Rural health care system barely holding on

PHOTO: Tony Alter, Flickr CC-BY

My latest essay for the Minnesota Reformer is out today. Read it now.

Longtime readers know that my mother suffered a serious stroke in late 2022 that changed her life and, to a lesser extent, mine. Every time we see a new doctor or medical provider, they look at her chart and remark how few patients experiencing her kind of stroke survive much less live independently. She lives comfortably in her own apartment, a small victory after a very hard year. I serve as her driver, secretary, heavy lifter and up-high reacher.

I knew from the start that I’d eventually write this column. At first, I was too upset. I was angry at how long it took our rural E.R. to diagnose the stroke. I was frustrated with how difficult it was to find the care mom needed during the crucial first months of recovery. And, to be honest, I was overwhelmed. I was 43. Mom was 62. It seemed too early, too unfair, for us to be talking about long term care.

Time and the support of friends and family helped. This year, I finally felt able to parse some of the broader public policy implications. What happened to my mom will happen to someone else. This is especially true if they are rural and poor, like her. Will their experience be better or worse? I still believe we should push ourselves as a society to do better.

I wrote this piece a couple months ago during the legislative session. In the time since, the state issued some temporary relief for rural EMS providers. But, as I wrote in May, this only touches the surface of the issues outlined in today’s column.

Read “Health care ‘implosion’ threatens Greater Minnesota” in the Minnesota Reformer.


  1. Gerald S says

    The worsening crisis in rural healthcare is caught in the ideologic pinch in American politics. Rural politicians, who should be leading the charge to get help for their constituents, are instead caught up in the ideologic divide in America. Our own area is an example. The congressional representatives of rural Minnesota and Wisconsin are, by and large, caught up in social issues where they try to force their own personal religious beliefs on the rest of the country, and in economic issues like sugar supports and bans on sugar imports and allowing foreign mining companies unlimited rights to pollute water and air. Their party tends to oppose any efforts to help low income and middle class citizens on an ideologic basis, including on health care spending.

    Of course, urban politicians and politicians representing areas with high numbers of retirees vote for improvement in Medicare and Medicaid benefits, but their efforts, naturally enough, focus on their own constituents. It should be no surprise that per capita spending and reimbursement of health professionals and hospitals are frequently three times as high in the Bronx and South Florida than in Bemidji and Cloquet, and that federal aid for health care facilities is focused on the areas represented by these activist politicians.

    Faced with inadequate reimbursement, hospitals struggle to find budgets for modern services and to recruit and retain nurses and other professionals, and doctors avoid rural areas in favor of suburban sites where reimbursement is better, schools are well funded, and amenities more plentiful, and there are more physicians to share call and case loads.

    Adding to the problem, doctors who are willing to move to rural areas are often foreign trained, and doctors from East Asia, Southwest Asia, and Africa frequently encounter discrimination against their ethnic and religious backgrounds when they venture into the closed world of rural America.

    We are in a situation where voters are being forced to make a choice. Support “our way of life,” including cultural values based on religious ideas, racism and xenophobia, homophobia and transphobia, and total disregard to protecting the environment, or adopt a ideology based on care for people and protection of the basic rights of all people including health care, We can choose between a region where women must drive hundreds of miles for basic health and people unlike us are made uncomfortable and unwelcome on one hand and a region where we get first rate health care service on the other. Unfortunately, in today’s political environment, that is the choice between the two political forces contending today. Choosing MAGA also means choosing the five hour waits for diagnosis and the long drives or helicopter rides that typify rural health care today.

    If Northern Minnesota wants good quality health care, they need to pay as much attention to their representatives’ positions on health care reform and improvement as they do to their votes on abortion, gay rights, and mining regulations that permit unlimited pollution. It all depends on what you care about, and what you are willing to hold your elected officials responsible for.

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