Re: Public vs private healthcare (was: RE: [CNN] Bush 2,909,465; Gore 2,907,722.)

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From: Jeff Bone (
Date: Wed Nov 15 2000 - 10:04:31 PST

> - It's very hard for rural areas to find doctors. Don't know if this would
> be easier or harder.

This (rural healthcare) is one general topic where I can speak with some amount
of familiarity. The shortage is so bad in West Texas that I worked for 4 years
during high school (after school, weekend, and summer job) in the lab and x-ray
department of a local clinic. I basically did everything a lab tech would do,
from phlebotomy to EKGs to microscopic hematology, and even though I was just a
science-oriented high school kid I was about the best / most cost effective
choice for an extra body that they could get.

My dad's spent ~20 of his 30 years in healthcare admin in rural areas; by
contrast, prior to that he was an exec for a mulitnational company that manages
big urban hospitals all over the western hemisphere, so there's some reasonable
contrasting context. In West Texas, where he's been for the last 20ish, there's
a huge shortage of medical personnel of all types. This despite the fact that
there are programs / incentives that aid in recruiting --- think Northern
Exposure. He's constantly working on recruiting docs and other personnel over a
year in advance of when they're needed.

Enter the Fed. One requirement in receiving Medi* payments that has been
imposed in the last several years regards staffing: the federal government now
imposes blanket staffing requirements for medical personnel in all hostpitals
that receive Medi* payments. Rather than let the local healthcare providers
staff out at / for their own needs, they now have to provide, on call and in
some cases in-house, certain personnel at all times. My dad constantly gripes
about the fact that they have to have particular specialists on call and on
payroll when, in fact, procedures involving them are *never* performed at those
hospitals, but rather patients needing those procedures are shipped down the
road to the "big city hospitals" in Lubbock. Consequently, this and other forms
of "overhead" imposed by federal-level regulation of healthcare make it
hard-to-impossible for rural healthcare to be conducted profitably without the
economies of scale that you see in more urban environments. A consequence of
this is that my Dad, a free marketer all the way, has had to champion and win
public bond elections in two counties in order to create local hospital tax
districts to fund the hospitals so they can stay open.



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