Distant Care – Existing Hospital Deserts

Counties in Red = No Hospital
Counties in Orange = in danger of losing all hospital
Over the past several posts I’ve spent a lot of time talking about the 30 counties that may lose their hospitals. But what about the 15 counties that currently have no hospital?

That’s what the red represents in this map.

I want to direct your attention to the line of counties that cut across the state diagonally on the line between the eastern and middle divisions of Tennessee. In all, only 14 of the 33 counties in East Tennessee will be left with any hospital to speak of.

Yes, most of those counties are rural. Yes, many of them have higher than average rates of poverty. But are the people who live in these counties, by virtue of their circumstances, any less human, or deserving of care?

I don’t think so.

Sacrificial Lambs of the “Market”

In his address to the State House and Senate, Gov. Haslam used a pretty standard dodge for politicians who don’t like taking responsibility for their actions…he blamed the Feds.

“If only the Feds would let us do it our way…”, he proclaimed, as though the plan he presented was somehow appreciably better than what Medicaid currently provides.

While there’s no question Medicaid has flaws, expanding it would also cover over 300,000 people. The best Gov. Haslam can do with his plan is cover just over 50% of those folks or 175,000 people.

Why does his plan cost more? Because rather than using the existing Medicaid structure for coverage, he wants to subsidize private companies with public dollars and buy care on the healthcare exchange he chose not to run.

So at once, Haslam blames the Feds for providing money to help care for people who can’t pay for it, and has the gall to say they wouldn’t let him cover fewer using a device in the law that he chose not to run in Tennessee.

Because, while there will eventually be some costs to Tennessee (we’ll get nine dollars for spending 1)…starting three years from now, there won’t be any costs now.

Shorter Distances = Survival

By now, its almost common knowledge that your chances of surviving a catastrophic health event like a heart attack or stroke are significantly increased when you make it to the hospital sooner.

A 2004 study by Cornell University quantified your chances of surviving a heart attack in this way:

Heart attack victims who make it to the hospital in time to receive medical attention are four to five times more likely to survive compared with those who don’t make it to a hospital promptly, according to a new Cornell University study. The research also finds that for each five-minute increase in distance from a hospital, a person’s probability of getting to the hospital in time falls by 1.25 percent.

For people that live in hospital deserts, the reality is, they will likely die from a catastrophic health event like a heart attack, because the distance to the hospital is just too great.

Understanding distance

I think its hard, particularly for people who live in urban areas, to understand just how long it takes to get to a hospital in a rural area. So here’s an example.

One of the Counties that make up the border between middle and east Tennessee, Morgan Co. is a small rural area of just under 22,000 people.

It occupies a special area. Nearly every county surrounding Morgan Co. has a hospital that is on the list of hospitals in danger.

Right now, if you lived in Wartburg, TN, which is where County government is located, travel to the nearest hospital would be Roane Medical Center in Harriman, just 22 min. away.

But Roane is on the list of hospitals in danger. If it closed, the next hospital would be Methodist Oak Ridge, which is about 37 min. away.

Unfortunately, it is also on the list of hospitals in danger of closure.

The nearest hospital, that isn’t listed as being in danger of closure is Parkwest Medical Center in Knoxville, nearly 50 minutes away.

That’s a really long drive, across some very winding roads. Can you imagine having to travel for an hour to receive “emergency” care. That’s what folks in Morgan County will be faced with if the worst comes to pass.

So let’s think about this. It takes between 5-10 min for the ambulance to get there. Followed by a 50 minute ride to the hospital. Your chances of surviving have been decreased by 15% due to distance alone. That doesn’t take into account complications or other issues, and it assumes the best possible scenario.

From my home in Memphis, an ambulance is less than 3 min. away. The nearest hospital, Methodist University, is 4 minutes away, by car. 10 min. tops to get to the hospital, increasing my chances of survival by nearly 10% over me if I had the same emergency in Lake Co.

Reality Check

Now I’m not arguing that there needs to be a hospital 10 min away from everyone. I understand just how impractical that is. What I am arguing is, any policy that makes it harder for smaller hospitals that serve a largely rural or poor population, by definition, unnecessarily puts those people at greater risk.

It seems to me that if we could prevent it, we should, for the good of those people.

Preventable Failures

The thing that really turns my stomach about all of this is just how preventable it is. While there’s no question that some areas are going to have to travel further for medical care, by virtue of their remoteness, choosing a policy that makes areas even more remote, out of what seems to be little more than partisanship and spite is both mean and lacks the kind of compassion you would expect from a leader making decisions that could be the difference between life and death.

Gov. Haslam noted that he doesn’t like “Obamacare”. Truth be told, there are things I don’t like about it either, though for very different reasons. But we’ve been having a conversation in this country about healthcare since Richard Nixon announced his support for a kind of nationalized HMO system over 40 years ago. This is the first policy that’s been able to gain the votes to get out of Congress.

In short, like it or not, its the policy we have.

Its unfortunate that someone’s dislike for a policy would so cloud their vision as to not even present a plan that might work…if for no other reason, than to help the people of their state. But that’s exactly what the Haslam Administration did. They presented a plan that was neither efficient in terms of delivery nor cost effective in terms of covering the most people for the fewest dollars.

They presented a plan they knew wouldn’t fly, for the very purpose of pinning the blame politically on the Feds. It is both a cynical and dishonest way to conduct business.

That’s something I’ll talk more about in my next post.

Until then, Happy Easter.

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