," it is politically unfeasible."

It's time to blow-up this canard. Democrats should begin talking about socialized fire-fighting, socialized coast guard, socialized hiways, socialized public schools, socialized policing, socialized disease control, socialized emergency response, and socialized security until the relationship between "socialized" and un-American is destroyed.

Democrats/liberals/progressives need to stop being cowards and start make frontal attacks in the war of framing. I'm tired of my allies sounding like simpering bitches with their tails tucked between their legs.

Tom, I am not picking a fight, however it appears you are at least up to the debate. Socialized public schools are a dismal failure, the same w/socialized disease control, socialize freeways are falling apart while a supposed Highway Trust Fund has been plundered for decades by both parties; they've done the same to socialized retirement.

Urban liberals don't get it or understand the polarizing effects of the democratic party PTB support of policies that have gutted farms, ranches, private property rights and logging in the rural west. The author of "What's The Matter with Kansas" missed it also. Rural westerners are more libertarian than conservative or liberal progressive. We want to be left alone rather than centrally planned for health care, education, economic policy and politics. The candidates that fail to realize this most often have a little 'd' after their last names.

Kurt,

Needless to say, I take a different view of the programs you criticize. The reality is that rural Americans benefit from government programs that urban livers pay more for, thanks to income tax.

If rural people want to live without this subsidy, they had better prepare for much poorer lifestyles. And, no, we will not let them destroy our common wealth just because they live closer to it.

Tom C wrote: "Democrats/liberals/progressives need to stop being cowards and start make frontal attacks in the war of framing."

I agree, I think you should be much more honest about your communistic tendencies. I would suggest quoting liberally (ha ha, get it, "liberally"?) from Mao's Little Red Book. He had all sorts of things to say about the role of government.

There are many ways we can improve health care in Oregon without devolving into a full-blown socialist nanny state. But ideological adherence to Canadian-style Sicko statism will only impede progress. It "frames" the health care debate as a choice between two poisonous ideological extremes. All opportunities for compromise and genuine progress are lost in the scuffle. What is the point of that?

I don't have a problem with government involvement in health care, but I certainly don't want to see a government monopoly like they have in Canada. I personally would like to start by restructuring the tax system to better encourage (and reward) individuals who take care of their own health care needs. I also find Scott J's suggestion about opening up the OHP to be interesting (I was thinking that myself). Anyone have further comment on this?

Neither of those will help the rural health care needs outlined in the original post, though. Perhaps one part of the solution could be to train more health care professionals. How about some tax and student funding incentives to encourage that? And maybe more tax incentives if these professionals live in underserved areas?

All I know is that snarky elitist comments like the first one in this thread will not help Oregon's health care situation one bit.

Jack Roberts wrote:

"...when money is scarce, their interests always get shortchanged because the votes are in the cities and suburbs, not rural communities."

That may the perception, Jack, but the reality is that rural people benefit from taxes paid by urbanites. The proportion of revenue paid by urbanites is far greater than their proportion of population, and therefore their votes. At the federal level, rural livers also get more representation, as rural, low population states like Wyoming get two senators, just like urbanized, high population states like New York.

Jack,

It's tiring to discuss economics with right wingers who think from their fantasies instead of reality. Western governments in the past several hundred years have always used both free market and socialist strategies to make things work. That's reality. The balance between them changes in time and place. That is what the discussion is about. Suggesting that someone who supports single payer health care should quote from Mao [I've never read him] is typical right wing bullshit. That works on Fox News, but not places where reality intrudes.

Canada, Germany, France, and ALL the other developed nations with universal health care are not communist states. They ARE places where the right wing bullshit you spout is not common currency of the corporate media, however. The American people are finally figuring this out, and support for universal coverage continues to grow.

Also, there is nothing elitist about noticing that Frank Luntz and his conservative brethren have effectively sabotaged political discourse with "death tax", "socialized medicine", "tax relief", "family values", "healthy forests", "clear skies" and other linguistic shell games. There is nothing elitist in suggesting that Democrats stop running from these phrases and demolish them instead.

mrfeerless writes: "Please provide a source for this blatant piece of hogwash. Aetna, Travellers, and the like are hardly owned by doctors."

Last time we discussed this I posted a url to a GOA study from 2003. That is not an exact quote but that info is in the forward, third paragraph.

I let you look it up and it might help not to be so rude.

MW