Article 30. Affordable Health Care in Cities but not in Rural Areas

Obamacare was designed after the Boston Health Care example with large populations and large numbers of hospitals and other health care facilities serving a large urban population.  It was built around the competition for health services for the urban population.  This strategy appears to work well in Boston New York and Chicago.  But this approach breaks down into complete failure in rural areas of the country that have only one hospital covering as much as a hundred square miles.   These rural hospitals struggle to survive anyway they can by charging enormous hospital fees and getting state and federal support.  Obamacare seeks to get around this problem by creating state wide competition among its hospitals an approach that has virtually no chance for success.

Example of the Rural vs. Urban problem
A close elderly friend of mine living a rural small town in Missouri needed Cataract Surgery for her to continue to drive her car.  Cataract Surgery involves replacing the damaged eye lens with a plastic lens costing about $11.  The procedure takes about five minuets for each eye.  Only one eye is done at a time in out patient surgery with the patient coming in the next day for the removal of the eye bandages and inspecting of the eye.

I did some research for her to find the most affordable alternative she had Medicare but no supplemental insurance these are the results:

1.  The best prices were in Springfield Missouri more than a hundred miles away. A private eye clinic gave me the following estimate:
$190 for eye examination
Cataract surgery Doctor and Clinic fee for each eye $1635 done in the clinic
Total cost for two eyes = $3460
Patients cost at 20% of total = $692
Total Cost to Medicare for two eyes = $2768
     
2. The second best price in her home town Rolla Missouri at Mercy Clinic.
$220 for eye examination
Cataract surgery each eye: Doctors fee $2066
Clinic out patient fee for each eye $5400 done in the clinic
Total cost for two eyes = $15,152
Patients cost at 20% of total = $3,030  
Total Cost to Medicare for two eyes = $12,122
  
3. The third and highest price in her home town at Rolla Missouri Phelps County hospital.
$220 for eye examination
Cataract surgery each eye: Doctors fee $1835
Clinic out patient fee for each eye $9500 done in the hospital,
Total cost for two eyes = $22,890
Patients cost at 20% of total = $4578      
Total Cost to Medicare for two eyes = $18,312

Since the patient could not get to the Springfield Missouri Clinic she decided to get MediGap supplemental insurance and have the Eye surgery done in her home town at the cost of the Medigap annual preimium cost. This an excellent example of the differences between urban and rural healthcare costs. 

I saw on TV recently that a group of Eye Surgeons from the US had flown to Africa for a one week stay to treat hundreds of indigent patients with Cataract Surgery at the cost of bandages and an eleven dollar plastic lens. Since there is practically no medical emergency associated with Cataract Surgery Why couldn’t  Medicare do this in the US at a fraction of the cost.  Could it be that there might be some objection from Eye Surgeons and other doctors who specialize in diseases of the rich tax payer.

Obama care has not addressed this affordable health care “dead on arrival” problem.  This problem is just one of what appears to hundreds of similar problems among them the higher cost of drugs in the US  being another.

Comment by Lawrence Rosier
Somehow the Federal Government must provide a competitive environment in health care in the rural areas of the US to even begin to make Obamacare work.

My recommendation is that since the federal government must provide health care for thousands of Veterans and that the current aging VA Hospitals need to be replaced.  I would replace them with efficient modular hospitals.   These new efficient hospitals could provide the basis for an affordable Health Care competitive system in the US.   But to do this I further recommend that the Washington bureaucrats not be allowed to design this new system and that it be designed by the DOD’s own Lean Six Sigma trained personnel.