Salus Health Care Forum: November 5, 2025

Bill B

During previous Salus forums, we were not just looking at segmentation of different parts of the United States. In our previous sessions, we’ve also talked about specific neighborhoods within urban communities and how specific neighborhoods are deadly deserts. They are not just nutritional deserts, but also deserts of support and caring. I love the fact that we talk about it in many ways. If you get down to the neighborhood, it could be even just one or two people in that neighborhood who could make a difference. So, it’s interesting that as we get down to smaller groups, there may be even greater possibilities.

Rich, you’ve looking at small rural communities where healthcare is working. Was it because in those small communities you could make a difference?

Rich

Well, it started as a commitment, actually, to the federal government. There’s a program called the National Service Corps. I was involved during its earliest years, which began about the mid-70s.

In fact, there’s a very nice book called The Dance of Legislation by Eric Redman that some of us with grayer hair may have actually read. It plays out how this legislation came to pass. I was supposed to serve in an underserved area, one year for each year of financial support. I had three years of support.

I actually spent four years in the most underserved county in Wisconsin. My wife and I grew up together here. When we moved to DC for medical school, I would tease her that we had an 800-mile-long umbilical cord being stretched.

Then we moved to Los Angeles. It was a 2,300 miles umbilical cord. When our first child came along, I knew it was going to mean a return to Wisconsin, which was fine. It’s been a great place to raise family.

What I also found was that I really enjoyed teaching. The other three doctors in our county of 18,000 would take their half days out of the clinic each week and go work on their farms or play golf. I always went up to volunteer teach. During those four years, my university counterparts who were staffing or precepting in the clinics kept saying, you’ve got to join us full-time. We’re getting this rural clinic set up. We really want you here.

That’s where it led me to. I had great people helping me see or realizing this: You get a much clearer sense of what the possibilities are when working in these communities. For example, I arrived in Darlington, the first community in which I worked, in the midst of the worst drought in the state’s history.

This was when farm aid was being set up by John Mellencamp. We actually had two young men, not related, commit suicide because they’d lost the family farms that had been in the families for 150 years. At the same time, the single largest employer was the county. Agriculture was the largest sector of the economy in that rural county, but the county was the largest single employer. They owned a 20-bed hospital, a nursing home, and so on. They came to the physicians and said: You guys have got to help us find a better way to do this. We’re spending so much money because we’re self-insured.