Civil War

The Commonwealth Fund recently came out with its annual state scorecard on health system performance. You may be interested in seeing how your own state is doing. It is instructive, first of all, that since we do not have any effective national policy to shape health care system performance, the variation among the states is enormous. You will not see this in civilized countries that have coherent national health care systems.

But I particularly want to draw your attention to Exhibit One, (click to enlarge) which shows an overall ranking of the states. Notice any patterns there? What do you think would happen if we colored those states red and blue depending on the likelihood that their senators will vote for national health care reform? Of the bottom ten, only Illinois gets a gold star. Of the top ten, South Dakota and Nebraska get a split, although we'll have to see what Ben Nelson ends up doing; Joe Lieberman might be a no vote but he doesn't represent his state; and Maine is likely a no although Sen. Snowe is still teasing us. Otherwise, they're all on board.

The picture is more mixed in the middle, and this picture interacts with population density, regional culture and other factors that influence both politics and health system quality. Still, the states with the worst health care systems are the least likely to have elected representatives who support change, while the states with the best systems are mostly for it. Why do you think that is?