South Carolina has better things to spend its money on than people

I’m afraid that many of those concerned with social justice have been bamboozled by the idea that health = health services = health insurance promoted by those who politically or financially benefit from continual increases in health care spending. It is not such a straightforward equation. The social determinants of health model suggests that somewhere between 80-90% of health and well-being of individuals and their communities are driven by factors such as income, education, race, social support systems, genetics, personal choices and environmental conditions. Health services make up the remaining balance.

Yet in last year’s Institute of Medicine roundtable summary, “The Healthcare Imperative: Lowering Costs and Improving Outcomes,” participants lamented that out-of-control health care spending is destabilizing the health care system, depressing growth in national wages and employment, and forcing states to divert money from other important programs such as education. Thus we have a vicious cycle where out-of-control spending on the 10-20% displaces potentially more effective spending on the 80-90%.

So there are valid arguments for why this expansion decision should ultimately rest with the states. For one, the Court determined it was unconstitutional otherwise. But just as importantly, because states are different. South Carolina is not Massachusetts or Vermont no matter how desperately the think tank crowd would want it to be. We have wildly different rates of poverty, educational attainment, racial mix and economic bases which are the primary drivers of health. Massachusetts was 93% insured prior to their reforms because of their wealth; they weren’t wealthy because they were 93% insured.

I think it’s fair for South Carolina and other states to want to debate catching-up on much needed investments and policy to increase per capita income and education levels before setting in concrete that health care services are the number one spending priority. And in South Carolina we are doing a pretty good job when you look at our recent economic wins – Boeing, GE, BMW, Bridgestone, and Google to name a few.