Saturday, July 1, 2017

Left behind

In the New Yorker, an illuminating interview with the only doctor in one of the poorest counties in Georgia.

Dr. Karen Kinsell sounds like a nominee for sainthood, although the interview is deficient in explaining exactly what the economic structure of her clinic is.

Nut grafs:

“Most people are so poor and kind of out of it that they don’t expect anything. They mostly just expect to not have insurance.

"This morning, we had a lady with post-menopausal bleeding, which could be cancer. The absolute best thing to do is have her checked out by a gynecologist, but we really don’t have a way to do that that she can afford. The health department has some programs, but they generally require a diagnosis of cancer before their programs can pick up. So that’s a problem.

"People constantly have a problem being able to afford their medicines. I use generics all the time. And prescription-assistance programs, which are a tremendous amount of paperwork, which people have trouble doing. We use samples from drug reps.

“There’s no mental-health care in the county, which is crazy. I just had an eighteen-year-old who needed some mental-health medications renewed, so I did that. There just isn’t what you’d expect to have in America down here."

It sounds a lot like Maui County, except we're rich. But we don't have any mental health care at the hospital, and not even any private mental health care for young people.

And it sounds even more like the rural parts of the state, like Kona.

It raises a question, whose answer is, to me, easy:  Do Americans in the hollowed-out parts of the country get any medical care?

RtO has pointed at this problem before; the review of "Wide Ruins," for example, referred to "wild rides." Those were to get sick people to the neares medical help, about 140 miles away over unpaved tracks.

It is out of the question to expect modern medical services nearby for people who live so far out in the sticks, but Clay County, Georgia, is not that remote. It even has a "chicken plant."

The New Yorker report does not explain it, but Georgia has small counties, a hangover from an old-time voting system called the county-unit, which gave rural voters excess voice in the Legislature, on the same principle that the U.S. Senate does to small states. The county-unit system is gone but Georgia  has never rationalized it tiny counties. It might, perhaps, be somewhat simpler to deliver medical care if Clay and nearby counties were combined into a larger county with greater total resources.

Anyway, Clay County seems to have benefited little from Obamacare, but the Republican approach  -- as exemplified by the idiotic Sen. Ron Johnson -- would just dump the rural poor into the hands of root-doctors.


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