On Wisconsin!

Wisconsin is in the press. Green Bay spends less than Los Angeles. Why does Wisconsin do so well? Yes, the folks are terrific. I was born and bred there and was dean of the Medical College of Wisconsin, so I know something about it, and I’m proud of Wisconsin. But I also studied it. Wisconsin does well in health care because of its favorable demographics and its prosperity. Few uninsured, good Medicaid coverage, excellent employer-sponsored insurance and moderate Medicare spending and low per capita spending overall, almost everywhere. But not in the Milwaukee region — spending is 30% greater than in the rest of the state. Why is that?  The answer is that it’s a complex urban environment, not as complex as Chicago or Los Angeles, but complex enough. It also turns out that Milwaukee is profoundly segregated. That allowed us to carve out what we termed the “poverty corridor,” where more than 90% of blacks and 75% of Latinos live and where poverty abounds. Hospital admission rates in the “corridor” were 66% higher than in the rest of Milwaukee, and they accounted for the entire difference. The Milwaukee region without its poverty corridor is like the rest of the state. Move the corridor to Green Bay, and Green Bay’s health care would resemble Newark’s. This should be familiar to the President. Milwaukee’s poverty corridor is like Chicago’s 17^th and 20^th wards, where the President worked. He knows about poverty. So let’s stop the Dartmouth doubletalk and start addressing the root cause of variation in spending -– p-o-v-e-r-t-y.