The enormous pop-up clinic trying to bridge America’s health divide
November 23, 2016 5:23 AM Subscribe
Every legislator who voted against funding to bridge the gap should have to get all their medical care once a year in a steaming hot circus tent.
posted by The Underpants Monster at 5:51 AM on November 23, 2016 [83 favorites]
posted by The Underpants Monster at 5:51 AM on November 23, 2016 [83 favorites]
What's even sadder is that operations like RAM will be pointed to by politicians as proof that those federal dollars are unnecessary and can be done away with entirely.
posted by Thorzdad at 5:51 AM on November 23, 2016 [32 favorites]
posted by Thorzdad at 5:51 AM on November 23, 2016 [32 favorites]
Locally I've seen mobile dental clinics and a version of the Veterans Stand Down, and I think there are mobile medical clinics from time to time. They do amazing work and deserve a lot of credit for helping to bridge missing links in health care, but in no way are they a substitute for what everyone should have access to, easy and routine medical access.
posted by Dip Flash at 6:00 AM on November 23, 2016 [6 favorites]
posted by Dip Flash at 6:00 AM on November 23, 2016 [6 favorites]
We're quickly becoming a third world country.
posted by HuronBob at 6:22 AM on November 23, 2016 [10 favorites]
posted by HuronBob at 6:22 AM on November 23, 2016 [10 favorites]
Just wait until Republicans try to replace medicare with private insurance subsidies and Medicaid with block grants. This sort of thing will be the norm in every state.
posted by vuron at 6:24 AM on November 23, 2016 [5 favorites]
posted by vuron at 6:24 AM on November 23, 2016 [5 favorites]
We're quickly becoming a third world country.
But, I've been told we'll be great again.
posted by Thorzdad at 6:24 AM on November 23, 2016 [13 favorites]
But, I've been told we'll be great again.
posted by Thorzdad at 6:24 AM on November 23, 2016 [13 favorites]
Beautiful on a personal level sure.. But no amount of fucking popups or GoFundMes (the online "popup") can compensate for a first-world infrastructure with serious healthcare delivered and organized at scale for the 310+ million people in the US.
In other words, as HuronBob says, we are a third world country. The difference, I'd hazard, is that in most third world countries I've visited (and yes, third-world is problematic and colonialist, but empirically useful here) people want to leave, they realized its fucked up. Here, we see the kind of examples above as bootstrapp-y goodness and continue to elect individuals and fight for people who want to dismantle the shit we built last century. Disgusting.
posted by yonation at 6:24 AM on November 23, 2016 [14 favorites]
In other words, as HuronBob says, we are a third world country. The difference, I'd hazard, is that in most third world countries I've visited (and yes, third-world is problematic and colonialist, but empirically useful here) people want to leave, they realized its fucked up. Here, we see the kind of examples above as bootstrapp-y goodness and continue to elect individuals and fight for people who want to dismantle the shit we built last century. Disgusting.
posted by yonation at 6:24 AM on November 23, 2016 [14 favorites]
There's a documentary about them on Netflix & it's worth watching, just to get a picture of the process and the communities they support: Remote Area Medical
posted by mochapickle at 6:27 AM on November 23, 2016 [6 favorites]
posted by mochapickle at 6:27 AM on November 23, 2016 [6 favorites]
This is my state. Reading this makes me profoundly sad. Not in a detached, starving-children-in-Africa kind of way. To me, this is personal. The author captured the essence of these people very well. Resolute, proud, stubborn. I know these people, they are my family, they are people I grew up knowing.
That region of Virginia has been absolutely devastated by poverty, and constantly abused by the state. They were some of the last regions in the state to receive electricity, running water. The people were exploited for coal, made sick, and given no viable job opportunities as the coal industry dies. Big corporations like Walmart are constantly pushing out other businesses, while offering poor pay and no benefits.
When I got the news that VA wasn't expanding Medicaid, I was devastated. At the time I was under employed, with no insurance, and desperately in need. I went without it. I have been without it most of my life, well back into my childhood. That's starting to catch up with me like a barreling train. I'm lucky, I got a job earlier this year that has health benefits. But after two decades without dental, I can't afford to get the care I need. Even with my benefits.
My partner is in the same boat. As an orphan, he had no access to care growing up. As an adult, he's unable to work but was denied disability. He works freelance from home, but the pay comes out to be below minimum wage and it's not even enough to make a dent. So he's left to manage mental illnesses and Crohn's disease on his own.
This man is truly a hero. I can't imagine how many of those people would have just gone undiagnosed and died. It's really that simple, and the powers that be are refusing to see it that way. There are sick people, and they're dying. From poor nutrition, from working in the mines, from untreated dental issues, from alcoholism. All things which could be fixed if we tried. It's going to be even worse now with a full-on republican government.
This needs to stop. These people don't need to die, there has to be a better way.
posted by FirstMateKate at 6:32 AM on November 23, 2016 [47 favorites]
That region of Virginia has been absolutely devastated by poverty, and constantly abused by the state. They were some of the last regions in the state to receive electricity, running water. The people were exploited for coal, made sick, and given no viable job opportunities as the coal industry dies. Big corporations like Walmart are constantly pushing out other businesses, while offering poor pay and no benefits.
When I got the news that VA wasn't expanding Medicaid, I was devastated. At the time I was under employed, with no insurance, and desperately in need. I went without it. I have been without it most of my life, well back into my childhood. That's starting to catch up with me like a barreling train. I'm lucky, I got a job earlier this year that has health benefits. But after two decades without dental, I can't afford to get the care I need. Even with my benefits.
My partner is in the same boat. As an orphan, he had no access to care growing up. As an adult, he's unable to work but was denied disability. He works freelance from home, but the pay comes out to be below minimum wage and it's not even enough to make a dent. So he's left to manage mental illnesses and Crohn's disease on his own.
This man is truly a hero. I can't imagine how many of those people would have just gone undiagnosed and died. It's really that simple, and the powers that be are refusing to see it that way. There are sick people, and they're dying. From poor nutrition, from working in the mines, from untreated dental issues, from alcoholism. All things which could be fixed if we tried. It's going to be even worse now with a full-on republican government.
This needs to stop. These people don't need to die, there has to be a better way.
posted by FirstMateKate at 6:32 AM on November 23, 2016 [47 favorites]
We're quickly becoming a third world country.
We have always been one. Several, really -- there are some Americas where kids starve, some where kids occasionally miss meals, and some where kids have no idea that other kids are starving a few miles away.
posted by Etrigan at 6:44 AM on November 23, 2016 [31 favorites]
We have always been one. Several, really -- there are some Americas where kids starve, some where kids occasionally miss meals, and some where kids have no idea that other kids are starving a few miles away.
posted by Etrigan at 6:44 AM on November 23, 2016 [31 favorites]
Every legislator who voted against funding to bridge the gap should have to get all their medical care once a year in a steaming hot circus tent.
Every legislator who voted against funding and who gets generous health care programs through their public office should be stripped of their benefits and have to scramble to procure medical care for the rest of their lives using whatever resources they can hunt, beg, borrow, or steal, given the conditions that they created.
posted by blucevalo at 6:52 AM on November 23, 2016 [18 favorites]
Every legislator who voted against funding and who gets generous health care programs through their public office should be stripped of their benefits and have to scramble to procure medical care for the rest of their lives using whatever resources they can hunt, beg, borrow, or steal, given the conditions that they created.
posted by blucevalo at 6:52 AM on November 23, 2016 [18 favorites]
The thing that kills me is that after being abused by the coal mines for so long, then abandoned by the energy companies, the people want the coal mines re-opened. Do any of you remember that awful book, "Who Moved My Cheese?". It's basically "adapt or die" for kids. It's a victim-blaming sort of philosophy. We need something other than bringing back coal (which is terrible for workers and the environment) or expanding benefits (which works but is politically untenable). I personally believe that UBI is the answer, but I can't even convince the people who need it most. To use the metaphor from the book, people refuse to look for new cheese or accept cheese from the government. Reading this article and knowing that these are the most solidly republican states in the US, I honestly think that there is no depth of poverty that people will hit that could persuade them to vote for expanded benefits. I am in despair.
posted by domo at 7:08 AM on November 23, 2016 [10 favorites]
posted by domo at 7:08 AM on November 23, 2016 [10 favorites]
Every legislator who voted against funding to bridge the gap should have to get all their medical care once a year in a steaming hot circus tent.
I've been thinking that the Democrats in Congress should try to attach wording to every Medicare, Medicaid, or SS defunding/privitization bill the R's are going to push through, stripping all elected officials of their taxpayer-supported healthcare benefits. Make the lot of them have to go out on the open-market for their (and their families') insurance, just like everyone else. Skin-in-the-game, and all that bootstrappy stuff.
posted by Thorzdad at 7:40 AM on November 23, 2016 [20 favorites]
I've been thinking that the Democrats in Congress should try to attach wording to every Medicare, Medicaid, or SS defunding/privitization bill the R's are going to push through, stripping all elected officials of their taxpayer-supported healthcare benefits. Make the lot of them have to go out on the open-market for their (and their families') insurance, just like everyone else. Skin-in-the-game, and all that bootstrappy stuff.
posted by Thorzdad at 7:40 AM on November 23, 2016 [20 favorites]
I've volunteered at RAM clinics and the thing that always impresses me most is how motivated people are to get there and get treatment for themselves and their families.
In areas like Appalachia, there'll be a mix of working class and unemployed. In cities like LA, you'll be seeing the self-employed, union laborers who can't get enough hours anymore, people with masters degrees who work at agencies and non-profits whose benefits have been slashed, middle-class workers who just can't afford dental work for their kids. Dental is always the biggest part of any clinic; dental care is a luxury for many Americans.
RAM is a great organization with a simple mission and an inclusive spirit, so it's always nice to see it get good media coverage. But in a better version of the USA, we really shouldn't need an organization like RAM at all.
That's the conundrum: It's great that RAM exists, but not great that RAM must exist.
posted by grounded at 7:42 AM on November 23, 2016 [15 favorites]
In areas like Appalachia, there'll be a mix of working class and unemployed. In cities like LA, you'll be seeing the self-employed, union laborers who can't get enough hours anymore, people with masters degrees who work at agencies and non-profits whose benefits have been slashed, middle-class workers who just can't afford dental work for their kids. Dental is always the biggest part of any clinic; dental care is a luxury for many Americans.
RAM is a great organization with a simple mission and an inclusive spirit, so it's always nice to see it get good media coverage. But in a better version of the USA, we really shouldn't need an organization like RAM at all.
That's the conundrum: It's great that RAM exists, but not great that RAM must exist.
posted by grounded at 7:42 AM on November 23, 2016 [15 favorites]
I personally believe that UBI is the answer, but I can't even convince the people who need it most. To use the metaphor from the book, people refuse to look for new cheese or accept cheese from the government. Reading this article and knowing that these are the most solidly republican states in the US, I honestly think that there is no depth of poverty that people will hit that could persuade them to vote for expanded benefits.
We're missing a voice in these communities who can credibly speak to their experiences and also frame something like a UBI and healthcare as a "common sense" "Washington outsider" issue. I really believe it's possible to show people the Emperor has no clothes, that stoking racial divides is a way to keep poor people of all races down, that cutting taxes and regulations does not bring back jobs because our hard labor has brought the boss enough money that he could afford to develop cheaper alternatives to our labor and coal sells for too cheap to support more jobs anyways... I think all that and more could sink in, especially when framed as a new conservatism, but crucially it needs to come from someone in that community's in group. We're talking enough cred to be acceptable and also Bill Clinton level charisma to help the medicine go down. And I don't know who that person would be.
posted by jason_steakums at 7:51 AM on November 23, 2016 [9 favorites]
We're missing a voice in these communities who can credibly speak to their experiences and also frame something like a UBI and healthcare as a "common sense" "Washington outsider" issue. I really believe it's possible to show people the Emperor has no clothes, that stoking racial divides is a way to keep poor people of all races down, that cutting taxes and regulations does not bring back jobs because our hard labor has brought the boss enough money that he could afford to develop cheaper alternatives to our labor and coal sells for too cheap to support more jobs anyways... I think all that and more could sink in, especially when framed as a new conservatism, but crucially it needs to come from someone in that community's in group. We're talking enough cred to be acceptable and also Bill Clinton level charisma to help the medicine go down. And I don't know who that person would be.
posted by jason_steakums at 7:51 AM on November 23, 2016 [9 favorites]
I've long thought that we are ripe for a third market healthcare economy. I thought that this was less necessary after ACA but now I can see that we are still ripe for it. I've wondered at the possibility of Native American tribes offering this. Can you imagine if, alongside the casinos, the tribes were offering basic medical and dental care, prescription coverage, physical therapy and alternative therapies. Think of all the retirees and snowbirds that would trek out to fill their prescriptions (drugs purchase from Canada and Mexico to keep costs down). This would give a new mission for Native Americans and a way to get education dollars flowing in and out of reservations, retaining people and drawing some back. It is probably codified in our constitution that tribes aren't allowed to do anything like that but they if they could...who knows?
posted by amanda at 8:09 AM on November 23, 2016 [12 favorites]
posted by amanda at 8:09 AM on November 23, 2016 [12 favorites]
Rural access to healthcare is still going to be an issue in many communities as fewer and fewer doctors want to practice medicine in the 1 doctor small town model. Even in communities where that is still an option there is a need to periodically bring in specialists in a model like this where communities can receive treatment from specialists.
It's crazy that we have to operate MSF style clinics like this but in many ways it's a function of our flawed medical system, our low population density and demand being way higher than supply.
Stuff like medicaid and ACA are absolutely critical because the more people you can treat before they become seriously sick and are forced to go to emergency rooms the better. Patient outcomes are better and costs are much lower.
Unfortunately we have a political party in this country that seems to be willfully ignorant of public health policy and fundamental economic sense.
posted by vuron at 8:15 AM on November 23, 2016 [6 favorites]
It's crazy that we have to operate MSF style clinics like this but in many ways it's a function of our flawed medical system, our low population density and demand being way higher than supply.
Stuff like medicaid and ACA are absolutely critical because the more people you can treat before they become seriously sick and are forced to go to emergency rooms the better. Patient outcomes are better and costs are much lower.
Unfortunately we have a political party in this country that seems to be willfully ignorant of public health policy and fundamental economic sense.
posted by vuron at 8:15 AM on November 23, 2016 [6 favorites]
It is probably codified in our constitution that tribes aren't allowed to do anything like that but they if they could...who knows?
Nope, nothing like that. Although tribal sovereignty issues may complicate physicians' certifications. It's been a long time since I did any Indian law so I can't say for sure, but some states have land use & regulatory jurisdiction inside the reservation, while in most states the tribes are basically considered federal land for the purposes of state regulations. It gets complicated.
posted by suelac at 8:26 AM on November 23, 2016 [3 favorites]
Nope, nothing like that. Although tribal sovereignty issues may complicate physicians' certifications. It's been a long time since I did any Indian law so I can't say for sure, but some states have land use & regulatory jurisdiction inside the reservation, while in most states the tribes are basically considered federal land for the purposes of state regulations. It gets complicated.
posted by suelac at 8:26 AM on November 23, 2016 [3 favorites]
Unfortunately we have a political party in this country that seems to be willfully ignorant of public health policy and fundamental economic sense.
It's also unfortunate that even though we have a political process that could help inform policy, most Americans don't bother to vote in midterm elections. And even when they do, many vote against their best interest in terms of health care.
posted by SteveInMaine at 8:32 AM on November 23, 2016 [2 favorites]
It's also unfortunate that even though we have a political process that could help inform policy, most Americans don't bother to vote in midterm elections. And even when they do, many vote against their best interest in terms of health care.
posted by SteveInMaine at 8:32 AM on November 23, 2016 [2 favorites]
I've been thinking that the Democrats in Congress should try to attach wording to every Medicare, Medicaid, or SS defunding/privitization bill the R's are going to push through, stripping all elected officials of their taxpayer-supported healthcare benefits. Make the lot of them have to go out on the open-market for their (and their families') insurance, just like everyone else.
*sad trombone*
This is already mostly the law. It used to be that MCs got the standard federal healthcare package. As part of obamacare, that got taken away. Under current law, they get (IIRC) what would be the federal contribution towards health care as money, but have to buy a plan from the exchanges or go on their spouse's insurance*. So you could take away that subsidy, but that's it.
There are minor exceptions; MCs can get outpatient care at DC-area military hospitals on an as-available basis (for anything serious their insurance has to reimburse the hospital), or pay for access to outpatient care from the attending physician's office.
*I suppose theoretically a Representative elected at the lower bound of age-eligibility could stay on his or her parents' plan for a year. That'd be amusing to see.
posted by ROU_Xenophobe at 8:35 AM on November 23, 2016 [6 favorites]
*sad trombone*
This is already mostly the law. It used to be that MCs got the standard federal healthcare package. As part of obamacare, that got taken away. Under current law, they get (IIRC) what would be the federal contribution towards health care as money, but have to buy a plan from the exchanges or go on their spouse's insurance*. So you could take away that subsidy, but that's it.
There are minor exceptions; MCs can get outpatient care at DC-area military hospitals on an as-available basis (for anything serious their insurance has to reimburse the hospital), or pay for access to outpatient care from the attending physician's office.
*I suppose theoretically a Representative elected at the lower bound of age-eligibility could stay on his or her parents' plan for a year. That'd be amusing to see.
posted by ROU_Xenophobe at 8:35 AM on November 23, 2016 [6 favorites]
Dear Conservatives:
Driving down the standard of living for your people is not the road to success.
We have the honor to be your obedient servants,
W. Coast
posted by Pirate-Bartender-Zombie-Monkey at 9:57 AM on November 23, 2016 [3 favorites]
Driving down the standard of living for your people is not the road to success.
We have the honor to be your obedient servants,
W. Coast
posted by Pirate-Bartender-Zombie-Monkey at 9:57 AM on November 23, 2016 [3 favorites]
I've wondered at the possibility of Native American tribes offering this.
That would certainly improve my situation. Traveling to Mexico for medical tourism would be prohibitively expensive for me, but I live half an hour away from Native American territory.
posted by The Underpants Monster at 10:10 AM on November 23, 2016 [1 favorite]
That would certainly improve my situation. Traveling to Mexico for medical tourism would be prohibitively expensive for me, but I live half an hour away from Native American territory.
posted by The Underpants Monster at 10:10 AM on November 23, 2016 [1 favorite]
RAM is a great group. I'm sorry we need them domestically, but they do good work.
posted by rmd1023 at 10:11 AM on November 23, 2016 [1 favorite]
posted by rmd1023 at 10:11 AM on November 23, 2016 [1 favorite]
Now, more than ever, "look for the people who are helping." Also, we need you now more than ever Fred Rogers.
posted by basicchannel at 10:20 AM on November 23, 2016 [4 favorites]
posted by basicchannel at 10:20 AM on November 23, 2016 [4 favorites]
I've been thinking that the Democrats in Congress should try to attach wording to every Medicare, Medicaid, or SS defunding/privitization bill the R's are going to push through, stripping all elected officials of their taxpayer-supported healthcare benefits. Make the lot of them have to go out on the open-market for their (and their families') insurance, just like everyone else. Skin-in-the-game, and all that bootstrappy stuff.
The problem is they all have a lot of skin. Net worth of Congress.
They won't even have to shop for their own health care, never mind feel a financial sting. They will just hire someone to do it for them.
Also these kinds of laws would keep ordinary people from seeking to be representatives because of the uncertainty of compensation.
posted by srboisvert at 10:36 AM on November 23, 2016
The problem is they all have a lot of skin. Net worth of Congress.
They won't even have to shop for their own health care, never mind feel a financial sting. They will just hire someone to do it for them.
Also these kinds of laws would keep ordinary people from seeking to be representatives because of the uncertainty of compensation.
posted by srboisvert at 10:36 AM on November 23, 2016
Every legislator who voted against funding and who gets generous health care programs through their public office should be stripped of their benefits and have to scramble to procure medical care for the rest of their lives using whatever resources they can hunt, beg, borrow, or steal, given the conditions that they created.
I know that that's the default reaction. But it's exactly their thinking too. The lazy poor don't deserve medical care. Hate isn't the answer here. Give them the best care in the world. But to tie it into Citizens United, make every politician on the campaign trail wear a spaghetti stained t-shirt or beater that says "I'm with stupid." and "Ask me how I received free healthcare for my family."
What's even sadder is that operations like RAM will be pointed to by politicians as proof that those federal dollars are unnecessary and can be done away with entirely.
Or pointed to by liberals that things aren't so bad here. That we have kind, compassionate people making things better, even in our darkest hour.
And we do, MAP sounds amazing and God bless them. But our entire model of government is upside down. Government shouldn't be pushing volunteerism and service for institutions that have clear econonimic benefits when centrally managed.
The difference, I'd hazard, is that in most third world countries I've visited (and yes, third-world is problematic and colonialist, but empirically useful here) people want to leave, they realized its fucked up.
Some of us do. Check please.
posted by formless at 11:06 AM on November 23, 2016
I know that that's the default reaction. But it's exactly their thinking too. The lazy poor don't deserve medical care. Hate isn't the answer here. Give them the best care in the world. But to tie it into Citizens United, make every politician on the campaign trail wear a spaghetti stained t-shirt or beater that says "I'm with stupid." and "Ask me how I received free healthcare for my family."
What's even sadder is that operations like RAM will be pointed to by politicians as proof that those federal dollars are unnecessary and can be done away with entirely.
Or pointed to by liberals that things aren't so bad here. That we have kind, compassionate people making things better, even in our darkest hour.
And we do, MAP sounds amazing and God bless them. But our entire model of government is upside down. Government shouldn't be pushing volunteerism and service for institutions that have clear econonimic benefits when centrally managed.
The difference, I'd hazard, is that in most third world countries I've visited (and yes, third-world is problematic and colonialist, but empirically useful here) people want to leave, they realized its fucked up.
Some of us do. Check please.
posted by formless at 11:06 AM on November 23, 2016
They're not just in red states without Medicaid expansion - Seattle, WA has held one for the past couple of years. Seattle/King County Clinic 2016.
I went to it this year; I'm on Medicaid, but they do not cover glasses for adults. So, I went to get glasses. Nor do they cover dental care, but I'm fortunate to have another source for that.
posted by spinifex23 at 11:14 AM on November 23, 2016 [2 favorites]
I went to it this year; I'm on Medicaid, but they do not cover glasses for adults. So, I went to get glasses. Nor do they cover dental care, but I'm fortunate to have another source for that.
posted by spinifex23 at 11:14 AM on November 23, 2016 [2 favorites]
Or pointed to by liberals that things aren't so bad here. That we have kind, compassionate people making things better, even in our darkest hour.
No liberal I've personally known, seen, or heard of in my life would do that, and I have no idea why they would.
posted by The Underpants Monster at 1:15 PM on November 23, 2016 [2 favorites]
No liberal I've personally known, seen, or heard of in my life would do that, and I have no idea why they would.
posted by The Underpants Monster at 1:15 PM on November 23, 2016 [2 favorites]
Original version in the Virginia Quarterly Review
posted by Zerowensboring at 1:38 PM on November 23, 2016 [2 favorites]
posted by Zerowensboring at 1:38 PM on November 23, 2016 [2 favorites]
Virginia is one of 19 states refusing federal dollars to close the healthcare “coverage gap” for people not poor enough for Medicaid, but too poor for anything else. Yet at the Wise County...
Would you believe that Wise County elects Republicans to the state legislature with such force that the Democrats don't appear to bother running anyone against them?
That’s why Ben voted against Obamacare expansion in the General Assembly.
2,277 residents voted for Ben, who opposed expanding coverage, compared to 40 write-ins that opposed him. But he loves guns and hates gay marriage, so I guess it's OK.
Can you imagine if, alongside the casinos, the tribes were offering basic medical and dental care, prescription coverage, physical therapy and alternative therapies. Think of all the retirees and snowbirds that would trek out to fill their prescriptions (drugs purchase from Canada and Mexico to keep costs down).
I'm not sure where the big savings would come from compared to just going to a doctor not on a reservation. I don't think Canada or Mexico would do bulk drug sales to tribes. I guess they could allow foreign educated doctors that are allowed to practice in the US but don't have the same mountain of debt to pay down, but it only takes a few dangerously under-qualified doctors causing accidents to taint the name of a program like this.
posted by Candleman at 2:08 PM on November 23, 2016 [1 favorite]
Would you believe that Wise County elects Republicans to the state legislature with such force that the Democrats don't appear to bother running anyone against them?
That’s why Ben voted against Obamacare expansion in the General Assembly.
2,277 residents voted for Ben, who opposed expanding coverage, compared to 40 write-ins that opposed him. But he loves guns and hates gay marriage, so I guess it's OK.
Can you imagine if, alongside the casinos, the tribes were offering basic medical and dental care, prescription coverage, physical therapy and alternative therapies. Think of all the retirees and snowbirds that would trek out to fill their prescriptions (drugs purchase from Canada and Mexico to keep costs down).
I'm not sure where the big savings would come from compared to just going to a doctor not on a reservation. I don't think Canada or Mexico would do bulk drug sales to tribes. I guess they could allow foreign educated doctors that are allowed to practice in the US but don't have the same mountain of debt to pay down, but it only takes a few dangerously under-qualified doctors causing accidents to taint the name of a program like this.
posted by Candleman at 2:08 PM on November 23, 2016 [1 favorite]
Yeah, I went to college near here, and it's dire. Some of my friends from metro DC were shocked when they visited me. My ex was (still is, I suppose) from here, and he and his family struggle. It's hard to live there and access medical care, but it's even harder to leave.
posted by chainsofreedom at 5:42 PM on November 23, 2016 [1 favorite]
posted by chainsofreedom at 5:42 PM on November 23, 2016 [1 favorite]
I... had no idea things were THAT bad in the US. Consider me shocked.
posted by Too-Ticky at 9:29 AM on November 24, 2016
posted by Too-Ticky at 9:29 AM on November 24, 2016
But in a better version of the USA, we really shouldn't need an organization like RAM at all.
The "remote" part is an inextricable part of the problem here: as vuron says, there are all manner of disincentives for doctors and medical staff -- the cost of a medical education, the bias towards specialisation and against general practice, the role of expensive imaging and diagnostic technology, the unlikelihood of breaking even, the basic professional snobbiness towards people working outside of big city facilities. (The NHSC-LRP provides incentives to practice in remote and deprived communities, but it's very limited.)
The most obvious comparison is the Flying Doctor in Australia, but that's a product of a huge country where most of the population lives in a handful of conurbations, where rural and remote communities needed a distinct approach to healthcare. The structural anti-urbanism of the US creates the conditions for places like SW VA where it's culturally 1916 but in need of 2016 medicine.
posted by holgate at 11:10 AM on November 24, 2016
The "remote" part is an inextricable part of the problem here: as vuron says, there are all manner of disincentives for doctors and medical staff -- the cost of a medical education, the bias towards specialisation and against general practice, the role of expensive imaging and diagnostic technology, the unlikelihood of breaking even, the basic professional snobbiness towards people working outside of big city facilities. (The NHSC-LRP provides incentives to practice in remote and deprived communities, but it's very limited.)
The most obvious comparison is the Flying Doctor in Australia, but that's a product of a huge country where most of the population lives in a handful of conurbations, where rural and remote communities needed a distinct approach to healthcare. The structural anti-urbanism of the US creates the conditions for places like SW VA where it's culturally 1916 but in need of 2016 medicine.
posted by holgate at 11:10 AM on November 24, 2016
The "remote" part is an inextricable part of the problem here
Wise County isn't really that remote, at least compared to most of the rural US. There are half a dozen medium-sized cities and one large city (Lexington) inside a 3 hour drive, as well as a number of large hospitals and universities. The brain drain must be terrible.
posted by miyabo at 8:02 PM on November 25, 2016
Wise County isn't really that remote, at least compared to most of the rural US. There are half a dozen medium-sized cities and one large city (Lexington) inside a 3 hour drive, as well as a number of large hospitals and universities. The brain drain must be terrible.
posted by miyabo at 8:02 PM on November 25, 2016
Wise County isn't really that remote, at least compared to most of the rural US. There are half a dozen medium-sized cities and one large city (Lexington) inside a 3 hour drive, as well as a number of large hospitals and universities. The brain drain must be terrible.
Dunno if you've been there or not, but Wise County is really frikkin hard to get to, comparison or not. There is a UVA campus there which I went to one time, to see a friend in a play. It took us forever to get there, and I went to a local university (we also got lost twice, because the amount of rural backroads that were not apparent on our maps were quite numerous).
You are right about the brain drain, though. I have two friends, one from Big Stone Gap and one from Appalachia (the town) who moved to Cincinnati and New York City, respectively, and they rarely go home. No one at home is doing anything, there are no opportunities or anything really going on, and . . . it's really hard to get to.
posted by chainsofreedom at 4:48 PM on November 26, 2016
Dunno if you've been there or not, but Wise County is really frikkin hard to get to, comparison or not. There is a UVA campus there which I went to one time, to see a friend in a play. It took us forever to get there, and I went to a local university (we also got lost twice, because the amount of rural backroads that were not apparent on our maps were quite numerous).
You are right about the brain drain, though. I have two friends, one from Big Stone Gap and one from Appalachia (the town) who moved to Cincinnati and New York City, respectively, and they rarely go home. No one at home is doing anything, there are no opportunities or anything really going on, and . . . it's really hard to get to.
posted by chainsofreedom at 4:48 PM on November 26, 2016
The rural areas of Virginia and West Virginia I visited do have their idiosyncrasies, but they're philosophically and economically not THAT different from the rural areas where I grew up, after the General Motors plant moved out. And their problems weren't caused by physical inaccessibility.
posted by The Underpants Monster at 7:09 AM on November 28, 2016
posted by The Underpants Monster at 7:09 AM on November 28, 2016
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Every autumn there's a two-day, pop-up event for veterans called Operation Stand Down Rhode Island where volunteers provide meals, and dental & health care, and just some company for vets who need it. This all takes place in the same park where well-heeled children tumble out of SUVs for their weekly soccer games, and the counterpoint is...pretty glaring. It makes me glad that people care enough to give their time and talents, but very sad that it's necessary.
posted by wenestvedt at 5:34 AM on November 23, 2016 [6 favorites]