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Health Care the Latest Red State Failure

June 17, 2007

A new study released this week revealed that 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. After all, whether the issue is health, education, working conditions, or virtually any indicator of social pathology, things are worst in precisely those states that voted for George W. Bush.
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.

But health care isn't the only area where denizens of the Republican heartland suffer relative to their blue state brethren. As Perrspectives detailed in January, minimum wage levels also vary significantly from state to state. Unsurprisingly, many of the "bluest" states lead the way in exceeding both the previous ($5.15 an hour) and recently passed ($7.25) federal requirements, with Washington, Oregon, California, Vermont, Massachusetts, Rhode Island and Connecticut mandating wages as high as $7.93. Only one of the 21 states (New Hampshire) mired at $5.15 an hour did not vote for George W. Bush in 2004. (Click here to view a map of the minimum wage by state.)
And the minimum wage is just the beginning. A December 2005 report Political Economy Research Institute at the University of Massachusetts showed that Americans' working conditions in general closely follow the 2004 electoral map. The report's Work Environment Index (WEI) rated the quality of Americans' working lives by a weighting of three factors: job opportunities, job quality, and job fairness. The top five states were Delaware, New Hampshire, Minnesota, Vermont and Iowa, the bottom five were South Carolina, Utah, Arkansas Texas and Louisiana. Unsurprisingly, all five of the cellar-dwellers are so-called "Right-to-Work" states featuring outright hostility towards union organizing. (Click the following links for maps of WEI by state and right-to-work states.)
When it comes to educational achievement, faithful red state Republicans do a little (but not much) better. Earlier this year, the U.S. Chamber of Commerce released a study titled "Leaders and Laggards: A State-by-State Report Card on Educational Effectiveness." The report looked at seven different performance categories, including return on education investment, workforce readiness, teacher skills, and academic achievement of low-income and minority students. Again, the top five states (Massachusetts, Minnesota, New Hampshire, Vermont and New Jersey) backed Democrat John Kerry in 2004. Only two of the bottom 15 states similarly supported Kerry.

The same dismal pattern applies to a wide array of measures of social dysfunction and pathology. 8 of the top 10 states with the highest murder rates are squarely in Red America. 7 of the 10 states with the lowest murder rates were in the Kerry column. (Interestingly, six of those states have no death penalty statute.) The 10 states with the highest divorce rates in 1998 all went for Bush in 2004. Red states constituted 9 on the top 10 in terms of out-of-wedlock births. And the Bible Belt has the greatest percentage of births to women under age 20, with the worst 15 states nationwide all among in the GOP ranks. By almost any measure of societal breakdown that so-called Republican "values voters" decry, it is Red State America where moral failure is greatest.
There are, of course, many explanations for the abysmal lifestyles and living conditions in the Republican strongholds. Poverty, age and homogeneity clearly matter. But when it comes to living standards, culture, politics and public policy are at least as important.
If the Republican electoral map closely correlates with social dysfunction, it is frequent church attendance which strongly predicts Republican party preference. Which is probably a good thing. Because if you live in a state that voted for George W. Bush, you're going to need all the help you can get.
UPDATE: In a further irony, Republicans in the Senate will likely block the Employee Free Choice Act (EFCA) from coming to a vote this week. Once again, it is red state workers who need EFCA most.

68 comments on “Health Care the Latest Red State Failure”

  1. That is a pretty damning portrait of the politics and culture of the Republican states. So much for the family values of red states.

  2. Excellent research!! The single biggest problem for the Democratic party in trying to win national and statewide elections seems to be that they have no ability to get this message comminucated out to these "values voter" morons that happily take it up the ass by continuing to elect government that cares nothing about them. This type of reporting should be included in every Dem. campaign intitiative in the red states. But alas in some cases these voters are too stupid or ignorant to pay attention to real facts. For them, like you state, it's more about Jesus than what's good for the all people.

  3. regarding the u.s.chamber of commerce link
    1st sentence of the overview
    The United States in the 21st century faces unprecedented economic and social challenges, ranging from the forces of global competition to the impending retirement of 77 million baby boomers.
    forgive me if i'm wrong on this, don't they usually support candidates that favor global competition and the removal of pension protections and such ??

  4. It is true that the U.S. Chamber of Commerce report reflects its biases in its metrics. For example, its "Flexibility in Management" metric is based in part of whether (and what kind) of state law for charter schools exist in a state. So by definition, states are a priori rewarded for supporting a Chamber position (charter schools) that has a very mixed record in the real world.

  5. It's been said for a long time: if you want to live like a Republican, vote for a Democrat.
    More such analysis at the link below. And, for a slightly different take from a Congressional delegation perspective, here.

  6. Well done study, impressive statistics. Yet report could look more convincing if it was not written with obvious anti-Republican bias. If you want to appeal to independent voters, you should try writing more objectively, and avoid explicit comments about red states. After all, Gore's film has made stronger impression on independent and moderates than Moore's documentaries because of objectivity and absense of liberal bias

  7. Very interesting, but I think this sentence must be incorrect
    "Only one of the 21 states (New Hampshire) mired at $5.15 an hour voted for George W. Bush in 2004." All but one voted for him.

  8. Hilary is scheduled to be the keynote speaker at the tenth anniversary of a local hospital which last year was the subject of a investigation and lawsuit by OIG.
    The hospital refunded some $3.75 million in Medicare/Medicaid funds due to "inadvertent errors in coding and billing".
    Wonder if this will be mentioned in the speech this Sunday, the amount of money being drained from the system by large players through incompetence or fraud?

  9. "it is frequent church attendance which strongly predicts Republican party preference. Which is probably a good thing. Because if you live in a state that voted for George W. Bush, you're going to need all the help you can get."
    I would contend that frequent church attendance (willful submission to a superstitious authoritarian organization) could be a contributing factor to these kinds of problems in the first place.

  10. Hey red states! So sorry that things have taken a less than ideal spin with you and the pinhead you elected in order to restore integrity to the White House � life for an unapologetic 28% brown-noser is unpredictable, equal portions of rabid Chihuahua and infuriating moron at the DMV at times when one aligns one�s self with a peer � I guess that�s why people tend to just give up, get used to the smell, and watch T.V. So what�s the outcome of all these health issues? Now that Dumbo has once again bent over for his retard Christian buddies and vetoed any hope for a possible cure for debilitating diseases (like red state fungus) is the medical profession just gonna walk you to the curb, put a love letter through your noggin, and spare you one less minute of misery? Speaking of misery � how does a year and a half of Republican constipation sound?
    Sounds like you�re having the same level of enjoyment I�ve been experiencing with the medical �profession� for the last 4 � 5 years. The biggest beef I have with them is that they never can just say, �Hey, you know what, we don�t know what the f**k it is!�, or �Hey, I have the same level of professionalism as the current �administration� so cut me some slack!�. Can�t blame you if you ended up flipping them the bird whilst exclaiming to them where they can put it. In a similar vein, I just got another referral to the same surgeon that did my shoulder surgery, as the Carl pain indicator needle is definitely cranked up into the red (insert irony here) even though simultaneously the red state intelligence needle is pointing at empty. Don�t really know what they can do for me except cut me open, and I�m getting really bored with that shit. The yoga classes are helping in that I don�t dwell so much on my f**ked lot in life, and there�s lots of pretty women in the class as well. In tights! Meanwhile, enjoy yourself!

  11. I question the high score for education in Kansas.
    I drilled down to the "report cards" for KS and MA and compared them. The report card for Kansas reads in part:
    Kansas gets mediocre marks on the credibility of its student proficiency scores.
    Kansas receives a low grade for the rigor of its standards. The state's math and science curriculum standards receive very poor marks.
    Kansas earns mediocre marks for its teacher workforce policies.
    The state receives a low score on how much freedom and flexibility it gives its schools and principals.
    Comparing the report cards of 7th-ranked KS and top-ranked MA produces a fishy smell.
    The overall rank for each state seems to be based largely on the NAEP scores of its fourth-grade students. A pretty sensible approach, I guess, for ranking school achievement, but one that probably says more about the composition of the student body (poverty, ESL, health) than the effectivenss of the state's policies and programs.

  12. This is a pretty worthless study. For example, the crime and social condition in New Orleans can't be attributed to Republicans just because Louisiana happens to be a red state. New Orleans is hardly a "republican stronghold". A better study would be to take a look at the county-by-county results, and then look at the precise places that these social concerns exist. I'm sure you'll find that the social disfunctions are located in and around urban centers, which tend to vote overwelmingly for the Democratic Party.

  13. hi good thank you New Orleans is hardly a "republican stronghold". A better study would be to take a look at the county-by-county results, and then look at the precise places that these social concerns exist. I'm sure you'll find that the social disfunctions are located in and around urban centers, which tend to vote overwelmingly for the Democratic Party.

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  18. I had this for diffuse large B-cell lymphoma (NHL) in summer-fall 2003, after losing 20 lb of mostly muscle (down to 93 lb). I gained back 30 during and after chemo.

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  20. As an independent, who likes to notice the legitimacy and idiocy and corruption of both sides, I'll just point this out for fun: maybe the reason why these are such strong Republican strongholds is because they have such a moral demise, and not that they have a moral demise because they're Republican strongholds. It makes a lot of sense to look to old-fashioned morals when you believe that old-fashioned means less crime, and you're facing an incredible amount of crime. Are they the Republicans that are causing these crimes, or looking for a response to them?
    This also makes me think back to the excellent work of Daniel Quinn, who suggests that a rise in crime accompanies any rise in population because resources become scarcer. This is probably a bad recollection of exactly his point. He writes it very well, and meanwhile, I believe there is always the opportunity for a growing population to produce actually a BETTER lifestyle if properly managed and encouraged. Too bad we have virtually no good management from our leaders; and those who have the right ideas are made to look like fools.
    That's what happens when you go against money.

  21. I have known about the discrepancies between the states for quite awhile. The author has done a brilliant job of exposing the differences between Republican states and Democratic ones. It will be a challenge way into the future to bring all states into alliance.


Jon Perr
Jon Perr is a technology marketing consultant and product strategist who writes about American politics and public policy.

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