No, this is not about getting a heart attack from shoveling snow (though that is a real phenomenon). It's about how the rising cost of health care is eroding the ability of state and local governments to fund investments in infrastructure. This becomes most apparent when that infrastructure is stressed, as it is, say, during a snow storm. Case in point: Boston.
As a former resident of “Beantown” I can attest to the fact that snow is a constant part of the winter landscape there. We could always count on the first snowfall to come before Thanksgiving (and could never count on being done before April. I recall 1 depressing year where it snowed in May! So I was not surprised, and was even a little nostalgic, when I witnessed Boston's second major snowstorm of the year. I was, however, surprised at how much the city struggled to cope with the snow, and in particular, how poorly the public transportation system held up under the circumstances. With another snowstorm arriving, the system failed completely. I was in town taking an executive education course at the Kennedy School of Government about health care delivery, which got me thinking about the connection between a failing transit system and health care.
Here is a slide from one of the lectures, taken from a publication by the Blue Cross Blue Shield of Massachusetts Foundation:
What it shows is that state spending on health care in Massachusetts has gone up, while everything else in the state budget, education, infrastructure, public safety, and more, has declined. As health care expenditures rise, it limits the ability of government to do everything else we want it to do, like making the trains run on time (or at all).
Here is something from Commonwealth Magazine from 2011: “The MBTA (the public transportation authority in greater Boston) is severely underfunded with regard to maintenance and upgrades of the regional bus and subway system. On the Orange Line, 120 cars built between 1979 and 1981 need to be replaced. On the Red Line, 74 cars from 1969 are well past their useful life. More than half of the MBTA's 82 commuter rail locomotives date to the 1970s, and nearly all are at or past the manufacturer's recommended lifespan of 25 years.”
This is neither good nor sustainable. I think it is one more piece of incontrovertible evidence that we need to lower health care costs.
What do you think?
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.