States differ in health spending per capita

Robert Pear writes in the NY Times about a new federal study that shows that there is a significant range in health care spending per capita among the 50 states.

Massachusetts led the way in per capita health spending at $6,700, while Utah was less than $4,000 per capita. As he writes,

The study, published on Monday in the Web edition of the journal Health Affairs, said that Massachusetts, Maine, New York, Alaska and Connecticut had the highest per capita spending on health care in 2004.

The lowest-spending states were Utah, Arizona, Idaho, New Mexico and Nevada. Per capita spending in Utah was 59 percent of that in Massachusetts. [ . . .]

Sara Rosenbaum, a professor of health law and policy at George Washington University, said, “The variations help explain why some states can achieve health care reform on their own, without a huge infusion of federal money, while others cannot.”

“In a low-spending state like New Mexico, you have less money in the health care system that can be recaptured and invested in coverage for the uninsured,” she said. “In a high-spending state like Massachusetts, the health care system has the resources to subsidize coverage of the uninsured.”

Read the full article . . .

Communities innovate to provide health insurance

The lack of leadership at the national level to provide health insurance to the over 45 million Americans that do not have it, has driven states like Maine, Massachussetts to create programs for the uninsured within their borders. As Kevin Sack writes in the New York Times, some cities are becoming local laboratories for health insurance innovation.

[...] Healthy San Francisco, is the first effort by a locality to guarantee care to all of its uninsured [82,000 resident], and it represents the latest attempt by state and local governments to patch a inadequate federal system.

It is financed mostly by the city, which is gambling that it can provide universal and sensibly managed care to the uninsured for about the amount being spent on their treatment now, often in emergency rooms.

After a two-month trial at two clinics in Chinatown, the program is scheduled to expand citywide to 20 more locations on Sept. 17.

Whether such a program might be replicated elsewhere is difficult to assess. In addition to its unique political culture, San Francisco, with a population of about 750,000, has the advantages of compact geography, a unified city-county government, an extensive network of public and community clinics and a relatively small number of uninsured adults. Virtually all the city’s children are covered by private insurance or government plans.

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Counter intuitive approaches to managing traffic

Many people in the U.S. have heard the expression "changing the rules of the game." In some European cities, however, traffic engineers are just about eliminating the rules of the road and removing all the streets signs American drivers are so familiar with.

As Matthias Schulz writes at Spiegel Online:

The plans derive inspiration and motivation from a large-scale experiment in the town of Drachten in the Netherlands, which has 45,000 inhabitants. There, cars have already been driving over red natural stone for years. Cyclists dutifully raise their arm when they want to make a turn, and drivers communicate by hand signs, nods and waving.

"More than half of our signs have already been scrapped," says traffic planner Koop Kerkstra. "Only two out of our original 18 traffic light crossings are left, and we've converted them to roundabouts." Now traffic is regulated by only two rules in Drachten: "Yield to the right" and "Get in someone's way and you'll be towed."

Strange as it may seem, the number of accidents has declined dramatically. Experts from Argentina and the United States have visited Drachten. Even London has expressed an interest in this new example of automobile anarchy. And the model is being tested in the British capital's Kensington neighborhood.