From the ‘we’ve come a long way’ file: an African-American man in Mississippi currently has a shorter life expectancy than an average American did in 1960. Whoa.

However you choose to slice it, the health care situation in the United States is a bit of a wreck, to be sure. The Commonwealth Fund just released some detailed rankings of health care performance state-by-state, and then the main authors of that research went deeper into their scorecard system in a post for the American Medical Association. Regardless, it’s all summarized at The Atlantic, and let’s go into a few key points. 

1. Because we all love to rank things, the top states are Minnesota (1), with Massachusetts, Vermont and New Hampshire tying for second. That’s generally unsurprising; with the exception of perhaps the Boston metro, all of those are family-oriented, relatively low-cost-of-living places with more white people than minorities. Truth be told, that’s going to give you better scores on any type of health care ranking. The bottom of the list? Mississippi is last, and Louisiana, Oklahoma and Arkansas are the other states at the bottom.

2. They break this all down by several metrics, including people losing “six or more teeth” (in a stereotype, West Virginia is the worst state there), but here’s an interesting one: deaths per 100K of the population from things that could have been treated, broken down by state and by race:


3. As you can see, the smallest gap above is in MA, and the widest is in Mississippi. Mississippi has ostensibly terrible life expectancy figures for African-Americans, as well as the out-and-out worst hospital in America by some studies. To pile it on Mississippi, which is actually a tremendous state in terms of overall job growth (thank you, United Airlines in-flight magazine): they have an obesity rate over 30 percent and just one abortion clinic.

4. Here’s the essential problem for residents of Mississippi in the context of health care figures, as told by The Atlantic:

Those Mississippians making between 100 percent of the federal poverty level, or $23,850 for a family of four, and 400 percent, can qualify for subsidies to buy health insurance on the exchanges. But 30 percent of uninsured Mississippians fall into the “coverage gap” between the state’s current income cutoff for Medicaid and the federal cutoff for health insurance subsidies. They don’t qualify for any kind of financial help to buy health insurance and are likely to remain uninsured.

5. This study’s focus is on Medicaid expansion — the authors believe it’s a good thing, and point out that 16 states in the bottom of their rankings aren’t expanding it at all. The problem on the flip side? It kills state budgets. (Here’s a little more on that.)

6. I’m not entirely sure what the answer is here — I’m definitely not a doctor, and while I worked in the health care space, it was for about a 12-week project assignment. It does kind of seem to me that periodically the issue in the space as a whole is that a good percentage of people are trying to accomplish the dual goals of “helping others” and “making a buck for me.” That’s hard to accomplish in a way that keeps things logical — and/or actually focuses on both aspects. The money you can make at any level of that space, from doctor to administrator, is pretty good relative to other fields, so people have a desire to enter it. Universal health care probably isn’t possible in the U.S. as a result of this and other factors, but we need a better system somehow. The good thing is: people are working on it, all over the country.


Ted Bauer

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