In Dr. Glenn Hurst’s mind, expanding health care is what it will take to revitalize rural Iowa.
Hurst is running in the Democratic primary for US Senate in hopes of challenging Republican Sen. Chuck Grassley. The southwest Iowa resident said having a Medicare for All infrastructure is one of the most important things to implement in Iowa and would push for it in the Senate.
“I don’t just see it here in my community. I see it everywhere,” Hurst said. “How health care has just diminished in availability. We’ve seen a diminishing population in our rural communities. And I see it as a place where we could invest in the infrastructure that could revitalize and make those communities viable again.”
Hurst said Medicare for All would expand the options people in small towns have because they could go to whatever doctor they wanted. It would also increase the demand for doctors because of how many more people would have the coverage to go to doctors rather than emergency rooms.
“Medicare for All does a variety of things for communities, individuals, and providers,” Hurst said. “For communities, it puts money into brick and mortar structures. It also puts reimbursement on the table for services that are provided that are frequently denied and not paid for by private insurance. It also opens up the number of patients available to that facility. There’s no closed networks in Medicare for All.”
He’s the only doctor in his town of Minden, in Pottawattamie County, but he only sees about a third of the population because private insurance companies make patients drive 30 minutes out of town to see in-network doctors.
“They don’t get to make a decision based on quality or convenience or personal preference,” Hurst said.
Under a more open system, he said more services will be needed, which also means more providers.
Small towns need that kind of convenience, Hurst said. Rural hospitals and nursing facilities had closed and available services, such as obstetrics and gynecology, are shrinking.
In Iowa, a shortage of providers is a big reason why OBGYN clinics have closed for the past several years. Distance, lack of insurance and workforce shortages are among the main reasons why access to care in rural areas is difficult, and why so many rural hospitals face closures.
Hurst’s definition of Medicare for All may be a little different from how many Iowans may view it.
“It should include offering health care services to every person in this country from birth to end of life. It includes vision, dental, hearing, long-term care, mental health care, and the basic hospitalizations, wellness that we are currently familiar with,” he said. “So the addition is everything up to those traditional health care services, doctor’s visits.”
Hurst said an open health care system such as the one he envisions would require changes and creativity to handle, whether that be expanded telemedicine or providing care where the patients are.
“For example, my clinic, before COVID, did an allergy shot clinic at our local school. And we would give shots to approximately seven to 10 patients every week,” Hurst said. “In doing that, we saved over 100 missed hours of work and school time by us going to the patients and doing it at a place where they already were versus having parents have to pick up kids, drive them into Council Bluffs 30 minutes away, where they would get their shots, drive them back to school, drive themselves back to work.”
It won’t be easy to sell, Hurst acknowledged, but he said he’d want a better information campaign for the public and a focus on what better health care would mean for individuals. He would also point out that costs may fluctuate as the country transitions, but ultimately it would go down because hospitals and suppliers wouldn’t have to shift costs onto patients who can pay.
“So not just price control of drugs then, but more price control of the actual services and therapies provided,” Hurst said. “Price control for physical therapy, occupational therapy, home health, hospice, all of those things that are beyond just the doctor bill, but are the actual implementation of treatment and comfort. Those prices should be less and they would be negotiated through the Medicare for All system.”
When it comes to getting this through the Senate and past lobbyists in the health care industry, Hurst said he would bring his experience in health care to the debate.
“It’s going to be awfully hard to intimidate me with a story that a lobbyist can bring in when I have hands-on experience as a health care provider in a clinic, in the hospital, in the nursing homes, as a hospice director,” he said.
Under this system, he said hospitals wouldn’t have to write off the cost of uninsured people going to the emergency room for health care. Also, even if reimbursement rates were lower, doctors would be paid more often, for every service they provide. Doctors and hospitals wouldn’t have to fill out complicated paperwork and negotiate with insurance companies either, he said.
“It will streamline the bureaucratic process and it will improve access. We should see more patients, more often, get paid for all of them, and do less work to try to get paid,” Hurst said.
by Nikoel Hytrek