Tennesseer
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Post by Tennesseer on Jun 23, 2019 16:29:49 GMT -5
‘Urgent needs from head to toe’: This clinic had two days to fix a lifetime of needsCLEVELAND, TENN. — They were told to arrive early if they wanted to see a doctor, so Lisa and Stevie Crider left their apartment in rural Tennessee almost 24 hours before the temporary medical clinic was scheduled to open. They packed a plastic bag with what had become their daily essentials after 21 years of marriage: An ice pack for his recurring chest pain. Tylenol for her swollen feet. Peroxide for the abscess in his mouth. Gatorade for her low blood sugar and chronic dehydration. They took a bus into the center of Cleveland, Tenn., a manufacturing town of 42,000, and slept for a few hours at a budget motel. Then they awoke in the middle of the night and walked toward the first-come, first-served clinic, bringing along a referral from a social worker for what they hoped would be their first doctor’s checkup in more than four years. “Urgent needs from head to toe,” the social worker had written. “Lacking primary care and basic medication. They have fallen into the gap.” Only when Stevie and Lisa arrived at the clinic a little after 2 a.m. did it occur to them how large that medical gap has become in parts of rural America. Dozens of people were sprawled out in sleeping bags on the asphalt parking lot. Others had pitched tents on an adjacent lawn. The lot was already filled with more than 300 cars from all over the rural South, where a growing number of people in medical distress wait for hours at emergency clinics in order to receive basic primary care. Tennessee has lost 14 percent of its rural physicians and 18 percent of its rural hospitals in the past decade, leaving an estimated 2.5 million residents with insufficient access to medical care. The federal government now estimates that a record 50 million rural Americans live in what it calls "health care shortage areas," where the number of hospitals, family doctors, surgeons and paramedics has declined to 20-year lows. Complete article here: ‘Urgent needs from head to toe’: This clinic had two days to fix a lifetime of needs
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OldCoyote
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Post by OldCoyote on Jun 23, 2019 17:53:12 GMT -5
Who's fault is this?
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busymom
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Post by busymom on Jun 23, 2019 20:28:55 GMT -5
The USA is the only industrialized, "wealthy" country, without a universal heath care system. We are long overdue for a system where no one falls between the cracks. We can do so much better.
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tbop77
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Post by tbop77 on Jun 24, 2019 5:20:17 GMT -5
Maybe it's time to stop laying the blame and solving the problem.
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resolution
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Post by resolution on Jun 24, 2019 6:37:28 GMT -5
I agree that the whole system needs to be overhauled, but in the meantime there are 14 states that could quickly expand Medicaid to childless adults. For the couple being profiled, their specific problem accessing medical care could be resolved right away if Tennessee were to adopt the Medicaid expansion.
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happyhoix
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Post by happyhoix on Jun 24, 2019 8:28:57 GMT -5
No one's fault. It's the way our system currently works.
Maybe it's time to re-evaluate how our system works.
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OldCoyote
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Post by OldCoyote on Jun 24, 2019 8:30:57 GMT -5
How are you going to get the Dr's to stay in the backwoods?
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buystoys
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Post by buystoys on Jun 25, 2019 7:30:02 GMT -5
There's been a shortage of doctors in small towns for decades. It's just getting worse and will continue to do so unless we change the rules governing medical education and offer some incentives for doctors to move to rural USA. I'll try to find the article again, but there's a limit on how many medical students/residents can be in each program. A lot of those slots are going to foreign students who then take their education back to their own country. The schools prefer this method as it allows them to charge higher tuitions.
I grew up in a rural town and worked at the small hospital in our town. People came from 50 miles away for care. For a small town, it's a very lucrative practice. I'm not certain how they'll replace the current doctor. It took them a while to find one willing to move to the boonies.
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happyhoix
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Post by happyhoix on Jun 25, 2019 7:40:55 GMT -5
I live in a rural area and my doctor was there because she was originally from South America and got some kind of grant to attend medical school in the US if she agreed, once she graduated, to work in an underserved rural area. She also got some kind of financial aid for college.
I don't blame doctors for wanting a practice in a high volume urban/suburban area where he can see a lot of patients, and most of the patients are not on medicare/Medicaid or uninsured. They want to make money like everyone else.
What we need is a not=for=profit medical system, where a doctor earns a set salary whether he works in a high volume city clinic or a small rural clinic. Not a chance of that actually happening, I think.
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thyme4change
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Post by thyme4change on Jun 25, 2019 8:33:45 GMT -5
Well rural people - you should keep voting Republican and complaining about "Obamacare" because that seems to be working out nicely for you.
You should also keep getting really pissed off when they say we should tax the 600 people that have more than a billion dollars. Because those people don't give a shit about you. So, that is logic at its finest.
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OldCoyote
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Post by OldCoyote on Jun 25, 2019 8:37:48 GMT -5
Well rural people - you should keep voting Republican and complaining about "Obamacare" because that seems to be working out nicely for you. You should also keep getting really pissed off when they say we should tax the 600 people that have more than a billion dollars. Because those people don't give a shit about you. So, that is logic at its finest. So, how is Obamacare, putting or keeping DR's in the rural areas?
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bean29
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Post by bean29 on Jun 25, 2019 8:54:22 GMT -5
Well rural people - you should keep voting Republican and complaining about "Obamacare" because that seems to be working out nicely for you. You should also keep getting really pissed off when they say we should tax the 600 people that have more than a billion dollars. Because those people don't give a shit about you. So, that is logic at its finest. So, how is Obamacare, putting or keeping DR's in the rural areas? If more people have insurance, then the doctors get paid to see the patients. If you have 2.5 million people in a state with no access to health insurance, well then you have less population to make $$ from. Same thing with mental health care. The ACA, or Obamacare as you labeled it, eliminated the lifetime caps that many plans had in them. Very few Dr's have gone into psychology in the past, because there was not a lot of $$ to be made.
We definitely have a system that is broken and needs fixing.
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djAdvocate
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Post by djAdvocate on Jun 25, 2019 10:01:34 GMT -5
So, how is Obamacare, putting or keeping DR's in the rural areas? If more people have insurance, then the doctors get paid to see the patients. If you have 2.5 million people in a state with no access to health insurance, well then you have less population to make $$ from. Same thing with mental health care. The ACA, or Obamacare as you labeled it, eliminated the lifetime caps that many plans had in them. Very few Dr's have gone into psychology in the past, because there was not a lot of $$ to be made.
We definitely have a system that is broken and needs fixing.
in Costa Rica, the government pays for the education of doctors who don't have the means to pay for school. in exchange, the doctors must donate a percent of their time to government hospitals. thereby, the government gets free medical care for it's citizens, for which it charges a rather minimal administrative fee.
the same thing could be done here. it would not be difficult. and I know MANY medical students that would jump at it.
the problem with thinking you are the best is that when there are better ideas out there, you ignore them. it will be our undoing, if it is not already.
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weltschmerz
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Post by weltschmerz on Jun 25, 2019 12:16:33 GMT -5
How are you going to get the Dr's to stay in the backwoods? Same way we do. Give them financial incentives to work in rural areas for a few years.
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Deleted
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Post by Deleted on Jun 25, 2019 12:32:00 GMT -5
How are you going to get the Dr's to stay in the backwoods? This hits the nail right on the head, it's very hard. Like everyone else who works for a paycheck, except for a very few, doctors are in it for the money. When the people are spread out thinly over large areas, expect to travel. Has nothing to do with affordable health care.You travel for just about everything. City distance perspective, cannot be applied to rural areas The story will sell papers in Cleveland.
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Deleted
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Post by Deleted on Jun 25, 2019 12:42:57 GMT -5
If more people have insurance, then the doctors get paid to see the patients. If you have 2.5 million people in a state with no access to health insurance, well then you have less population to make $$ from. Same thing with mental health care. The ACA, or Obamacare as you labeled it, eliminated the lifetime caps that many plans had in them. Very few Dr's have gone into psychology in the past, because there was not a lot of $$ to be made.
We definitely have a system that is broken and needs fixing.
in Costa Rica, the government pays for the education of doctors who don't have the means to pay for school. in exchange, the doctors must donate a percent of their time to government hospitals. thereby, the government gets free medical care for it's citizens, for which it charges a rather minimal administrative fee.
the same thing could be done here. it would not be difficult. and I know MANY medical students that would jump at it.
the problem with thinking you are the best is that when there are better ideas out there, you ignore them. it will be our undoing, if it is not already.
Great idea for Costa Rica. Think it will work for low density population areas of the United States, which can be much larger than the whole country of Costa Rico ?
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grumpyhermit
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Post by grumpyhermit on Jun 25, 2019 13:25:43 GMT -5
As long as we, as a country, are fine with for-profit health care, this isn't going to change.
Can't really find it in myself to care, as rural voters often support politicians who vote to keep that system firmly in place. Live with the consequences of your decisions. What's the advice we give to people when there aren't jobs in their area? Move.
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djAdvocate
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Post by djAdvocate on Jun 25, 2019 14:17:51 GMT -5
in Costa Rica, the government pays for the education of doctors who don't have the means to pay for school. in exchange, the doctors must donate a percent of their time to government hospitals. thereby, the government gets free medical care for it's citizens, for which it charges a rather minimal administrative fee.
the same thing could be done here. it would not be difficult. and I know MANY medical students that would jump at it.
the problem with thinking you are the best is that when there are better ideas out there, you ignore them. it will be our undoing, if it is not already.
Great idea for Costa Rica. Think it will work for low density population areas of the United States, which can be much larger than the whole country of Costa Rico ? yes, i already said that i think it would work.
and....i find it deeply troubling when we spend more time making excuses for our shortcomings than fixing them.
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Deleted
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Post by Deleted on Jun 26, 2019 12:05:35 GMT -5
Great idea for Costa Rica. Think it will work for low density population areas of the United States, which can be much larger than the whole country of Costa Rico ? yes, i already said that i think it would work.
and....i find it deeply troubling when we spend more time making excuses for our shortcomings than fixing them.
I wouldn't call it a shortcoming, more like an existing problem being blamed on something that doesn't relate. The affordable health care issue vs number of doctors in thinly populated areas.
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Deleted
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Post by Deleted on Jun 26, 2019 12:23:23 GMT -5
As long as we, as a country, are fine with for-profit health care, this isn't going to change.
Can't really find it in myself to care, as rural voters often support politicians who vote to keep that system firmly in place. Live with the consequences of your decisions. What's the advice we give to people when there aren't jobs in their area? Move.
Exactly ! If you want a doctor close to you so you don't have to travel, you need to live in an area with a population density high enough to support it. As an aside, I volunteer at a roller rink because it's what I like to do while being retired. It's an 80 mile trip, one way, same for most of the rinks customers. Nearest Toyota dealer ? 65 miles. My DW's eye specialist ? 120 miles, and he's only at the office 2 days a week because of the lack of patients. He splits between another office 250 miles west into Oklahoma. The traveling has nothing to do with the affordability of the service. Neither can the government afford to put doctors where the patients don't exist. So voting for something doesn't help. They're already up to their ass in alligators, paying for the existing deficits/debt.
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thyme4change
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Post by thyme4change on Jun 27, 2019 9:18:27 GMT -5
Paying for a doctor to do rounds between 5 or 10 offices in underserved areas may actually be break even. Which is good for government work. They don't need to promise 10% returns to their stockholders.
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happyhoix
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Post by happyhoix on Jun 27, 2019 9:45:17 GMT -5
in Costa Rica, the government pays for the education of doctors who don't have the means to pay for school. in exchange, the doctors must donate a percent of their time to government hospitals. thereby, the government gets free medical care for it's citizens, for which it charges a rather minimal administrative fee.
the same thing could be done here. it would not be difficult. and I know MANY medical students that would jump at it.
the problem with thinking you are the best is that when there are better ideas out there, you ignore them. it will be our undoing, if it is not already.
Great idea for Costa Rica. Think it will work for low density population areas of the United States, which can be much larger than the whole country of Costa Rico ? Our little rural county had a physician who had assistance from the government to get her MD in exchange for working in an underserved area. She worked a few days in our little county, and a few days in the adjacent rural county.
I really liked her, but she worked for a hospital that was having financial difficulties, and they stopped paying her salary for six months, and she had to leave to work someplace where she would get paid.
Now we have a nurse practitioner a few days a week.
So yes, I think there are people out there who would love to be a doctor and work in an underserved area in exchange for tuition assistance.
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Deleted
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Post by Deleted on Jun 27, 2019 12:00:51 GMT -5
Paying for a doctor to do rounds between 5 or 10 offices in underserved areas may actually be break even. Which is good for government work. They don't need to promise 10% returns to their stockholders. Still wouldn't cover the rural areas that are present in this country. Traveling long distance is part of the way of life in rural areas. Still has nothing to do with the affordability of the care. It's the affordability of the traveling. You want less traveling, move to an urban area. May come as a surprise, but doctors aren't publicly sold as a service. No stockholders.
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Deleted
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Post by Deleted on Jun 27, 2019 12:01:54 GMT -5
Great idea for Costa Rica. Think it will work for low density population areas of the United States, which can be much larger than the whole country of Costa Rico ? Our little rural county had a physician who had assistance from the government to get her MD in exchange for working in an underserved area. She worked a few days in our little county, and a few days in the adjacent rural county.
I really liked her, but she worked for a hospital that was having financial difficulties, and they stopped paying her salary for six months, and she had to leave to work someplace where she would get paid.
Now we have a nurse practitioner a few days a week.
So yes, I think there are people out there who would love to be a doctor and work in an underserved area in exchange for tuition assistance.
Until the tuition is paid, then it's off to where the money is to be made. Even the offspring of the doctors in our rural area move away after their schooling is complete. Not enough patients for even a father/son, mother/daughter, or any combination of, doctors office.
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thyme4change
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Post by thyme4change on Jun 27, 2019 12:57:42 GMT -5
Paying for a doctor to do rounds between 5 or 10 offices in underserved areas may actually be break even. Which is good for government work. They don't need to promise 10% returns to their stockholders. Still wouldn't cover the rural areas that are present in this country. Traveling long distance is part of the way of life in rural areas. Still has nothing to do with the affordability of the care. It's the affordability of the traveling. You want less traveling, move to an urban area. May come as a surprise, but doctors aren't publicly sold as a service. No stockholders. 60% of doctors work either in a group practice or are employees of other organizations. I don't know if they are publically traded, but there are investment groups that are funding large groups, in exchange for full or partial ownership and share in the profit. They absolutely care if each portion of a doctor's activities are profitable.
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Deleted
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Post by Deleted on Jun 27, 2019 13:07:12 GMT -5
Still wouldn't cover the rural areas that are present in this country. Traveling long distance is part of the way of life in rural areas. Still has nothing to do with the affordability of the care. It's the affordability of the traveling. You want less traveling, move to an urban area. May come as a surprise, but doctors aren't publicly sold as a service. No stockholders. 60% of doctors work either in a group practice or are employees of other organizations. I don't know if they are publically traded, but there are investment groups that are funding large groups, in exchange for full or partial ownership and share in the profit. They absolutely care if each portion of a doctor's activities are profitable. You are talking about groups that organizes where a doctor works ? As an employee ? This only adds to the cost of healthcare. Does nothing for the cost of travel in thinly populated areas.
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NastyWoman
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Post by NastyWoman on Jun 27, 2019 15:57:16 GMT -5
Paying for a doctor to do rounds between 5 or 10 offices in underserved areas may actually be break even. Which is good for government work. They don't need to promise 10% returns to their stockholders. Still wouldn't cover the rural areas that are present in this country. Traveling long distance is part of the way of life in rural areas. Still has nothing to do with the affordability of the care.
It's the affordability of the traveling. You want less traveling, move to an urban area. May come as a surprise, but doctors aren't publicly sold as a service. No stockholders. Unless you can get care without travelling you can not decouple these two. If you can't get to the place where care is povided because you can't afford to get there, care is unaffordable
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Deleted
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Post by Deleted on Jun 30, 2019 10:51:10 GMT -5
Still wouldn't cover the rural areas that are present in this country. Traveling long distance is part of the way of life in rural areas. Still has nothing to do with the affordability of the care.
It's the affordability of the traveling. You want less traveling, move to an urban area. May come as a surprise, but doctors aren't publicly sold as a service. No stockholders. Unless you can get care without travelling you can not decouple these two. If you can't get to the place where care is povided because you can't afford to get there, care is unaffordable They are not connected. Affordable care is just that, affordable care. Affordable travel is just that, affordable travel. Because you have a longer distance to travel, doesn't change the price of the care. Nor does cheaper care, change the price of travel.
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djAdvocate
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Post by djAdvocate on Jul 1, 2019 0:40:20 GMT -5
yes, i already said that i think it would work.
and....i find it deeply troubling when we spend more time making excuses for our shortcomings than fixing them.
I wouldn't call it a shortcoming, more like an existing problem being blamed on something that doesn't relate. The affordable health care issue vs number of doctors in thinly populated areas. imo, if you fix one of those problems the other will get fixed, too.
sorry if that wasn't clear from my earlier reply.
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djAdvocate
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Post by djAdvocate on Jul 1, 2019 0:45:39 GMT -5
Our little rural county had a physician who had assistance from the government to get her MD in exchange for working in an underserved area. She worked a few days in our little county, and a few days in the adjacent rural county.
I really liked her, but she worked for a hospital that was having financial difficulties, and they stopped paying her salary for six months, and she had to leave to work someplace where she would get paid.
Now we have a nurse practitioner a few days a week.
So yes, I think there are people out there who would love to be a doctor and work in an underserved area in exchange for tuition assistance.
Until the tuition is paid, then it's off to where the money is to be made.Even the offspring of the doctors in our rural area move away after their schooling is complete. Not enough patients for even a father/son, mother/daughter, or any combination of, doctors office. that is not how the program works. there is no "repayment program".
how it works in the CR system is the degree to which you are provided assistance is the degree to which you are required to serve for the rest of your professional career.
if you take 90% assistance, you spend 90% of your time working for the government. if you take 10% assistance, you spend 10% of your time working for the government.
if you are wealthy, you end up in private practice in CR. but if you do, you might not be able to charge as much as you like, because a government doctor basically charges nothing. you will have to compete with that. so unless you are getting a facelift or something that is not government funded, you are going to have a tough time.
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