From the beginning, two great, largely unmentioned ironies hung over the contentious health care debate. The first elephant in the room (pun intended) is that health care is worst in those states where Republicans poll best. The second is that it will be blue state taxpayers helping fund the improvement of the dismal health care systems in those reddest (and mostly southern) states. So to raging Red Staters furious about Sunday's landmark legislation, the message from Blue America is a simple one.
You're welcome.
In what has become almost a law of Republican politics, the opposition to health care reform is loudest from those GOP leaders whose constituents need it most. In October, the Commonwealth Fund released its 2009 state health care scorecard and the news for Grand Old Party was hardly grand. 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.

And Haley Barbour's Mississippi brought up the rear when it came to the health of 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. The 2009 rankings of 22 indicators of health revealed 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.

The ironies don't end there. As the Washington Post, the New York Times and yours truly among others documented, the steadfast opposition to the Democratic health care legislation presents 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 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.
So to the Cheechakos and Sourdoughs in Sarah Palin's Alaska, you're quite welcome. While your half-term governor decried "leftists" she insisted will be held "accountable" for improving your 34th rated health care system, she had no problem leading the nation in per capita earmark dollars awarded or with her state's 3rd place ranking in raking in overall federal budget dollars. So much for taking a stand against "government largesse."
To those with the misfortune to be represented the likes of Rick Perry, John Cornyn and Louie Gohmert in Texas, we're only too happy help out. They say everything is bigger in Texas and that includes the ranks of the uninsured. A whopping 25% of adults under 65 have no coverage. While from 2007 to 2009 the Lone Star State nudged its way from a horrific 48th to a merely miserable 46th in the Commonwealth Fund rankings, the health care system there remains an ongoing calamity for its residents. Among the poster children for the failure of red state health care, Perry's state brought up the rear across the five indicators measured. When it comes to health care access and equity, Texas is dead last. Mercifully, health care is coming - even for the secessionists.
The blue grass state of Kentucky also needs some blue state health care. While Senate Minority Leader Mitch McConnell warned that President Obama's health care initiative "denies, delays, or rations health care," he told David Gregory on Meet the Press that Americans "don't go without health care." McConnell needs to go home more often: Kentucky's health care system rates a grim 45th and its residents are the 41st healthiest in the nation. While McConnell echoed George W. Bush, Tom Delay and countless other Republicans in counseling people to "just go to an emergency room," Blue America stands ready to make that a thing of the past.
Meanwhile in Jim Demint's South Carolina, not everyone is in shape to fight a 21st century "Waterloo." The good people of the Palmetto State rank 46th among the healthiest states, while the state system overall comes in at 33rd. Hiking the Appalachian Trail is no substitute for health insurance.
For its part, Newsweek on Monday listed "Health Care Reform's Winners and Losers." But the biggest winners - the denizens of red state America - were left off the list. While the Republicans representing those workers and families will never utter a word of thanks, it's not necessary. At the end of the day, 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. Grateful or not, the message to Red Staters is the same.
You're welcome.