Smart but shrinking



Here’s a cheerier note about declining population in rural Iowa: It’s all what you make of it. That is at least the spirit of the findings of a report by an Iowa State University sociologist, David Peters, who found that small towns that are shrinking still can have a high quality of life. He calls them “smart shrinking” towns, as opposed to “poor shrinking” towns. Bancroft in Kossuth County is a smart shrinking town, Newell a poor one, as just two examples since we know something about each.

Our roots are in Bancroft, where our mother was reared. It is a wealthy, German Catholic farming community that still resents the fact that its county seat was stolen by Algona more than a century ago. After the nuclear war, a bar somehow will open at 6 a.m. in Bancroft. The sociological data from Newell are harder for us to understand. It has a high school, strong churches and wealthy retired farmers (many of whom are of Danish heritage). An old auctioneer will tell you that farms around Newell won’t sell as strong as those around Nemaha, but that doesn’t mean that Nemaha is any smarter or that Newell is any poorer for it. We could go on with that sort of quibbling. Newell, while not as tight and exclusionary as Bancroft (or Hull in the Dutch iteration) seems to us a healthy small town with a café and a bar and a bank and a post office and a large share of town pride. They call their summer festival Pride Day. We’re sticking up for Newell.

But Professor Peters’ point is well-taken. He cites Sac City as a place that is shrinking but has strong community bonds and vitality, according to the data. It has a high quality of life, he reports. We often think of Albert City without a resident high school as an especially strong rural town, so Swede it is. Loving Iowa is a state of mind, after all.

Too bad to dwell on it, but at some point quality of life disappears when life does. Juniata has no quality of life except for the cattle who live there. If you accept shrinkage because you like your little town it might not be there when you wake up in the morning. Small Iowa towns are tremendously resilient — Varina still has church on Sunday, but St. Columbkille’s always stands under threat of abandonment. We sometimes stop at St. Patrick’s on the Lizard a quarter mile off the Clare road. You can see from the tombstones that there was a little Irish settlement there. But it got gobbled up by Clare just down the blacktop, and only the buried remain along Lizard Creek. Clare has been all but shut down in the shadow of Fort Dodge. St. Patrick’s on the Lizard may have shrunk smart, but it receded right into the graveyard.

Public option resurrected

Gov. Kim Reynolds cannot bring herself to elocute the fact that the Medicaid privatization experiment is a failure, a disaster that will cost the state hundreds of millions of dollars that we have not yet calculated or at least been made aware of. This week, the state was forced to resurrect the state-managed “fee-for-service” program that Gov. Terry Branstad burned down with his unilateral reorganization of the health insurance program that serves the working poor, the elderly and the disabled. AmeriHealth, one of three Medicaid insurance managers under the “reformed” Branstad/Reynolds system, pulled out because it realized it was losing hundreds of millions of dollars under this house of cards. The remaining two insurers said they could not afford to lose even more money by taking on all of AmeriHealth’s former customers. Hence, the state must step in and provide a service for those lost 10,000 souls who will end up with better service than those stuck with the private insurance companies.

This should be evidence that the Medicaid privatization effort is imploding under its faulty arithmetic. Branstad figured that the state could save $400 million or so by shifting Medicaid onto private insurers. In fact, more than a dozen nursing homes (including North Lake Manor) have been closed, Faith Hope and Charity was forced to merge with Hope Haven, and local health care providers are not getting paid on time or in full.

The full cost of this debacle should be exposed in the next legislative session as more bills come home to roost. It will become eminently clear that we must return to a system that works for the poor and infirm, for the taxpayers and for rural communities trying to provide vital services. This system is not working. The public option did. Now Iowa is offering at least 10,000 people that choice. What about the other 200,000 who are denied that choice? Reynolds insists that the public option is too expensive, even though she is reverting to it in a state of emergency. We know how much the old system cost. The public has absolutely no idea how much this debacle will cost. Reynolds bottom line: “I’m not going back.”

She might not be. But 10,000 other Iowans are.