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2014

Getting people who

America: Spending More Money
don’t have health

and Achieving Fewer Results
insurance to sign up

for it should have
Even though we spend more on health care than other Western nations,
we don’t seem as healthy. We have worse infant mortality and shorter life
been the easy part.
spans, for example. Why? Some of these apparent differences might have
other explanations:

Most of the disparity in united States infant mortality is from premature

births, a greater share of which the united States counts as live births than
in other countries. American pediatrics looks worse statistically because of
Forward!
our expectation that modern medicine can save almost any newborn—even
As the TennCare history illustrates, those that doctors in other countries would deem too small to live.

it is unlikely that a failed ACA can be u.S. life expectancy is likely shorter from an unhealthy lifestyle. for
rolled back. Tennessee Republican example, almost 28 percent of Americans are obese. only about 5 percent

governor donald Sundquist made no of Japanese are. hawaii has the longest-lived Americans and also has the

attempt to undo his democratic prede- second-lowest obesity rate. (Tennessee is the second-most obese state and
cessor’s program, instead saying, “More is 44th in life expectancy.)

than 1.3 million of our fellow Tennes- Another explanation for a shorter life expectancy could be demograph-
seans depend on TennCare for their ics. Life expectancies in germany (80.7 years), Sweden (81.8), and Norway

health care, and we’re not going to let (81.3) surpass that of the united States (78.6), but in Minnesota—where the

them down.” Sundquist, who ran as a climate is much like Scandinavia and more than three-fourths of the popu-
tight-fisted conservative, infamously lation is of Western European descent—life expectancy (81.1) is comparable

proposed a state income tax for three to Europe’s best.
consecutive years to save the belea-

guered program. Tennesseans revolted,

and Nashville was besieged by car-
honking and in some cases window- to 56 percent [gallup poll]. health care between now and then the

breaking protesters.
in the united States seemed broken most pressing issue for Tennessee
Consequently, TennCare was left by before the 2008 elections, but it was a to resolve is whether to expand

bredesen’s reforms far different from mess that Americans wanted the gov- Medicaid and accept the three years
its initial design. After the cuts, gordon ernment to intervene in and fix. Now of federal dollars that would come

bonnyman, executive director of the the problems are perceived as partly of with the expansion. Regardless of

Tennessee Justice Center, said, “The the government’s own making—mean- which party wins the 2014 house
hallmarks of TennCare were wall-to- ing that simply walking away is no and Senate or the Presidency in

wall [set fee] managed care and cover- longer a political option.
2016, like Sundquist and bredesen
age to a broad population of uninsured Not all the bad news has gone over before them, haslam’s and obama’s

Tennesseans. both of those are now the dam yet, either. In 2014, along
successors will find themselves

gone. Tennessee has gone from among with the individual mandate, the $60 addressing the ACA’s legacy in a
the top-ranked states to the bottom on billion tax on health insurers goes into fashion not as much dictated by

many measures in a very short time.”
effect. Cuts in the Medicare Advantage partisanship as reality.
Likewise, in only seven years sup- program—necessary to give the ACA’s

port for the federal government’s budget projections some semblance of Mark Spurlock is a freelance writer and sometime computer

responsibility for health insurance has solvency—will accelerate. Then in 2015 programmer who lives with his two children and several
dropped from 69 percent to 42 percent, comes the employer mandate, and in animals in Maryville. Besides all forms of writing, his interests

while belief it is not the government’s 2018 the tax on “Cadillac” plans that are education, the Internet, politics, and the performing
responsibility doubled from 28 percent
offer the most health-care benefits.
arts. You can reach him at mark@markspurlock.info.

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