Posted by: Francis Koster Published: October 25, 2020

North Carolina Is Breaking My Heart

When compared to other wealthy countries The United States has a life expectancy that ranks 35th in the world, and it is falling. If that was not bad enough, among the 50 states in America, the life expectancy of citizens of North Carolinas ranks 37th. [2]  Why is that?
When I was still working as an administrator in pediatrics, I would often pass through waiting rooms full of mothers holding crying children who had a birth defect.  With proper care during pregnancy, much of this damage was preventable.  These memories still break my heart.
These children were born with a preventable birth defect caused by a vitamin deficiency in their mother.
A key tool that prevents these birth defects and raises life expectancy is health insurance.
As my dad used to say, “All behavior has consequences – good behavior, good consequences, bad behavior, bad consequences”.
When people talk about healthcare in America, they often use the words “Healthcare System”.   There is no such thing.
There are actually two very different “systems”.  The first is the “Health Insurance System” (that is supposed to pay for medical care), and the second is the “Healthcare Delivery System” (The ambulances, hospitals, doctors, and nurses who treat patients).  It is important to be clear about this when discussing healthcare in America.
North Carolina is limited by a health insurance environment that is so bad that we rank 41st of all 50 states for the percentage of insured residents.[3]
It does not need to be this way.  Under current federal law, all states can expand Medicaid – largely paid for by the federal government.  North Carolina is one of 12 states that has not seized that opportunity.
More than one million North Carolinians have no health insurance – about one out of 10 of our neighbors.[4]    Overwhelmingly they are poor.  When you are poor and uninsured, minor illness becomes major because the patient does not have the ability to go to a doctor. They get sicker and wind up in the hospital – which does not get paid.  Then some percentage of those sick people lose either physical capability or mental sharpness, become less employable, and wind up needing welfare or other forms of public support.  Taxes go up.
I am a fiscal conservative.  I am often surprised by people who do not know the difference between an expense and an investment.  Spend $20.00 on flowers for your front yard, and it is an expense.  Invest $20.00 to insulate your electric water heater, and you get a reduction in energy expense of about $20.00 annually. [5] You earned 100% annual return on your investment for life.
When a state adopts Medicaid expansion, 90% of the cost is paid for by the Federal Government.[6] Some people argue that their state cannot afford the cost of their 10% portion.  Many reliable studies have found the adopting states earn positive rates of return on their 10% investment due to the cost-saving impact of preventive care or early treatment, reductions in state spending for unemployment benefits, mental health care, and a decline in enrollment in taxpayer-supported programs like supplemental social security.[7]
One of the best reviews of a state’s return on investment in Medicaid expansion was done by the Kaiser Family Foundation, which reviewed over a thousand separate studies. [8] They found that in those states that adopted Medicaid expansion, total employment grew 1.3%, more than those states that did not adopt.  For example, Colorado experienced 31,074 additional jobs as a result of the adoption, and growth in healthcare employment of 3.2%. The employment of handicapped workers went up because the employer did not have to pay their health insurance.
In North Carolina, healthcare providers provide about a billion dollars a year in “uncompensated care” because people without insurance cannot pay for it.[9]  Insuring patients through the Medicaid expansion would pay a significant chunk of that “uncompensated care” which would allow healthcare providers to survive in low-income counties.
Since this Medicaid expansion opportunity became available, three-quarters of all rural hospitals that have closed in America have been in the 12 states that rejected it.[10],[11]
From a patient’s point of view, after the program was adopted by most states in the union, the death rate among older adults who gained insurance was reduced (depending on the state) between one-third and two-thirds of prior rates.[12]  The percentage of pregnant women covered by insurance doubled.[13] States that have expanded Medicaid saw a 50 percent greater reduction in infant mortality than non-expansion states. [14]
As a state, what values do we hold that block our adopting a program that improves the quality of life of the least fortunate amongst us, lowers private insurance rates, pays a positive financial rate of return for taxpayers, helps hospitals survive, and protects children?
North Carolina is breaking my heart.
Authored by Francis Koster Ed. D.
About the Author:
Dr. Koster lives in Kannapolis N.C..  His advanced degrees focused on the health and economic impacts of threats to the basic life support systems of air, water, food, and fuel.  He finished up his paid career as Chief Innovation Office at one of the nation’s largest pediatric healthcare systems.  You can see the sources of all facts cited in this article at his website

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Francis P. Koster Ed.D.

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