OUR VOICE: Keeping rural towns viable

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Farm Forum

To say that small rural towns are feeling picked on would not be an understatement.

First it was the months-long selection process by the U.S. Postal Service as it painstakingly tried to determine which rural post offices should be closed.

Now there is the threatened cut of Medicare funding which has the potential to close 26 rural hospitals in South Dakota alone, about 900 nationwide.

Here’s the formula: Critical access hospitals must be at least 35 miles away from another hospital to receive Medicare funding. Critical access hospitals receive 101 percent of the cost of treating Medicare patients versus a 70 percent rate. The reason for this is so that geographically isolated hospitals have sufficient funding to stay open. So any two hospitals that are fewer than 35 miles apart face the looming possibility that one will have to be eliminated.

It’s obvious that many of our small communities are simply circling the drain – businesses have closed, the young and educated have moved to urban areas to seek their fortune and now, the basic amenities upon which the remaining residents rely, are being severely curtailed.

It is unfortunate that the demographic of our rural towns is made up of the elderly and low-income residents who do not have the physical or financial ability to travel long distances for postal services, medical care and even church services. Even so, these are our neighbors and should not be marginalized.

Maria Kefalas, author of “Hollowing Out the Middle: The Rural Brain Drain and What It Means for America,” posits that rural schools do a brilliant job of developing academically and physically strong students, educated by teachers who develop solid and long-lasting relationships with their students.

Small towns have been enormously successful in producing confident young men and women who are encouraged to leave home and seek their fortunes elsewhere, resulting in a form of “community suicide.”

But there is another movement afoot, one in which those same students eventually want to come back to a safer, simpler place to raise and educate their own children. They leave for economic reasons and return for emotional ones. And when they return, what will they find? A deserted main street, co-opted schools and lack of services and amenities. In fact, in many rural towns the only remaining active business is the local tavern.

As with small-school teachers, the family physician is also a member of the community who has the time and knowledge to provide intimate family care, who can develop a long-term relationship with his patients.

It is without question that a health care facility is an economic engine in any community, particularly small ones.

Closing rural hospitals seems to be a step backward. We are being beaten over the head with reminders that the Baby Boomer generation comprises the greatest percentage of our population and yet we plan to “underserve” this majority by making health care more difficult to access.

This is more than a matter of simple economics. We must be far-sighted in this decision. We have to see beyond the next two or three years, see where society is headed. Are ghost towns on the prairie the future we want?