Studs Terkel, the eternally optimistic author of Hope Dies Last was always a champion of the little guy. The health care legislation we can expect from Congress still leaves millions of Americans uninsured, does nothing to lower premiums and certainly does nothing to increase access to health care in under served areas. Studs must be rolling in his grave.

Farmers and other rural residents are severely limited in their access to health care. Rural hospitals and clinics have been taken over by health care corporations, closed or merged, their services outsourced. Small town doctors in private practice are, in many cases, forced by the inherent economics of the insurance bureaucracy, to become part of the corporate system.

Is this bad for rural residents? It forces us to use larger urban hospitals, which, for those of us with inadequate or no insurance, is unaffordable. It also takes away the availability of adequate local care and doctors who see patients as people, not as a compilation of statistics and test results to be run through the system in assembly line fashion.

I remember the days of the family doctor making house calls, the local hospital where we could get stitched up, have babies and minor surgery. Part of the hospital was a nursing home that provided seniors the opportunity to stay in their small town when they needed care. The doctors were not rich, but they were loved, respected and a part of the community.

I can get health insurance from a number of private insurance companies, unlike urban markets where competition is often limited to only a few corporate insurance providers. Problem is, I and roughly 46 million other Americans cannot afford insurance, whether we are rural or urban.

In rural areas, health care is an acute problem. Rural residents are twice as likely to be uninsured as urban Americans. Farmers and ranchers are four times as likely to be “underinsured”, (covered by insurance with reduced benefits and high deductibles) and our access to health care is often limited.

The American Academy of Family Physicians noted that in choosing their practice site, graduating physicians rated factors such as family, culture, community and schools ahead of income potential. While many doctors might shun rural family practice for higher paying specialties or prefer the social life of the city, most of us would much prefer a physician who saw community and people as more important than money. After all, that is what drives most small farmers and rural folk.

The Medical Group Management Association, in its 2008 compensation report indicated that family physicians and general surgeons who worked in private practice tended to make more than those who worked for hospitals, so the income potential is there. However, due to the pressures of collecting insurance reimbursement, paperwork, dealing with the uninsured and caring for those who, due to lack of insurance coverage, are unable to seek preventative care and to pay for subsequent illnesses, rural areas are less appealing.

So, it is not the people, the pay, the work or the culture that puts rural Americans in a health care desert. It appears that rural Americans lack available, affordable health care because the corporate health care system and private health insurance companies have eliminated access, driven physicians away and priced insurance and health care out of reach. Subsidizing insurance premiums will not reduce administrative costs, nor does anything else in the pending Senate legislation.

The private health insurance system has no competition to keep premiums in check. Insurance companies are already ramping up premiums for 2010, so, health insurance will cost more, for individuals and employers. Again, the Senate legislation does nothing to address this.

Obama’s promised “Robust Public Option” is dead. Expanded Medicare coverage, which could have been the single most effective way to cover all Americans and reduce health care costs is dead as well. Despite the findings of Johns Hopkins Hospital and School of Medicine, that Medicare beneficiaries are overwhelmingly satisfied with their coverage and, Medicare is very efficient by any objective means, expanded Medicare is dead.

A study done by the California Nurses Association noted that “a comprehensive Medicare based Single Payer system can make significant contributions to access of quality care for all US residents and in the process generate a much needed and very substantial economic stimulus in the form of jobs, enhanced business and public revenues and increased wages for the population at large”.

The President and Congress tell us that health insurance reform must be “budget neutral”. Why health health care spending but not, for example, military spending? Of course those who plan wars know they will not be called upon to die or suffer, just as those blocking insurance reform know they will always have gold edge coverage.

Protecting the insurance companies, the health care corporations and campaign contributions is apparently more important than decent, fair coverage for the rest of us.

Because the President presented no plan, because his campaign promises were empty, because Progressives in Congress had no support from the White House, because he sold out the on the health care needs of the self employed, of union members, of farmers, indeed, of everyone that is or may ever become sick or injured; hope is dead.