Actually, it's unfair to single out Idaho, because the entire region has some issues when it comes to access and to quality of care. But the situation in Idaho is the most dire [1] in the nation in a critical component: number of physicians. Yup, Idaho is dead last when it comes to the doctor to patient ratio, around 140 for every 100,000 residents.

It's actually not much better for the rest of the region [2]. None is in the top half of states when it comes provider access: Nevada comes in at number 48 (not counting D.C.), Wyoming at 47, Utah at 44, Arizona at 37, Montana at 35, New Mexico at 32.
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The health care debate in the country and the region has largely been focused around insurance--a valid concern, since some 47 million [3] Americans are uninsured, about 16 percent of the total U.S. population. Those numbers are a little less grim when you look at the Mountain States. In a Democracy Corps poll [4] (pdf) conducted last spring, 10 percent said they were currently uninsured. But when combined with those who had been uninsured sometime in the past five years, the percentage rises to 23.

Of course, having health insurance is small comfort if it takes you four or five or even six months to get an appointment with a regular family doctor. Which is probably why, along with lack of insurance, health care remains in the top two or three issues for voters across the nation. Given the criticality of the health care issue, and armed with this wrinkle of access to practitioners, I decided to do a little research in our leading presidential candidates and what they had to say about rural health issues. Turns out it's not a lot.

Let's start with the Republicans.

• Here's Romney's statement [5] on health care: "The health of our nation can be improved by extending health insurance to all Americans, not through a government program or new taxes, but through market reforms."
• Thompson's approach [6] can be boiled down to this, "Access to affordable, portable health care can be made available for all Americans without imposing new mandates or raising taxes. Current government programs must also be streamlined and improved so that those who truly need help can get the health care they need."
• Giuliani has the most extensive policy statement [7] among the Republicans, with a big focus on market reforms and "increasing competition." The focus of Giuliani's plan seems to be nibbling about the edges of federal and state bureaucracy.

None of the Republican address the issue of lack of access to care. Let's see how the Democrats do.

• Unsurprising, Clinton's plan [8] is fairly comprehensive (she has had some practice in this), addressing how insurance and drug companies, individuals, providers, employers, and the government will interact to ensure universal coverage. Nothing about access to providers in rural areas.
• Obama likewise presents a comprehensive plan [9] that would "build upon the strengths of the U.S. health care system, including innovative state efforts, and address its glaring weaknesses, such as affordability. Through partnerships among federal and state governments, employers, providers and individuals, the Obama plan will save a typical American family up to $2,500 every year on medical expenditures." His plan talks about modernizing health care systems throughout the country, but again doesn't acknowledge the basic problem of physician shortages in rural areas.
• Edwards too has a multi-point plan [10] for covering the uninsured, but what's more, has an issue page [11] devoted to rural issues, and on it is this: "The Edwards plan for universal health care will cover the 9 million rural Americans that lack insurance and establish a nationwide network of safety net clinics and public hospitals. He will rewrite the unfair Medicare and Medicaid funding formulas that punish rural states and communities. He will also support investments in telemedicine to instantaneously connect distant specialists and advanced equipment with local doctors and patients, allowing better monitoring, chronic disease management, and emergency response."

Joan McCarter is a contributing editor of DailyKos.com and a researcher of Western politics
Bingo, provided he can find a way to get doctors to Idaho to staff the safety net clinics and hospitals. And that's not even taking into account the severe nursing shortage [12] the entire nation is experiencing.

A candidate's health care plan is pretty much worth the pixels with which it's presented on a Web site, once the various interest groups, industries, and individual members of Congress actually get into the mix. But it would be encouraging if more of our candidates at least threw rural America a bone, and recognized the very particular part of the problem rural America faces when it comes to the nation's most pressing domestic issue.

Editor’s note: Joan McCarter's weekly blogs are part of a new feature on The Denver Post's PoliticsWest.com site called "Diary of a Mad Voter." The group blog, published in partnership with NewWest.Net/Politics [13], is intended to give a glimpse into the hearts and minds of several independent-minded voters and thinkers in the Rocky Mountain West in the '08 election cycle. Check back regularly at www.politicswest.com [14] for "Diary of a Mad Voter."