Vilsack, the public option & the short end of a very long stick

"There's lots of debate about what the answer is but I'll tell you the one answer that ought not to be the acceptable to anybody regardless of what your position is on all of this is: maintaining the status quo. We have got to reform health care in this country…Rural America really comes out on the short end of a very long stick under the current health care system." — U.S. Ag Secretary Tom Vilsack, August 19, 2009

U.S. Ag Secretary Tom Vilsack held a town hall meeting at the Iowa State Fair this morning. (Read and hear more about the event here.) (This is a live blog of the forum.) During a 55-minute question-and-answer session with a crowd of about 200, health care reform came up just once.  Denise O'Brien, a Democrat who ran unsuccessfully for state ag secretary in 2006, asked about community supported agriculture, but then segued into health care.

"One of the things which is such a point of contention now all over the United States is the health care issue. I believe strongly that we have to have a single payer health care system need that will cover people so we don't have to worry about losing our farms, losing our homes, and that we don't have to worry about whether or not we can go to the doctor for preventative medicine," O'Brien said and many in the crowd applauded.

Vilsack gave an answer that started, as O'Brien had, with the subject of community supported agriculture, then he launched into health care.  Vilsack made no mention of a "public option." Here is the transcript of his answer:

"The issue of health care, obviously we've had an interesting conversation about that in thiscountry.  Let me just put it in a rural perspective so that people fully understand why the status quo is not acceptable.  Now, we can have a discussion and debate about what the answer is, but here's why the status quo for rural America's not acceptable. (Vilsack briefly mentions he's talked about the issue with Congressman Leonard Boswell; Boswell is sitting next to Vilsack.)

"Twenty-three percent of people who live in communities of less than 2500 do not have insurance.  Now, you look at Iowa, a state of 950-some towns — the vast majority of which have less than 1000 people. So virtually one out of every four people in…small towns in Iowa do not have health insurance coverage.

"Now, here's what happens:  it's not that these people stop getting sick because they don't have insurance coverage.  They stop going to the doctor because they can't pay the doctor, but the get sicker and sicker and they finally end up in emergency rooms.  Hospitals say, 'Look, we've got to take these people.  They're sick.  We've got to take care of them.' That's the most expensive health care you can get.  Somebody's got to pay for it, so what the hospitals have to do is they have to shift that cost to people who can afford to pay for health insurance, so I don't know the fact in Iowa but I think it's somewhere in the neighborhood of $950 million of costs get shifted to insured customers, so the rest of us who paying insurance premiums, we're paying more and for self-employed people — for farmers — that's tough. 

"(The) second thing is that people in rural communities actually end of paying more for their insurance than folksin urban centers. It's about $1000 more — higher co-pays, higher deductibles, more out-of-pocket expense and so there's another hidden cost that we pay in rural areas which makes it more difficult for farmers, self-employed people and because we have a disproportionate share of small businesses and self-employed people, it exacerbates the problem.

"And then finally is the issue of access. Because we don't have reimbursement levels that are fair, that focus on quality instead of on services, states like Iowa don't get fairly reimbursed, which means that it's harder for physicians and hospitals to stay in small communities where they're working 24/7 and making substantially less than their urban counterparts, so we don't have docs, we don't have clinics and our hospitals struggle.

"I'm sure the congressman has heard this as he's traveled around his district, there's lots of debate about what the answer is but I'll tell you the one answer that ought not to be the acceptable to anybody regardless of what your position is on all of this is maintaining the status quo. We have got to reform health care in this country for the reasons Denise mentioned andfor the reasons that I have mentioned which is that rural America really comes out on the short end of a very long stick under the current health care system."