I like maps like these, because they demonstrate the great diversity to be found within the United States of America, and how important regionalism is in the country. I posted it along with some commentary a couple weeks back on my other blog, but it originally comes from FlowingData.com. (Should you not like pictures, you can see the figures in table form over at Business Week.) The disparity should not be too surprising; the United States has a federal system of government, and while the Founding Fathers may not have intended for Hawaiians to live an average of eight years longer than residents of the District of Columbia, they set up the country on the understanding that the states were not uniform and conditions therein were not interchangeable.
The disparities among the states that cause the differences in life expectancy are not too hard to see; people tend to live longer in states that are wealthier and live more healthful lifestyles. States with modern professional economies tend to do well, as do states that lean Democrat, though that correlation may not necessarily be a cause.
Something that obviously does correlate with and cause longer life expectancy – though even it is not everything – is health care. It should be no surprise that the long-living Hawaiians have one of the best health care systems in the country, and similarly long-lived states like Iowa, Vermont, Minnesota, Maine, and New Hampshire have comparatively cheaper, more readily available, or better quality health care systems. It’s not rocket science: if it’s easier for you to see a doctor, you’ll probably live longer. Similarly, even though other factors like income play a significant role, states with poor health care, for instance Southern states such as Louisiana and Mississippi, have below average life expectancy rates.
The big talk around health care reform in the States this past week or so has been Senate Majority Leader Harry Reid’s endorsement of a public option, with an opt-out provision. This basically means that the government would set up a health care system, but if individual states decided they did not want to make use of that option, their citizens could not be a part of it, and the government would not offer insurance in that state. Politico describes it as “a very American idea,” saying,”[o]ur founders established the notion of federalism to allow states that felt strongly about public policy to operate under different laws and procedures.” As Politico goes on to explain, opting out isn’t as straightforward as it sounds. It isn’t clear how states would decide to opt out – should the legislature decide? The governor? The people, by referendum? If a state chose to opt out, would the sick migrate to a state that did offer public insurance? And does the government really want to create a precedent of allowing states to pick and choose which federal laws apply to them?
These are all questions that will be answered during the long process of the Senate writing, debating and approving the legislation. But one likely pitfall of the opt out provision may not be realised until it’s actually in place and states actually are opting out.
Back when Congress passed a stimulus package aimed at injecting funds back into the American economy, Republican Governors like Louisiana’s Bobby Jindal and South Carolina’s Mark Sanford made a show of rejecting the Federal hand outs – whether for reasons of ideology, grandstanding, or both. Some, like Mississippi’s Governor Haley Barbour were concerned they’d be obliged to accept welfare conditions of which they did not approve, while Jindal and Sanford were, at the time, possible 2012 Presidential nominees who had an incentive to please the Republican base.
The opt-out provision could become a similar political football, and if Governors like Jindal and Barbour are once again the ones kicking it around, citizens of the states who could most benefit from health care reform will suffer. Remember, states like Jindal’s Louisiana and Barbour’s Mississippi are poor states with little health care coverage that would definitely benefit from a government program.
When the stimulus package passed, a South Carolina Representative, Jim Clyburn, inserted a provision into the bill to allow state legislatures to override any Governor who rejected federal funds. (Disclosure: I will be working as an unpaid intern in Clyburn’s office for a period next year.) To ensure health care remains about insuring more people, it might be a smart idea for an opt-out public option to include a similar safeguard.
Elsewhere, if you liked my post about Maine’s place in America’s future, you might like to take a look at Politico’s profile of its senators and its political culture. It gives an excellent overview of the reasons why this odd little state is at the centre of so many of the country’s big battles.