Lolo Montana Rural America

Montana’s Health Crisis: Capitalist Devastation in Rural America

In August of 2015, Lolo Family Practice, the only health service provider for Lolo, Montana, closed its doors. This sudden closure, which was due to state budget cuts, left the nearly 4,000 people of Lolo without any access to healthcare in their town. They now have to make the ten-mile drive to Florence, Montana, for all their medical needs. Ten miles may not seem like much, especially in Montana. Still, when it’s the dead of winter, with a foot or more of snow on the road, ten miles can seem like an eternity, especially in an emergency when every second counts.

The plight of Lolo mirrors the crisis facing much of rural America. Since 2010, 119 rural hospitals and clinics have shut down across the country. This figure does not include mental health facilities, rehab centers, or nursing homes. Montana has been especially affected by this crisis. Since 2017, the state mental health budget has been cut by $49 million, leading to the closure of several mental health clinics. The closure of any health facility in Montana is exaggerated by the vast distances that separate population centers in the state. For some towns, the closest “city” may be a three-hour drive under ideal conditions.

Empty hospital beds
Since 2010, 119 rural hospitals and clinics have shut down across the country, and Montana has been especially affected by this crisis. / Image: Public Domain

These closures are, therefore, acutely felt. Montana has the highest annual suicide rate in the US. At 30 deaths per 100,000 people, this exceeds the per-capita suicide rate of any nation. It also has the highest per-capita mental health services usage. The number of Montana residents seeking mental health care nearly doubled between 2007 to 2015—coinciding neatly with the 2008 recession—rising from 26,200 to 41,800 clients. Yet, per-capita spending fell from $241 per person per year to $160 over the same period.

Physical health care facilities have also been gutted. According to a study by Navigant conducted in February of this year, twelve rural hospitals in Montana are at risk of closure. All twelve of these hospitals are considered essential to their communities. The reason for the looming closures? “A loss of agricultural and manufacturing jobs has led to a corresponding degradation of the payer mix.” The serviced population has become poorer, so the rates of “uncompensated and undercompensated care” has increased. After having their livelihoods destroyed by the crisis of capitalism, workers are then essentially told, “Sorry, but you can’t afford to live.”

Further straining the system is the opioid epidemic ravaging the state. Montana suffers 12 opioid-related deaths per 100,000 residents per year. This is lower than the national average of 22 people per 100,000, but Montana’s inpatient stay rate due to opioid abuse is right at the national average of 240 people per 100,000. Montana’s hepatitis C infection rate is double the national average, at 26.41 people per 100,000 as compared to 13.9. This is due, at least partially, because only four of Montana’s 56 counties operate needle exchange programs. The lack of such programs has also contributed to two Montana counties becoming some of the most at-risk counties in the nation for HIV infection.

In 2017, AMFAR reported that 90% of people with a drug addiction in Montana were not receiving any form of treatment. Of course, it’s hard to seek help when the facilities providing that care keep closing. Since 2014, three rehab centers have closed in Montana, and only one new facility has opened. Access to medical care of any kind is extremely limited in Montana. 13.9% of Montanans have no health insurance, higher than the national average of 12.16%. In Glacier County—which happens to be nearly two-thirds Native American—that rate spikes to 48.8%. The reality of the healthcare situation in Montana may be much worse than all the statistics reflect because most counties in Montana don’t report many health metrics to the Montana Department of Health and Human Services. For instance, in 2016, only 18 of the 56 counties reported the number of new HIV cases they experienced.

Jardine, Montana Ghost Town
In Montana, the devastation of the last capitalist crisis remains to this day—just as the next crisis threatens to hit. / Image: Public Domain

Montana is often thought of as one of the last frontiers of America, where the rural way of life still dominates. This was the perception I had before coming to the state, but the reality is far different. Driving along its expansive highways and backroads, one is mesmerized by the seemingly endless and astonishingly beautiful scenery. But one also passes through the decaying remains of abandoned or burnt-out towns, places with a hundred homes, but only twenty of them occupied, where nature is slowly reclaiming the lots and fallow farmland wrested from it. In such places, the vaunted claims of economic recovery and growth pushed by the capitalist politicians seem particularly outlandish. The devastation of the last capitalist crisis remains to this day—just as the next crisis threatens to hit.

Like so many other rural corners of the US, the state once known as “The Last Best Place,” is being hollowed out. Over half of America’s rural and micropolitan counties—those with 10,000 to 50,000 residents—have shrunk in both population and employment every year since 2008. Due to the abysmal employment opportunities at home, their younger residents have been forced to emigrate to urban centers, where they face skyrocketing housing costs and low wages. The tax bases of the places they leave are sent into freefall. So how does the capitalist system respond to the plight of those who are left behind? With abandonment and the systemic gutting of what few social services remain. Only a socialist revolution, the conquest of political and economic power by the working class, can put an end to this macabre state of affairs and ensure a decent livelihood and a brighter future for all.

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