Monday, March 22, 2010

The Urban/Rural Divide on Health Care

- posted by Craig Albert

I was struck, in the House votes on the health care bill yesterday, by the urban-rural divide in the vote tally. There are 75 cities in this nation whose population exceeds 250,000, and the total population of those cities is about 55 million. The House members representing 56 of those cities voted in favor of the bill, while those representing 18 voted against (Miami split). The "no votes" came predominantly from small cities. Apart from Fort Worth and Oklahoma City, all of the urban "no" votes were from cities ranked 40th and smaller by population, totaling less than 7 million. Now, if you look at the map, it's easy to see that gerrymandering concentrates Democratic power within cities, while Republican districts are drawn to go to the city border and no farther. But I wonder whether the well-documented disparities between urban and rural areas in availability of health care services has given rise to a difference in attitude toward paying for health care. The story would be that people who don't have ready access to health care and therefore use doctors less frequently, and have learned to get along without ready access, don't feel the need or desire to participate in a plan that doesn't necessarily increase access to health care services in their own communities. (By the way, the rural dwellers are not healthier than their city counterparts. According to a CDC survey, non-MSA dwellers self-report themselves as being in "fair" or "poor" health at about 50% greater frequency than MSA dwellers, although the distribution of the number of doctor visits per adult is roughly similar among the two groups.)


michael a. livingston said...

It's also possible that rural folk have better access to informal networks of both health and economic support--family, friends, perhaps even doctors who volunteer through churches and other voluntary groups--and accordingly less need for organized support. Then again, it's possible that some of the poorer rural folk were forced into the cities precisely by lack of this kind of support. An interesting angle on a continuing problem.

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