For many Republicans from Dixie, the old times there are not forgotten. But in equating the health care reform bill to the "Great War of Yankee Aggression," Rep. Paul Broun (R-GA) has served up a double irony. For starters, Broun is among the growing legion of Congressional Republicans trying to kill Medicare through privatization. More ironic still, the unhealthiest residents and worst health care systems can be found in pecisely those red southern states where Republicans poll best. To the blue state taxpayers who will pay for improved health care for their red state brethren, Paul Broun's message should simply be, "thank you."
As he showed during a health care debate on the House floor yesterday, Rep, Broun was still fighting the Civil War:

"If ObamaCare passes, that free insurance card that's in people's pockets is gonna be as worthless as a Confederate dollar after the War Between The States -- the Great War of Yankee Aggression."

Sadly for Broun, the South is also losing the war to bring health care to its residents.
In November, a study by funded by UnitedHealth brought some unwelcome news for the GOP braintrust: the red states they represent are the unhealthiest in the nation. Following on the heels of the Commonwealth Fund's 2009 Scorecard of state health care system performance, the United Health Foundation's report was just the latest confirmation that health care is worst where Republicans poll best.
As Forbes noted:

The annual ranking looks at 22 indicators of health, including everything from how many children receive recommended vaccinations, to obesity and smoking rates, to cancer deaths.

The diagnosis isn't pretty for Republicans committed to denying the health care their constituents need most of all. The 2009 rankings reveal that nine of the top 10 healthiest states voted for Barack Obama in 2008. Conversely, 9 of the 10 cellar dwellers backed John McCain in 2008; four years earlier, the 15 unhealthiest states voted for George W. Bush for President.

With Vermont topping the list and Mississippi bringing up the rear, Americans would do to listen to Dr. Howard Dean and not Governor Haley Barbour when it comes to the health care debate.

Vermont ranked first this year thanks in part to its low rate of obesity, high number of doctors and a low rate of child poverty. New England in general sets a benchmark for the country, the report found. All six New England states are in the top 10. These states have favorable demographics and an excellent public health infrastructure, including a large number of doctors per capita.
Eight of the 10 bottom-ranked states are from the south, with Mississippi coming in dead last for the ninth consecutive year. Mississippi has a sky-high death rate from heart disease and high infant mortality. In general, residents of these states are more likely to be smokers or to be obese, the report found. They also have worse health insurance coverage, fewer physicians per capita and live in areas with high violent crime and more child poverty.

As it turns out, Mississippi residents aren't merely the sickest in the United States. They are also plagued by the worst state health care system in America.
In October, the Commonwealth Fund released its 2009 state health care scorecard. There, too, Mississippi led the Republican south in providing dismal health care. Again, while nine of the top 10 performing states voted for Barack Obama in 2008, four of the bottom five (including Arkansas, Mississippi, Oklahoma and Louisiana) and 14 of the last 20 backed John McCain. (That at least is an improvement from the 2007 data, in which all 10 cellar dwellers had voted for George W. Bush three years earlier.)

(Here is the Commonwealth Fund's 2009 state-by-state health care scorecard. Here are links to the executive summary, the full report and PDF and Powerpoint chart packs.)
In theory, their steadfast opposition to the health care legislation before the Senate should present a double quandary for the Republican leadership in Congress and in the states. After all, their residents not only need health care reform desperately. As it turns out, the funding for it would come in part from blue state taxpayers.
As the Washington Post noted in May ("A Red State Booster Shot"):

Health-care reform may be overdue in a country with 45 million uninsured and soaring medical costs, but it will also represent a substantial wealth transfer from the North and the East to the South and the West. The Northeast and the Midwest have much higher rates of coverage than the rest of the country, led by Massachusetts, where all but 3 percent of residents are insured. The disproportionate share of uninsured is in the South and the West, the result of employment patterns, weak unions and stingy state governments. Texas leads the way, with a quarter of its population uninsured; it would be at the top even without its many illegal immigrants.

As it turns out, health care reform spending would be little different from the overall pattern of red state socialism. That is, red state residents disproportionately benefit from the steady one-way flow of tax dollars and earmarks spreading the wealth from Washington to their states.

As the 2007 analysis (above) of 2005 federal spending per tax dollar received by state shows, the reddest states generally reaped the most green. Eight of the top 10 beneficiaries of federal largesse voted for John McCain for President. Unsurprisingly, all 10 states at the bottom of the list - those whose outflow of tax revenue is funding programs elsewhere in the country - all voted for Barack Obama in 2008. And as the Wall Street Journal documented last March and again in July, Republican states are reaping outsized benefits from the $787 billion Obama stimulus package they so fiercely opposed.
Back in December, the New York Times detailed the quandary for several (mostly blue) states "pushing back against the Senate overhaul bill, arguing that it unfairly penalizes them in favor of states that have done little or nothing to extend benefits to the uninsured." But at the end of the day, that is largely as it should be. Any American who cares about the quality and accessibility of health care for all Americans doesn't let his or her concern stop at the state border.
And for all the secessionist talk and rebel yells of the likes of Paul Broun, should the health care reform bill finally become law, blue state Americans will have a two-word reply.
You're welcome.