PERRspectives: U.S. Health Care in Red and Blue

March 24, 2008

U.S. Health Care in Red and Blue

A new study released last week revealed a Republican Party ever more out of touch with the mushrooming crisis of the American health care system. Predictably, 68% of Republicans believe the U.S. has the best health system in the world, compared to only three in 10 Democrats. Ironically, those findings come just as new studies show a growing "income gap" in Americans' life expectancy and the painful impact of rising health care costs on Americans' stagnant wages. Most ironic, the failure of the health care system is at its worst in precisely those states that voted for George W. Bush.

The survey from the Harvard School of Public Health showed sharp partisan cleavages in perceptions of the U.S. health care system. While 45% of Americans claim the U.S. has the best health care in the world, only 32% of Democrats and 40% of independents compared to 7 in 10 Republicans believe that is the case. (39% of all respondents believe other nations provide superior health care, 15% didn't know or didn't answer.)

Unsurprisingly, Americans of all political persuasions made these claims despite knowing little to nothing about the systems in other nations. Large percentages answered that they didn't know how the United States compared to France (53%), the UK (40%) or even Canada (26%).

The division between Democrats and Republicans is just as pronounced when it comes to both what is ailing the American health care system and what to do about it. Followers of the GOP seemed to believe that access to medical care is not a problem for Americans. "Four-in-ten (40%) Republicans believe the U.S health care system is better than other countries when it comes to making sure everyone can get affordable health care, compared to just one-in-five Democrats (19%) and Independents (22%) who share that belief." Predictably, 56% of Democrats and 37% of independents say they would support a presidential candidate wanting to make the U.S. system more like those in Canada, France and Great Britain.

Which is a tragedy for Red State America. While the GOP's country club class no doubt suffers little from or knows even less about the chronic failure of the American health care system (George W. Bush dominated the 2004 vote among every income group earning over $100,000 annually), the Republican base has it the worst.

That health care is just another major red state failure is the inescapable conclusion of a 2007 analysis by the Commonwealth Fund. As it turns out, Americans' health care varies dramatically from state to state. It should come as no surprise that in general Southern states ranked at the bottom in almost every category.

The Commonwealth Fund report, "Aiming Higher: Results from a State Scorecard on Health System Performance," examined states' performance across 32 indicators of health care access, quality, outcomes and hospital use. Topping the list were Hawaii, Iowa, New Hampshire, Vermont and Maine. Bringing up the rear were the Bush bastions of Kentucky, Louisiana, Nevada, Arkansas, Texas, with Mississippi and Oklahoma. The 10 worst performing states were all solidly Republican in 2004.

The extremes in health care performance are startling. For example, 30% of adults and 20% of children in Texas lacked health insurance, compared to 11% in Minnesota and 5% in Vermont, respectively. Premature death rates from preventable conditions were almost double (141.7 per 100,000 people) in Tennessee, Arkansas, Louisiana and Mississippi compared to the top performing states (74.1 per 100,000). Adults over 50 receiving preventative care topped 50% in Minnesota compared to only 33% in Idaho. Childhood immunizations reached 94% in Massachusetts, compared to just 75% in the bottom five states. As the report details, federal and state policies, such as insurance requirements and Medicaid incentives, clearly impact health care outcomes.

Sadly, conditions have only deteriorated further since the Commonwealth Fund study was published. In November 2007, research from the Economic Policy Institute showed that employer-provided health care in the United States has dropped sharply, with workplace insurance covering only 59.7% of Americans now, compared to 64.2% in 2000. As the New York Times reported this morning, premiums for family health insurance have surged 78% since 2001 to over $12,000 a year. That cost explosion comes even as Americans' salaries and wages have barely moved: "inflation-adjusted median family income has dipped 2.6 percent -- or nearly $1,000 annually since 2000." It should come as no surprise that the wealthiest Americans now live 4.5 years longer than the least-well off, a startling jump from just a 2.8 year gap reported in 1982.

Despite their own worsening circumstances, followers of the GOP seem blissfully unaware - or unconcerned - about an American health care system on the brink of breakdown. Perhaps, as Jonathan Chait and Thomas Frank among others suggest, social and national security issues real or imagined trump economic self-interest for working Republicans. In 2008, they risk once again enabling the agenda of their country club cousins. After all, it's impossible to cure the disease that is weakening the American health care system without first acknowledging there is have a problem.

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