It costs an average of $6,000 per person per year in federal, state, and local taxes to cover the government’s share of our national health care bill.
The three levels of government pay about 71%, or roughly $1.8 trillion, of our nation’s annual health expenditures. It is no wonder that most rational people want policymakers to do more to bring these costs under control.
Policy leaders talk all the time about controlling health care expenditures. This would help.
But if we actually want to reduce costs significantly, we have to invest in prevention and public health. This is a position I’ve pushed in the past. All it takes to understand why is to recognize that prevention and public health have been responsible for half of our increased life expectancy during the past century while absorbing less than 5% of our overall health spending.
This is old health policy news. So why aren’t policymakers doing more in prevention?
The answer may boil down to two words – term limits. Term limits, it seems, are bad for your health.
State legislators have a direct say in how roughly 40-45% of government health dollars are spent, and an indirect say in much more. We now have almost twenty years of experience with term limit laws. States that limit the terms of their state legislators do a worse job protecting the health of their people than states that do not.
Term limit legislation swept through half the nation in the 1990s as citizens sought to rein in the power of lifetime citizen politicians. California, Colorado, and Oklahoma were the first states to enact them in 1990. Nebraska, the 21st, was the most recent in 2000.
There are currently fifteen states with term limits for state legislators. California and Florida are the most prominent among them. With just a handful of exceptions, none of them ranks near the top in my States for Your Health ranking, the Healthy State rankings (which focus on public health), or the Kids Count rankings (which focus on children and prevention).
Only four of these fifteen term-limiting states – Colorado, Nebraska, California, and Maine – make even the top half of the States for Your Health. Only Colorado, Maine, and Nebraska are in the top 20 in the Healthy State rankings. And only California, Maine, and Nebraska are in the top 20 in the Kids Count rankings.
Overall, the average ranking for the fifteen states with term limits is 31st in all three rankings. The average ranking for the 35 states without term limits is 23rd.
Six states – Idaho, Massachusetts, Oregon, Utah, Washington, and Wyoming – enacted term limits and then repealed them. Their average rank is 13th in my rankings, 11th in the Healthy State rankings, and 15th in the Kids Count rankings.
The reason term limits have such a significant effect on the health of a state’s population may be because term-limited politicians don’t have the time to come up to speed on complex health issues.
Election to office or appointment to a legislative committee does not make one an instant expert on policy. And term-limited politicians are often political lame ducks the day they get elected, with no incentive to work on issues with a long-term policy payoff.
Public health and prevention initiatives demand patience, with payoffs often measured in decades, not four two-year terms. For example, reducing smoking prevalence from 42% of the U.S. population in 1965 to 21% in 2006 required a generation of a Surgeon General-led public education campaign, bans on smoking in public places, increased cigarette taxes, and restrictions on sales of tobacco products to minors. Saving billions in cancer and heart disease costs required this level of ongoing effort.
It also required having in place long-term legislators with whom tobacco lobbyists had to deal.
When the top-ranked state for health, Massachusetts, passed its health reform legislation in 2006 that led to near-universal coverage in the state, two legislators who spearheaded the effort – the Speaker of the House and the President of the Senate – had been in office for 27 years and 13 years, respectively. And in Connecticut, my second-rated state for health, the current Speaker of the House has been in office for 19 years, and the Senate President has served for 18 years. Both have considerable achievements in health and environmental health during the past decade – long after term-limiting states would have put them out of office.
In fifteen states, term limits have led us to trust a large portion of $6,000 a year in health spending annually to people without this experience.
And that has proven to be very bad for our health.
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