Gutting rural hospitals

Cutting spending on Medicare is easier from Washington than Storm Lake, Sac City or Pocahontas, where the elderly population is growing. So it went last week that the Office of Inspector General for the Department of Health and Human Services recommended scaling back the number of “critical access” hospitals in rural areas to save about $1 billion per year. Such a move would hurt Buena Vista Regional Medical Center and would be disastrous for Loring Hospital in Sac City and Pocahontas Community Hospital.

The watchdog for HHS reported that 849 of the 1,339 critical access hospitals do not meet the basic requirements of the program — that they be at least 35 miles from the next hospital. That knocks all three of the mentioned hospitals off the list, since they are all within 35 miles of another hospital. Eighty-two of Iowa’s 118 hospitals depend on the higher rates for outpatient care — about $400 per head — that the critical access program provides.

The report sent alarms through the rural hospital community.

It might have been premature. The Obama Administration is not proposing what the Inspector General recommends. Rather, the Administration would require a 10-mile distance between hospitals, affecting only about 60 of the 1,300 hospitals nationwide. But you just don’t know what this idea might pick up if it gets on a roll.

A bit of history is in order:

Iowa hospitals were chronically underpaid for Medicare services until they accessed the Critical Access program. The stories were legendary about how a hospital in New York or Florida was charging 10 times the amount for an appendectomy than a rural Iowa hospital would. Iowa’s congressional delegation got nowhere urging a change in the formula to reflect actual costs of doing business. That’s when the program was normalized for nearly every rural hospital, as a simple way around a tangle of unfair red tape.

They were not trying to rape the system, just to get by.

One could mount an argument that the Spencer and Storm Lake hospitals would do okay without Critical Access designation. Yet, Iowa’s health care cost structure is still below the coasts by a long shot. The Critical Access program helps BVRMC deliver the latest medical technology and allows it to compete for talent. Just because you live in Iowa does not mean you should suffer substandard care. Paring back the Critical Access program would destroy the hospitals in Pocahontas and Sac City, and it would seriously impair the services offered in Storm Lake. That would simply drive patients to urban hospitals where the care level may or may not be better.

It is an example where cutting the program could make health care delivery more inefficient and costly, by driving customers from Storm Lake to Omaha, say, which has an overall higher cost structure. That’s the wrong direction to go.

Dog days of politics

With the Iowa State Fair just behind us, the campaign season for 2014 and beyond has begun. Scott Brown, former Republican senator from Massachusetts, was the last in a string of GOP presidential hopefuls to sample a corn dog or pork fritter at the fair. Sen. Amy Klobuchar, D-Minn., spoke to Democrats gathered in Northwood for the North Iowa Wing Ding (what a great name for a political gathering). Vice President Joe Biden is headlining Sen. Tom Harkin’s September Steak Fry at Indianola, the biggest introductory event in national Democratic politics. And Hillary Clinton will be in Davenport one of these days.

Gov. Terry Branstad already announced his list of BV County supporters, the same as last time. Three Democrats few have ever heard of think they can beat the perennial campaigner.

Rep. Bruce Braley, D-Waterloo, will be at Diane and Steve Hamilton’s Casino Beach home this Saturday at noon for a fundraiser. The Hamilton’s pad is usually a first stop for a Democrat trying to figure out rural western Iowa. Several Republicans in search of a nomination are in full-throated attacks against Braley for defending the Affordable Care Act. The polling must have been done on that one. Following about two years of radio attack ads, voters will begin to believe that the health care reform is as bad as Social Security and Braley is worse. First, the party needs to nominate a candidate from a field of a half dozen or more no-names.

Jim Mowrer of Boone is working hard to get a name in his contest against national zealot Rep. Steve King, R-Kiron.

Chris Christie, the New Jersey governor who made nice with President Obama, is telling Republicans that if they want to win they should nominate him and forget about ideology. It remains to be seen how that plays, or if he plays, in the Iowa caucuses dominated by Christian conservative evangelicals and Tea Partiers. Would South Carolina be any more forgiving to a Noreaster?

Clinton is the prohibitive front-runner among Democrats. She was the same eight years ago until a Chicago guy with big ears and a funny last name showed up at Harkin’s steak fry. She polls better than Christie. Who would think Tom Harkin could have unseated Rep. Bill Scherle in 1974? That’s his message to Mowrer.

These are the dog days, when people are sniffing around, trying to find someone or some thing that sticks.