[imgcontainer right] [img:tim+preceptor.jpeg] Rural health care administrator Tim Size. [/imgcontainer]

I love my digital video recorder, during election season more than ever. 

It is great to record favorite shows for watching whenever you want to. And it preserves my aging sanity to be able to click forward over the endless televised political tantrums. 

Like many of us in Wisconsin, I’m tired of the endless candidate robocalls. Call me stupid, but I really don’t think that Republicans will send granny (my wife) over the cliff or that the Democrats will put her before a “death panel.” 

The real differences between the parties are significant. But both share the reality that Medicare is going broke and needs to be reformed. The question is how to do it?

FactCheck.org describes the differences (8/22/12): “The Obama approach is to stay with government-provided traditional Medicare while putting pressure on health care providers to deliver care more efficiently, and instituting new payment models and coordination of care to cut costs. The Romney-Ryan plan turns to competition among insurance companies to lower costs and premium support payments to induce seniors to pick their health plans based on price.”

This may be an election in which we get to pick our poison: health care run by big government or by big business. 

As an optimist, I believe Medicare over time will not stray too far from its American roots – taking care of our seniors while maintaining a healthy tension between the public sector and the marketplace. 

But a lot of specifics are missing in action. I need to know what the new Medicare will do to rural Medicare beneficiaries, rural communities and the health care providers that serve them. For me, the following questions apply equally to both parties. Will a new Medicare:

…protect or undermine rural beneficiaries’ getting healthcare locally?

… make it harder for the rest of the rural community to receive care locally?

… encourage insurers and providers to serve all rural patients, including the least healthy?

… support the unique role of rural hospitals and clinics? 

… increase or decrease the jobs available in rural America?

Like many of us who live and/or work in rural America, I am sick of being treated as if we are a drag on the Medicare program. Some would want you to believe that rural is a black hole for scarce Medicare dollars.

In fact, the opposite is true, according to a new report by iVantage Health Analytics: “Physician services payments are 18% lower and hospital service payments are 2% lower for Medicare beneficiaries living in rural versus non-rural settings. Cost per Medicare beneficiary is 3.7% lower overall for rural vs. urban beneficiaries.”

The report continues: “Approximately $7.2 billion in annual savings to the Medicare program could be realized if the average cost per urban beneficiary were equal to the average cost per rural beneficiary. Medicare already benefits from $2.2 billion of lower beneficiary costs for care delivered to rural beneficiaries vs. urban.”

Rural citizens pay taxes at the same rate as all Americans. Some may wish to have rural pay more to receive less than the rest of the country. 

But there is no basis for saying that rural is receiving more than its fair share of Medicare spending.

Regardless of who wins this election, those of us in rural healthcare must be part of the solution. To be part of saving Medicare, rural healthcare providers, like all providers, need to continue doing more and better for less.

We need to make the full transition to adopt health information technology. We need to focus on providing quality and cost-effective care as opposed to simply increasing the volume of service. We need to collaborate with each other and urban providers to deliver the continuum of care seamlessly to  all patients. We need to partner with all parts of our rural communities to create a healthier people.

Bottom line: rural America is affected by where our health care dollars are spent; rural communities are hurt badly when policy and politics ignore the impact on rural health and the impact on the local rural economy.

Tim Size is executive director of Rural Wisconsin Health Cooperative in Sauk City and former National Rural Health Association president. This article first appears in the September edition of RWHC Quarterly.

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