Canary in the Coal mine?

The Washington Post published a deep dive into a group, Remote Area Medical, providing a free medical clinic in rural Tennesee.  They follow the story of a couple, Lisa and Stevie, trying to navigate getting care for their myriad of issues. 

This truly is a story of two people left behind by the country they live in.  They can't find care due to a lack of providers (retiring or moving away),  a lack of insurance (due to not having a good job with benefits), and a lack of money to pay for it (due to not being able to work because of their health issues).  They grow increasingly poor, in poor health, and despondent in their situation.

So, they come to the clinic to seek some redress.  What this article doesn't say, is that Remote Area Medical was formed to provide care in third world countries.  They soon learned, unfortunately, that third world conditions existed right in their back yard.

And, it is certain to get worse for those on the margins.  In Tennessee alone:

"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 thata 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."

Hospital closures are accelerating - more than 100 have rural hospitals have closed since 2010.  Along with this, come provider shortages, allied health shortages (pharmacists, etc), and a downturn in the local economy. 

Those areas that are already on the brink will feel these pains the most - smaller, rural, underserved communities.  Communities like the one in Cleveland, TN, where Stevie and Lisa sought care. 

How long, though, will it be before these effects are felt in other communities?  Those that thought they were immune to such problems?  Communities that are one business closure away from a downturn that has ripple effects not yet understood?

Later, the Washington Post correctly diagnosed one of Tennessee's problems - Medicaid Expansion (or the lack thereof).  Their key point:

"The point is that much of the collapse of rural health care could have been avoided, and could be easily reversed if so many state governments hadn’t chosen to impose misery on their own rural constituents."

I do not think it is too alarmist to fear that what is happening in in these rural, underserved areas could spread further.   Let's not forget Lisa and Stevie.