Hoosiers need greater access to quality health care

Toby Twotoes and I are having lunch. Frankly, I don’t know if Twotoes is his real name or just a nickname. Is he a Native
American, a disabled veteran, or the unfortunate operator of a lawn mower? It doesn’t matter; he’s a good guy.

"I’m worried," Toby says.

"About what?" I ask.

"Health," he says.

"Whose health?" I ask.

"Everybody’s," he says.

"Why?" I
ask.

"All during the election campaigns," he elaborates, putting aside his tuna melt, "the candidates for president,
governor
and other offices talked and talked about health care, but they meant health insurance. They never really got around to discussing
access and quality of health care."

"Probably so," I say, more focused on my walnut-spinach salad than on the conversation.

"And then there’s all this talk about Indiana as a leader in biotech and life sciences and whatnot," he continues.
"That’s
undoubtedly important to the state’s economy, but I don’t know how that actually helps the health of Hoosiers."

"Interesting,"
I say, sipping my hot herbal tea, which has been my drink of choice with meals since I learned that hot drinks are better
than cold ones for your digestion.

"Yeah," Toby says, "I’ve been looking at the data and on the surface it looks good, but there is an underlying
problem."

"Hmmm?" I question, adding more balsamic vinaigrette dressing to my salad.

Toby takes a deep breath and says, "As I see it, health care is only one component of the health industry. Health care
is
what’s available to local folks. Other components of the health industry, such as pharmaceuticals, export a lot of their output
to foreign places like Oklahoma and Oman.

"In 1997, health care and related services (including family and community services) accounted for 6.6 percent of the
gross
domestic product for both the nation and Indiana. By 2007, the national figure rose just slightly, to 6.7 percent, while Indiana
jumped to 7.2 percent.

"On the surface, it looks as if health and related services are becoming a larger part of the Indiana economy. But that’s
because our state’s GDP grew at about half the national rate (17 percent for us compared with 33 percent for the United States)
while our health care services grew closer to the national increase (29 percent vs. 35 percent)." In 1997, Indiana ranked
25th in the nation for health care and related services as a share of state GDP, but in 2007, we ranked 19th.

"And what does all that mean?" I ask.

"Simply that," Toby responds, "weakness in our state’s economy can mislead us into thinking that we’re increasing
health care
services to our citizens. The truth is that Indiana’s economic woes are of long standing and may be having an adverse effect
on the health of our people, because Hoosiers can’t consistently gain access to excellent health care."

"Maybe," I respond. "Or maybe you’re missing important information. We have three major metro areas on our
borders — Chicago,
Cincinnati and Louisville. Many Hoosiers go to those places for major health care services. Your data may be accurate, but
your thinking may be defective."

"OK, so it’s complicated," Toby agrees, "but we need to think about the care available to all our citizens.
They may have
to go outside their home communities to get quality care because sophisticated procedures and specialized services are too
costly for places with small populations. But one of our goals should be to reduce the necessity to travel far for quality
care."

"I’ll go for that," I say, pushing my salad plate away. After a while, too much healthful food makes me sick.

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Marcus taught economics for more than 30 years at Indiana University and is the former director of IU’s Business Research
Center. His column appears weekly. He can be reached at mmarcus@ibj.com.