I’m Voting Yes on September 18—Here’s Why

Next week, Alabama voters will have an opportunity to do direct democracy.  We, the voters, not our elected representatives, will make the call.  Will we continue to operate essential state functions by using our state savings account, the Alabama Trust Fund?  Or will we fold and hand the decision back to folks who have already shown they can’t do it right?

 I’m voting Yes.  It was not an easy decision.  Like many of you, I am frustrated that our elected representatives could not do an effective job and that this has been thrown in our laps for political convenience, not because they really care what we think.  There are more responsible ways to manage our state budget, and it is tempting to think we could force a better choice by voting no.  I’ll get to my thoughts on why that isn’t likely in my last piece this week.

There’s another reason progressives give for their No, and this one chills me to the bone. Some people think that if we vote no and Montgomery fails to fix it, enough suffering will happen that voters will cry foul and either immediately force a funding change or vote this crowd out of office in 2014. I can’t go there, for both political and ethical reasons, because the suffering will fall too heavily on the voiceless, the children, who shouldn’t be held to account for the votes of their parents.  I know there are other groups served by Medicaid, including persons who are disabled or elderly, and that there are other functions of the state affected by the vote next week.  Right now, though, it’s hard for me to think about anything but the children.

For those who can grit their teeth and consider the nuclear No option, I’m wondering if this rests on the expectation that once funding is fully restored, whether after a few months in 2013 or later in 2014, we can quickly revive services we lost.  For medical care, that simply isn’t true.  A short lapse in adequate funding, including payment delays from “temporary cash flow” problems, could create a disaster that will take years if not decades to overcome.  If you think Obama got a raw deal inheriting the Bush economy, you need to think twice about your No.  A new group in 2014, no matter how good they are, could not possibly repair the damage in time to let voters notice a difference.  Don’t set your candidates up to fail.

Today, I’ll focus on rural medicine, and later this week I’ll address the somewhat different situation in semi-urban and urban areas.

The life of a rural physician is hard, not only for financial reasons.  In fact, rural life can just be hard, period, for people who are not accustomed to it.  I come from Tuscaloosa, and I did practice for about 1.5 years in rural North Carolina before my family returned to our home state.  It was lovely, and the people were marvelous, but Lord, have mercy.  There was no pediatric emergency room, no neonatologist, no pediatric specialist—we were it, at all hours. 

In small places, a doctor is really never off call.  My residency program had an arrangement with the only pediatrician in a small town nearby.  Once a month, a senior resident would drive down and stay in a hotel to cover the practice for the weekend.  The pediatrician had learned the only way he could use this time off to be with his family was to leave town completely and tell no one where he was going.  Otherwise, the patients would find him.  For parents with young children, this is wearing.  I left my daughter’s 5year old birthday party to help one unexpectedly busy Saturday when I was supposed to be off.  It might sound trivial, but she can’t get that day back, and as you can see I still feel bad about it.  I have tremendous admiration for doctors with enough commitment and character who stay and serve their patients.  They are truly heroes in my book.

That’s why the retention rate for doctors is far higher for those who grew up there and appreciate the wonderful parts so much they return after training.  It is higher when they have mentoring contact during training with established rural doctors.  And it is higher when there are other doctors already in the community, so that they can share call responsibilities and have a network of support.

We have in our state two initiatives that take these factors into account, the Rural Medical Scholars Program and the Rural Medical Program.  Simple loan repayment plans that help doctors afford training in exchange for a term of work in an underserved community have a degree of success, but far too many graduates leave the area when they’ve finished their obligation.  Alabama’s programs have a different approach—they identify potential doctors in rural areas years in advance and begin prepping them for long-term practice.  The results have been phenomenal.  I help teach many of the students and Family Practice residents who participate—it is an honor to contribute to the health of rural communities in my state.

These rural doctors are the first who will feel the effects of Medicaid payment cuts or delays, even if short term.  Sure, some will take out loans as they had to last spring during the payment delays, but if this is the second time in a year, maybe not.  They may just have to make the painful decision to relocate, perhaps even out of state.  They are talking about it already, because of the constant uncertainty.  Others close to retirement may decide the time to end their careers is at hand.  When these doctors leave—uproot their families, sell their homes, and get established in new locations (hard and stressful to do for doctors in primary care, where we are used to building long-term relationships with patients)—they will not turn around and come back upon the restoration of funding. 

How long would it take us to get other doctors into those places?   The work of recruiting through the Rural Medical Program begins at least 7 to 8 years in advance- at the end of college, followed by 4 years of medical school and 3 years of residency. There is even some contact with interested high school seniors.  Those close to finishing residency next summer will hesitate to go into practice in communities where the established doctors have just left the state, and they are making these decisions and interviewing for jobs right now.  The others, if they lose access to rural mentors during earlier parts of their training, are less likely to choose rural practice at all.  I’ve told you about the domino effect before—the doctors leave, the nurses and other medical employees have nowhere to work, and the hospitals without staff can’t help you.

I talked to Dr. Bill Coleman, director of Huntsville’s Rural Medicine Program, a few days ago.  He told me that interest in rural practice, partly because of all these years of effort, has been increasing—he said we were “on the cusp” of significantly expanding our rural physician infrastructure.  He is dismayed at the possibility we could lose the doctors serving as mentors, already at maximum capacity and serving at financial cost to themselves.  He has put his heart and soul into this work, now coming to fruition.  What a useless waste, for all that time and sweat to be undone in a fit of political posturing.

I’m voting Yes next Tuesday.  My Yes is not to the politicians who have failed us or to the irresponsible misuse of funds.  My Yes is to these honorable men and women who have put their lives into serving the rural poor and to the children in their care.  Will you join me?



Filed under Alabama Fall 2012, Children's Issues

10 responses to “I’m Voting Yes on September 18—Here’s Why

  1. You got that right Sylvia Parker. We do not want them to raid this fund and kick the can down the road like the Damned Democrats have done for the past several decades locally and nationally. I was afraid that Bentley would cave after he Accepted The Hate Speeches that the Democrat Bundlers and AEA funded his campaign by running Lying Ass Ads against Bradley Byrne who should be our governor now, had it not been for the Democrat Pac working on Bentley’s Behalf. Bentley sees this as Pay Back Time Now for the AEA and The Alabama Democrat Party. WE must defeat this Scheme.

  2. Well done.

    Stan (205)215-9400 (cell&text) stan@stanjohnson.com

    • Vote No on this outrageous Raid on the Trust Fund. We have to Down Size government at every level of government. The government’s job should not go beyond providing for national, state and local security. Citizens should be encouraged to take care of themselves when possible. We need safety nets for those who truly are disabled, too old, or too young, but all the Able Bodied Deadbeats need to Take Care of Themselves. It is like Abe Lincon told the Southern Aristorcrats when they said, “what will we do without our slaves?” Abe told them to “Root Hog or Die!!” That is the message we need to be sending to people and get government out of our personal lives, and also to stop passing regulations and laws that destroy business and profits and by reducing the size of government, these Spend Thrifts who Buy Elections By Promising more and more Free Stuff to Deadbatss will not be reelected and we get a government that Simply Does It’s Job of Public Safety and Security and Nothing More.

      • I don’t think you understand. Almost half the children in our state have Medicaid, much higher percentage in rural areas, and the money that brings in helps provide the funds for the doctors’ offices and hospitals the adults with insurance go to in those places. No money for the CT scanner and so on, minus Medicaid. There are not enough people with money/ insurance in those areas of the state to pay a doctor or hospital just for themselves. You just don’t see “concierge” type offices in, say, Pickens County, even though there are plenty of hardworking people who live there. So with your plan, only deadbeats should live in rural areas I guess? Since there will be no doctors or hospitals there? Or just don’t get sick, I guess.

        Businesses also don’t want to locate in areas without medical care for their employees. This will hurt our economy even further.

      • When I was growing up in rural Alabama in the 1950’s and 1960’s my parents worked for West Point Pepperell Textiles company. My folks paid for health insurance at their jobs which covered Major Medical. Our parents did not use ER’s for First Aid Stations for Skinned Knees, sneezes or a common cold. If our parents took us to see our family physician for a checkup or a non emmergency situation, they paid for the visit and the prescriptions, if needed out of pocket, and we grew up just fine and healthy. When we started all these Medicaid Programs for the so-called poor, the system began to be abused big time and has grown worse every year as the Welfare State Bureaucratic Empires have grown in Size, Power and Spending and who still go out and Recruit New Folks to Put on Welfare and Food Stamps and Medicaid. They call it Job Security by building Their Bureaucratic Empires. Doctors had to become intellectually dishonest by seeing Skinned Knees and Sneezes and Common Colds in order to Get Medicaid Dollars, instead of telling these parent to take care of First Aid Needs at home. When people have to Pay for A Hospital Visit, Prescriptions, and Doctor’s Visits, they Do Not Abuse It if they Have To Pay. The more of anything you Give Away, the More Takers You Get, and with the Takers who believe they are Entitled To Take, they lose All Respect for what they have and what they get and Replace Gratitude with a Demanding Attitude because they have been taught and trained to believe they are Entitled. We have had the Hill Burton Act for decades and the poor and indigent have never been denied Critical or Necessary Medical Care. The Current system is wrought with Fraud, Waste and Abuse and needs to return to Sanity and Normalcy in Health Care and in all other areas of our Sick Society, and I do not mean Physically Sick, I men Sick as our situation is Sickening and Is Reucing the USA to the status of a Third Rate Communist Third World Country, and I cannot believe a Practicing Physician would suppor this Bogus System unless this is the Only Business you have.

      • Please look at my post today, to see an example. Cuts in Medicaid could mean yet another rural hospital can’t deliver ANY babies at all– not the babies of the pay-your-way people, not the babies of the privately insured, no babies, period. Is this really what you want?

  3. 2012nancyj


    Thank you so much. I will get my list of e-mails and forward to as many as I can this week. You are right on target with your blog!

    Wish I had more time to do more. We have gotten moved. 303 Williams, suite 125. IN the Gold building on the Gallatin street side. When you get ready to do your Nutrition Program, let me know and I will find a good place for you to hold that. We have room in our “file room” for that large table, a white board and will accommodate 5-6 people.

    I am right across the hall from the CPA firm of Melvin, Bibb, Pinson & Segars. I certainly don’t mind asking them about access to their large conference room if my room will not accommodate you. Come down the street and see us when you can. Call ahead to make sure we are here. My office phone is the same, cell is same, 256-508-2480.

    Have a good week and how lucky we are to speak up with such good voice and correct information!


    Nancy Gill

    256-880-9628 Office

    256-508-2480 Cell


  4. I don’t want to appear like the National GOP in voting against progress in the hopes that things will get so bad something big will change, that is for sure. The lives of the jobless they have ruined would be on my conscious.

  5. L. Menefee

    Voting YES on this ballot measure is a ‘band-aid’ fix, but there is NO way I can vote NO and possibly allow thousands of Alabamians to suffer. I know I couldn’t sleep at night. I’M VOTING YES!

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