By Miryam Ehrlich Williamson

[Photo credit:  Jeheme / flickr]

President Obama yesterday issued an executive order establishing a White House Office of Health Reform, meant to coordinate efforts with a similar office in Health and Human Services. It begins

By the authority vested in me as President by the Constitution and the laws of the United States of America, and in the interest of providing all Americans access to affordable and high-quality health care, it is hereby ordered as follows:

Section 1. Policy. Reforming the health care system is a key goal of my Administration. The health care system suffers from serious and pervasive problems; access to health care is constrained by high and rising costs; and the quality of care is not consistent and must be improved, in order to improve the health of our citizens and our economic security.

Sec. 2. Establishment. (a) There is established a White House Office of Health Reform (Health Reform Office) within the Executive Office of the President that will provide leadership to the executive branch in establishing policies, priorities, and objectives for the Federal Government’s comprehensive effort to improve access to health care, the quality of such care, and the sustainability of the health care system.

One of the many tasks assigned to the Office of Health Reform is to

(e) bring to the President’s attention concerns, ideas, and policy options for strengthening, increasing the efficiency, and improving the quality of the health care system;

With this order, Obama is declaring his intention to be a hands-on participant in the process of curing our desperately ill system of delivering health care.

Nowhere is the need for health care reform more strongly felt than in rural America. With spectacularly good timing, the Center for Rural Affairs, based in Lyons, Nebraska (population 963) has reissued its 2004 report “Health Care in Rural America.” The report may be more than four years old, but it reads like today’s news – another shameful reflection on the regime that fell from power in the 2008 election.

This report is sure to be a potent voice calling the President’s attention to the health care needs of rural residents.

The report is in two parts. The first part looks at the status of health care in rural America; the second discuses possible solutions. A companion piece brings the 2004 situation more nearly up to date. What follows is a brief look at those facts.

• The 50 million people who live in America’s rural areas are at a distinct disadvantage in terms of access to health care providers. They are far more likely to be uninsured, largely because so many are self-employed or working for businesses too small to be able to offer health insurance as a benefit.

• Rural people have more chronic diseases and higher rates of disability. They are older and have lower incomes than the rest of the nation. The median age in rural America is 40; in the rest of the country it’s 36. The median household income in rural areas is 77 percent of that in urban areas. These facts alone make rural people more in need of publicly supported health insurance and health care.

• Nearly half the children in rural areas live in low-income families, a higher rate than non-rural children. Of the top 50 counties in terms of uninsured children, 44 are rural counties. A 2007 study found that rural children aged 10 to 17 have a 15 percent higher rate of obesity than their non-rural counterparts, and that nearly one-third of rural children are overweight or obese. This is a reflection both of fewer opportunities for vigorous physical activity for rural children, and the association of low income with decreased availability of healthful foodstuffs. Obesity is also more prevalent among rural adults.

• A third of rural Americans live in areas that are “medically underserved;” there simply aren’t enough doctors, nurses, and other medical professionals to provide adequate care to those who need it. Worse, only a tiny percentage of today’s medical students plan to practice in rural areas. Mental health and emergency services are even more scarce in rural counties.

Against these dismal facts, the Center for Rural Affairs proposes five principles on which to base health care reform. They say it should be

• Universal – because of the long-term health and societal consequences of being uninsured and underinsured, health care coverage should be available to everyone.

• Continuous – gaps or interruptions in coverage lead to inadequate care and worse health outcomes. This is particularly important for rural people since rural residents lack health insurance for longer periods; any solution must have a long-term focus to assist rural people.

• Affordable to individuals and families – the primary reason given by businesses, employers, and people for lacking health insurance benefits is cost; the affordability challenge is even greater for low- and moderate-income individuals and families.

• Affordable and sustainable for society – any reform proposal must be cost effective and efficient, both to the society as a whole and to individuals and families.

• Enhance health and well-being – coverage should include those services that provide for long-term health.

Tomorrow’s post will list the Center’s top ten points to consider in the ongoing health care debate.

Posted on April 9th, 2009 by Miryam Ehrlich Williamson
Filed under: Uncategorized