Rotten Teeth Report Card

May 28, 2014
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We Hoosiers spend more than we should on health care.

But if we’re looking for someone to blame, we should look in the mirror.

Quite literally.

Indiana ranks 10th in the nation for the highest spending on health care and 10th in the nation for the number of adults missing six or more teeth, according to trove of health care data released last month by the New York-based Commonwealth Fund.

That’s not a coincidence.

Hoosiers do a poor job all around of taking care of themselves, according to the numbers collected by the Commonwealth Fund. Missing teeth are just an example of it that you can’t miss.

And we end up paying for it in higher taxes and health insurance premiums.

How much more?

I figure nearly $400 more per person each year than the national average, as you can see in this database. That’s a 5.5 percent surcharge for Hoosiers that the average American does not pay.

If Indiana’s health care spending were at the same level as Minnesota’s, each Hoosier would be paying $1,450 less per year. That means a 24 percent surcharge for Hoosiers.

It’s important to note these “surcharges” are not directly paid out of Hoosiers’ pockets. The Medicare payments are funded by taxpayers from around the country. And many of the private insurance premiums are paid for by employers.

But higher health spending certainly does necessitate higher state and federal taxes, and lower wages from employers, none of which is good for the economy.

Hoosiers, via their health insurance plans, are spending more money on health care than all but nine other states. You can see how the states stack up in this spreadsheet.

The Commonwealth Fund’s numbers let us see that because the Fund adjusted private health insurance premiums and Medicare spending on doctors and hospitals to reflect the differences from state to state in how much health care workers are paid.

In other words, when adjusted for what it costs to actually deliver the care locally, Hoosiers are spending more than 80 percent of the rest of the country. (For you wonks, you might also be interested to know that the Commonwealth Fund's calculations remove all Medicare payments for graduate medical education and for treating low-income patients.)

The higher spending is good for health care businesses around Indiana. I’ve written elsewhere that Indiana’s health care industry receives $5 billion more per year than it would if Hoosiers spent at the same level of their incomes as average Americans.

Some of that clearly goes to health insurance companies, which appear to have higher profits in Indiana than in other states.

And some of it clearly fills the coffers of hospital systems, whose prices have been documented as running higher than their peers.

But the data collected by the Commonwealth Fund make it clear that high health care spending goes hand in hand with poor health. Sick people tend to consume more health care.

Consider these facts from the Fund's data:

- Significantly more Hoosiers smoke and are obese than their peers across the country. Slightly more Hoosier adults than their peers across the country die from breast cancer, colorectal cancer and suicide.

- Hoosiers die from preventable conditions 8 percent more often than Americans overall. The Commonwealth Fund reports “mortality amenable to health care.” That’s number of people that die from one of 33 different causes before age 75 (or as a child, for some of the causes). Each of the 33 conditions, which include some infections, some cancers, diabetes, hypertension, influenza, pneumonia and maternal death in childbirth, are “treatable or preventable with timely and appropriate medical care,” notes the Commonwealth Fund. That means patients aren’t getting medical care soon enough and health care providers aren’t catching illnesses until they’re expensive-to-treat crises.

- Also, public health looks pretty bad in Indiana, where infant mortality is significantly higher than the rest of the country. Dr. Bill VanNess, the state health commissioner, is working on attacking this terrible problem, which has dogged Indiana for quite some time.

- The kicker for me on health status is the percentage of working-age adults, aged 18 to 64, that are missing six or more teeth. Indiana is tied for 10th worst among states, at 13 percent. The national average is 10 percent. West Virginia leads in this Rotten Teeth Report Card, at 23 percent.

I totaled up the rankings of all 50 states in 11 categories of health status, and then ranked the states by this aggregated ranking. You can see all the data in this spreadsheet.

The result? Eleven of the 15 highest spending states were also among the 15 that ranked worst in health status.

Indiana was one of those 11. It ranked 10th in health care spending and 12th in health status.

Other states that also made this high cost-poor health list were Indiana’s next door neighbors Kentucky, Michigan and Ohio, southern states Alabama, Mississippi, Louisiana and Tennessee, as well as Oklahoma, Missouri and West Virginia.

It’s a perverse system that financially rewards health care providers and insurers simply for serving higher numbers of sick people. A better system would encourage doctors, health systems and insurers to prevent the most expensive treatments in the first place (which, by the way, is starting to happen, albeit slowly).

But the source of the high spending does not appear to be the hospitals, doctors and insurers themselves. It’s us.

So, while we can gripe and complain about the high cost of health care, the answer looks fairly simple: Be healthier.

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  • stats?
    How do you come up with a number of people missing 6 or more teeth? My guess is most people with serious dental issues are not seeing a dentist or doctor regularly? So many statistics - especially gov't ones are not believable. What is that old saying, "there are lies, damn lies and statistics"
    • How do they know that?
      The missing teeth stat does cause one to wonder how they collected that information, in all 50 states...does that count wisdom teeth? You have 4 of those...I still have 2 of mine at age 59, but I had 2 teeth pulled when I was a kid to make room for braces, so I am missing 4, but I would likely be considered a healthy Hoosier, as I have seen a dentist regularly my entire life, and have never been hospitalized for anything...we (Indiana) probably would rank higher if this stat measured all Hoosiers, when you consider we have one of the worst meth problems in the country...that stuff will rot your teeth out in a matter of months. This is one of those stats that you could consider as fodder for the stereotype of the typical Hoosier, or "hillbilly" from even further south...I notice West Virginia (home of Boone County's W. VA.'s notorious "The Wild and Wonderful Whites of West Virginia" leads in this dubious category...in other related news, I saw a rerun of "Deliverance" the other night...
    • Mississippi??
      Hum... Mississippi is in our league...were North of Mississippi.
    • To Jim and metalinmyleg
      It's interesting that you guys are skeptical on this point. The tooth decay data come from the Behavioral Risk Factor Surveillance System, which is operated by each state's health department. It does telephone surveys with adults every month, and includes a total of 350,000 adults each year. That makes it the largest telephone survey in the world. The missing teeth question was asked in 2012 of 8,483 Hoosier adults--which is a huge sample size. Most political polls survey just 1,000-2,000 people, and even less than that sometimes at a state level. So as statistics go, this is pretty solid stuff. You can read the results of the Indiana survey here: http://www.in.gov/isdh/reports/brfss/2012/Final%20Report%20Tables/c06.02.htm
    • Non-skeptic
      This data makes perfect sense, as it probably represents a similar distribution in income across the nation (Michigan seems a little suspect, but they've had their problems for quite a few years). Our race to the bottom puts us among the poorest per capita, in the US. And while hospitals have to treat you whether you can pay or not, not many have a dentist on the staff.
    • Not really surprised
      I know several people that just don't go to the dentist. They've either got dentist phobia or think that having a tooth pulled is cheaper than twice yearly dental check ups and cleaning. And we know that folks who don't get their teeth cleaned have a higher average of heart disease because of the plaque and tarter which causes gingivitis and inflammation in the mouth and throughout the body. And these people are sicker than the rest of us in the long run. It's so sad and preventable.
    • Teeth, the bodies Heath indicator.
      By the time you go to the dentist it is too late. Yearly or semi annual dentist visits will not prevent tooth decay. Did you know that there is a very high percentage of people who have crowns in their mouth that have developed cancer. Tooth decay is not an indication of how many times you brush your teeth or how your oral hygiene is. It is an indication of how healthy your body is. Dr. Westin Price was a dentist that traveled around the globe visiting primitive societies. His finding in these societies is facinating. There was no tooth decay and they had straight beautiful teeth. They never saw a dentist and they never brushed. They did have a wonderful diet. Fast forward a few years later to these societies and the westernization of them. Their diets changed and the tooth decay was setting in. Their children's teeth were crooked. The only thing that changed in these societies was diet and exercise. I have 6 kids, 3 of them have Autism. It is really hard to get them to brush. We don't eat much processed foods and try to do as much organic and made at home as we can. They have beautiful straight teeth and no decay. The only one of my kids that will need braces is my oldest. We did not change our diet soon enough for her.

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    1. So much for Eric Holder's conversation about race. If white people have got something to say, they get sued over it. Bottom line: white people have un-freer speech than others as a consequence of the misnamed "Civil rights laws."

    2. I agree, having seen three shows, that I was less than wowed. Disappointing!!

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