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Build coalition

Meaningful Medicare reform will require teamwork by rural states

Oregon Sen. Ron Wyden says it's difficult to get anyone in Washington, D.C. to pay attention to anything but the war in Iraq. As a result, action to fix the scandalous inequities in Medicare reimbursements is unlikely anytime soon.

All the more reason to build a coalition now to demand attention to a problem that threatens the health care systems of Oregon and other largely rural states.

Like the one now pushing toward Baghdad, this coalition needs to move aggressively. Its target is not enemy troops, it is a system of Medicare reimbursement that rewards inefficient, high-cost medical care in some parts of the country at the expense of efficient, lower-cost care elsewhere.

Some senior residents of Southern Oregon have to search for months to find a doctor willing to see them because the payments doctors receive for treating Medicare patients is less than the cost of keeping their offices open.

Some doctors have dropped out of internal medicine ' the specialty that focuses on older adults. Most have set limits on the number of Medicare patients they will see. And finding new doctors to move here when vacancies occur is getting more and more difficult.

While our health care system teeters on the brink of collapse, those in some parts of the country fare better.

Insurance companies providing coverage for Medicare patients in Miami, Fla., get &

36;834.20 per patient per month from the federal government. In Medford the figure is &

36;500.37.

The disparity is bad enough, but the really aggravating thing is that states with much higher reimbursement rates are less efficient at providing care.

Wyden points out that the average hospital stay in New York is eight days; in Oregon it's four days. But the Medicare reimbursement rate in Bronx County, N.Y. is &

36;811.91.

States such as New York, Florida and California have managed to maintain these unequal payments because they have larger populations and therefore much greater clout in Congress. The only way to counter that clout is for the congressional delegations of smaller, rural states to band together.

Only when there are enough votes to block legislation the big states want will there be any hope of changing the system. Every member of Oregon's congressional delegation should be enlisting in this fight, and recruiting colleagues across the country as well.

Do your part

An insidious pest ' the mosquito ' not long from now will be hatching around homes in Jackson County. This year that threat will be worse than usual as the West Nile virus arrives in Oregon for the first time.

The virus causes a flu-like illness in humans. It's not usually fatal, but can be to the elderly and others with weakened immune systems. Horses are particularly susceptible.

Oregon has all the conditions that make it a prime location for the West Nile virus: lots of migratory birds, lots of mosquitoes that can carry it from birds to humans, a large horse population ' and lots of water.

Water is the key. Standing water is where mosquitoes hatch.

Residents should be checking now and emptying containers that can hold water, such buckets, ornamental pots and old tires.

That's good advice every spring and summer ' mosquitoes are annoying even if they don't carry disease ' but it's even more important this year.