Providing rural services at a reasonable cost

"They've got to stop the spending!" is a common, plaintive cry that can be heard in many a coffee shop when political issues come up.

But just how common is that opinion? And, just what spending should be cut?

That's where the outrage becomes a little less focused.

According to the 18th annual University of Nebraska-Lincoln Rural Poll, which was reported in Monday's Gazette, the only area the majority of the 6,320 households surveyed agreed should be cut is unemployment compensation. And, that was only a 1 percent majority -- 51 percent would support less public spending for people who are out of work.

Residents of Nebraska's 84 nonmetropolitan counties said they would like to see no change in the level of spending in police, fire and public safety, 69 percent; hospitals and health care, 64 percent; natural resources, parks and recreation, 63 percent; corrections and rehabilitation, housing and community development, both 61 percent; workforce training, 60 percent; public broadcasting, 59 percent; roads and bridges, 56 percent; and medical assistance to the poor, 53 percent.

Thirty-eight supported more spending on roads and bridges, 35 percent more spending for education, and no other public services garnered more than 21 percent support for an increase in public spending.

Naturally enough, responses were skewed by personal factors of those being surveyed. People in the ages of 19-29 were far more likely to support more spending for education, 47 to 21 percent, and people with jobs in agriculture were more likely to support more spending on roads and bridges.

The survey, of course, didn't ask respondents to make the tough choices that our leaders have to make in the face of declining tax revenues.

Another report, from the University of Nebraska Medical Center for Health Policy, offered an example of rural problems -- and possible solutions.

That study pointed out the need for better dental care in much of rural Nebraska.

"The State of Nebraska designates 48 counties as general dentistry shortage areas and 20 counties don't even have a dentist," said Jim Stimpson, PhD, director of the center. "Even more alarming, the study found that there has been a steady decline in the number or practicing dentists in the state over the last five years."

It's a big deal; the American Dental Association estimates that dental issues contribute to 164 million lost work hours last year, many of them problems that could be avoided with proper prevention.

Nebraska's dental schools are full, however, that the supply of dentists is so tight that many are working into their 70s and 80s. And, people with emergency dental care often find themselves in medical clinics and emergency rooms ill-equipped to handle the problems.

The UNMC study offered several possible solutions, such as giving dental hygienists authority to provide sealants and cleanings on their own, allowing them to provide preventive care in other locations such as a pediatrician's office or health clinic, increase the student loan reimbursement rate for dentists who agree to practice in a shortage area; and fluoridating water.

The state already offers dental students $80,000 in reimbursement over four years, but that hasn't kept up with inflation, which sees the average student loan debt of more than $200,000.

As for fluoridation -- we won't even go there.

But the other ideas represent the kind of thinking that can help provide the services rural residents need at a reasonable cost.