Introduction

Declining Health

A message from the publisher

t’s ironic that advances in medical science are accelerating just as some of our key systems for delivering health care services are deteriorating. The media are full of stories about new drugs or procedures or equipment that promise leap-frogging progress in medical care.

I wish our report in this issue assessing health care delivery in the states could be as cheery. However, as the introduction notes, “Americans are living with first-rate medicine and a third-rate health care system. And the problem is getting worse instead of better. Clearly, there is a health care crisis in America, but it is in no way a medical problem. It is a fiscal problem.”

In most areas we cover — education, welfare, environment, public safety, technology, management — there are problems, but there usually is at least some incremental amount of progress at any given time. That is not the case with health care; we’re sliding backwards.

This report is the sixth in a series completed under the aegis of the Government Performance Project, an academic-journalistic alliance funded by the Pew Charitable Trusts.

Unlike past reports, this one does not issue grades for the 50 states, but that doesn’t mean we shy away from making judgments. Instead, we have divided the broad subject of health care into six areas: public health, mental health, long-term care, children’s care, prescription drugs, and insurance coverage. At the end of each of these six reports, we include a summary on “success stories” and “trouble spots.” As we discovered, a state may serve as a model in one, two or even three areas, but then have major problems in another.

You can see what an ambitious undertaking this is. It reflects almost a year of effort, countless interviews with experts in each of the six areas, and wading through mountains of studies and reports. Health care has become such a key domestic issue that there is no shortage of serious research or academic expertise. What has been lacking is an understandable and accessible analysis of where we stand, at least until now.

The in-depth reporting, as in past GPP reports, was done by the trio of Katherine Barrett, Richard Greene and Michele Mariani. Credit for the excellence of the overall product goes to Executive Editor Alan Ehrenhalt, who can cut through to the true essence of the most complex story faster than any journalist I know, and Associate Editor Penelope Lemov, who brought her expertise on health care issues to the project. Managing Editor Anne Jordan, Research Director Melissa Conradi and Art Director Richard Steadham enriched the package with graphics and artwork.

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