South Dakota
Why South Dakota health care is the nation's second most expensive • South Dakota Searchlight
Several months ago, Forbes, a respected business and economics publication, released an analysis of the “The Most (And Least) Expensive States for Healthcare 2024.” A striking — and concerning — finding was that health care expenses in South Dakota were the second highest in the nation.
The multiplicity of payers and the differing demographics of populations in diverse geographic areas make measuring and comparing total health care costs across different regions a highly complex undertaking. Nonetheless, the findings in the Forbes article have been supported by other research.
An extensive and very interesting paper was published several years ago by the Health Care Pricing Project. This analysis looked at both Medicare costs and private insurance expenditures in 306 health care regions across the U.S. In that study, private insurance expenditures in the Sioux Falls region were the 14th highest in the nation but Medicare expenditures were near the bottom (275th out of 306). The huge difference can be explained by the fact that Medicare prices are set by the Medicare program, whereas each private payer has to negotiate prices with the individual providers.
In eastern South Dakota, there is intense competition between two large health care systems. One could reasonably expect that costs would be lower. The results show that just the opposite is true.
How can this be? The reality is that the economics of health care do not follow the principles that govern prices in standard consumer markets.
For a conventional consumer market to function efficiently, multiple suppliers need to compete based on price and the quality of products available. Consumers need to have full understanding of both product quality as well as the price charged. They need to be free to switch suppliers if they find a “better deal.” They should have the freedom to “shop around.”
So how does all this apply to health care?
First, and probably most basic, health care providers rarely compete based on price. In fact, unless patients make an effort to ask, the price of a service may well not be known until the bill arrives. Since so much of health care is paid for by third-party payers, patients often have little incentive to ask. Additionally, there is little motivation to “shop” for the best price even if that is an option available to them, which it may not be.
Furthermore, if patients do have prices to compare from competing providers, they sometimes have skepticism about low-priced services. They may be concerned that providers have “cut corners” or that the service is less trustworthy. This follows directly from the fact that, unlike most consumer goods, patients usually do not have access to objective information about the quality of the actual service being considered. They usually rely on broad provider reputations or word-of-mouth evaluations. Such sources can provide helpful perspectives but are often lacking in specifics about particular procedures, individual providers, etc.
Treating health care as a commodity has not driven costs lower
Shopping around to get the best deal makes good sense if one is buying groceries or gasoline, but it presents major problems in health care. Limitations imposed by insurance networks are real. More basically, moving from one provider to another hinders continuity of care and raises the risk of important past history being overlooked or serious risks going unnoticed. Additionally, multiple payers with multiple sets of reimbursement rules have led to administrative complexity and enormous administrative costs.
From the provider perspective, competition all too often leads to duplication of facilities and services. Rather than refer patients/customers to a competitor, each one sets up their own service. This can be a logical action from a business perspective, but in highly technical services such as organ transplantation, small volumes raise the risk of above average cost and poorer outcomes. Competition, instead of promoting lower cost and better service, actually does the opposite.
Paying for health care services is an exceedingly complex undertaking. In the U.S., health care expenditures are the highest in the world, even though we have significant portions of our population who are not getting care. Commitment to conventional market principles has served us well in much of our economy. It is clear, however, that it is not serving us well in the health care.
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MITCHELL — It’s been nearly a full calendar year since the Mitchell High School boys basketball team last lost a game.
Since its last loss on Jan. 2, the Kernels have rattled off 20-straight victories — 17 in a row to end their championship run last season, plus a 3-0 start to the current campaign.
Mitchell is the first Class AA boys basketball program with a 20-game win streak since Sioux Falls Roosevelt won 35 in a row between the 2020-21 and 2021-22 seasons.
During the current streak, Mitchell has defeated 16 different programs. The only current Class AA teams Mitchell hasn’t beaten during the streak are Harrisburg, Douglas and class newcomer Tea Area. Included in the 20 wins are 13 double-digit victories, including five of 20-plus points. Nine wins came against Eastern South Dakota Conference foes, with seven against Metro Conference opponents and four against West River squads.
Here’s a closer look at how the Kernels reached 20 wins in a row:
No. 1: Mitchell 49, Yankton 45
Jan. 5, 2024, at the Corn Palace
Three days following an overtime loss to Harrisburg on the same court, Mitchell went to an extra period again to survive a stern test from ESD rival Yankton in the first meeting since the 2023 state title tilt. Landen Soulek’s 12 points, including a go-ahead 3-pointer in overtime, carried the day for the Kernels.
No. 2: Mitchell 67, Huron 56
Jan. 9, 2024, at the Corn Palace
No. 3: Mitchell 57, Sioux Falls Lincoln 51
Jan. 18, 2024, at the Corn Palace
Adam Thury / Mitchell Republic
No. 4: Mitchell 68, Brookings 55
Jan. 25, 2024, at Brookings
No. 5: Mitchell 71, Sioux Falls Jefferson 58
Jan. 30, 2024, at Jefferson H.S.
One week after taking over the No. 1 ranking in the South Dakota Prep Media poll for the first time in 12 years, the Kernels won a fifth-straight game by taking out an eventual state tournament team on the road. Mitchell led by eight points at halftime but ballooned the cushion to 22 points in the second half. Colton Smith had a big night with 20 points, nine rebounds, five assists and three steals.
Landon Dierks / Mitchell Republic
No. 6: Mitchell 71, Sturgis 42
Feb. 2, 2024, at Sturgis
No. 7: Mitchell 59, Spearfish 45
Feb. 3, 2024, at Spearfish
In the last of four consecutive road games after claiming the top spot, Mitchell cemented its place atop the rankings. The Kernels won the third quarter 24-9 to turn a three-point halftime lead into an 18-point advantage entering the final frame. Gavin Soukup tossed in 21 points to lead the way.
No. 8: Mitchell 68, Aberdeen Central 56
Feb. 6, 2024, at the Corn Palace
Landon Dierks / Mitchell Republic
No. 9: Mitchell 60, Sioux Falls Washington 55
Feb. 13, 2024, at Washington H.S.
No. 10: Mitchell 74, Pierre 50
Feb. 16, 2024, at Pierre
With a blowout road win over another ESD rival, the win streak reached 10 games in a row. Colton Smith posted a 23-point, 10-rebound double-double with five assists, and Markus Talley added 20 points, six rebounds and six assists.
No. 11: Mitchell 75, Sioux Falls Roosevelt 53
Feb. 17, 2024, at Roosevelt H.S.
Capping a stretch of three road games in five days, the Kernels dominated. Colton Smith scored 14 points in each half to spur Mitchell’s season-high scoring output. It was also the Kernels’ first win at Roosevelt High School in 20 years
No. 12: Mitchell 59, Brandon Valley 54
Feb. 20, 2024, at the Corn Palace
A preview of the eventual state championship contest, Mitchell overcame an early 12-point deficit to snap the Lynx’s own 12-game win streak. Gavin Soukup, Markus Talley and Colton Smith all provided 15 points for the Kernels, while Parker Mandel tossed in 10 points off the bench. Mitchell clinched a share of the Eastern South Dakota Conference title.
Adam Thury / Mitchell Republic
No. 13: Mitchell 60, O’Gorman 50
Feb. 23, 2024, at O’Gorman H.S.
Powered by 23 points and seven rebounds from Gavin Soukup, the Kernels polished off a 19-1 regular season record and secured the No. 1 seed in the Class AA postseason.
No. 14: Mitchell 60, Yankton 46
March 2, 2024, at the Corn Palace — Class AA SoDak 16
Facing a postseason rematch of the 2023 Class AA state title game to reach the state tournament, Mitchell roared out to a 20-point halftime lead and didn’t let Yankton closer than eight points the rest of the way. Six Kernels scored at least six points as Mitchell punched its tournament ticket, paced by Markus Talley’s 25 points, four rebounds and four assists. The win secured a fourth-straight state tournament berth for the program.
Adam Thury / Mitchell Republic
No. 15: Mitchell 69, Sioux Falls Jefferson 61
March 14, 2024, at the Premier Center, Sioux Falls — Class AA quarterfinal
Mitchell’s championship charge received a stern test in the opening round, as the Cavaliers chopped down a double-digit deficit to just two points in the fourth before the Kernels put the game away.
Adam Thury / Mitchell Republic
No. 16: Mitchell 72, Sioux Falls Washington 51
March 15, 2024, at the Premier Center, Sioux Falls — Class AA semifinal
Following a sweat-inducing quarterfinal, the Kernels’ semifinal affair was never in doubt. Mitchell’s lead was 13 or more points the entire second half, growing as large as 27 points. Gavin Soukup propelled the effort with 22 points and eight assists.
Adam Thury / Mitchell Republic
No. 17: Mitchell 46, Brandon Valley 45
March 16, 2024, at the Premier Center, Sioux Falls — Class AA championship
Markus Talley found Gavin Hinker for the title-winning layup with _ seconds to play, and the Kernels came up with a pair of defensive stops on the final possession to capture the program’s first state championship since 2005. Mitchell’s 17th state championship all-time, the most in state history, ended with a 23-1 record.
Adam Thury / Mitchell Republic
End of 2023-24 season; start of 2024-25 season.
No. 18: Mitchell 70, Watertown 44
Dec. 17, 2024, at Watertown
Kernels open title defense with a blowout road win in ESD play. Markus Talley drops in 27 points, while Gavin Hinker nets a career-high 14 points in the victory.
No. 19: Mitchell 55, Rapid City Stevens 52
Dec. 30, 2024, at Stevens H.S.
After trailing for much of the second half, the Kernels went on an 8-0 run late in the fourth quarter to swipe a road win. Markus Talley led the way with 26 points, including the last five to clinch it for MHS.
No. 20: Mitchell 61, Rapid City Central 47
Dec. 21, 2024, at Central H.S.
Tackling a third road game in five days to open up the new season, Mitchell pulls away late behind 19 second-half points from Colton Smith. All told, Smith (24) and Markus Talley (26) combined for 50 points in the win. It was coach Ryker Kreutzfeldt’s 60th career head coaching win in 75 games, a win percentage of .800.
South Dakota
There was ‘no room at the inn’ for this dog, but a St. Paul rescue helped save her (and her puppies)
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It was a Saturday afternoon in December and the Petco on Ford Parkway in St. Paul was busy with shoppers coming and going, some of them accompanied by dogs wearing holiday sweaters.
At the center of the store, enticing customers to pause, was a gaggle of six puppies from three litters, up for adoption through Pooches United with People (PUP).
“Where’s their mom?” asked a volunteer about two of the puppies.
“She’s in my basement,” said PUP founder Jeanne Weigum. “It’s a good story and a bad story.”
“Most are,” said the volunteer.
True, and this one is our Christmas story.
Jeanne
If anyone in St. Paul has a big enough heart to rescue dogs, it’s Weigum, who at 80 is still volunteering on several fronts.
It was a year ago that the St. Paul City Council voted to declare Dec. 13, 2023, as “Jeanne Weigum Day” in honor of her volunteer work, which includes serving as the president of the Association for Non-Smokers-MN. She has also fought against billboards and planted ornamental gardens, spending decades working to improve the city where she lives.
The city council’s resolution called her the “grande dame of advocacy and community building in St. Paul … and beyond for the past 50-plus years.”
Weigum’s work with animals is rooted in both St. Paul and western South Dakota, where she grew up.
“I still have a home in Mobridge,” she said of her hometown.
While Weigum started volunteering locally with the Animal Humane Society and then Second Chance Animal Rescue, she also wanted to help in South Dakota, especially alongside her neighbors from the Standing Rock Indian Reservation.
“I was connected to Judy White Bull of Wamakaskan Onsaka, which in Lakota loosely translates to ‘animals in need,’” she said.
While her friend has since passed away, South Dakota is still Weigum’s focus for helping animals and the people who love them. Working with locals, Pooches United with People coordinates wellness clinics, animal rescues and more.
It was one such local who saved a dog called Lola.
Lola
Weigum emailed the Pioneer Press about a dog from South Dakota on Nov. 30.
“I have a pooch that I think you and your readers might find interesting to learn about and follow,” she wrote.
It was Lola.
“Lola was abandoned by her family in a 300-person town,” Weigum explained.
Rudy Little Shield of Mobridge, a volunteer with PUP, was familiar with the young dog, a mutt with floppy ears and a reserved disposition.
“I first saw her as a little pup. We vaccinated her along with a couple other ones,” Little Shield recalled in a phone interview. “I knew Lola’s family, but they ended up moving. I don’t know why they left her, I just knew she didn’t have anybody. She was always running around — I don’t think she stayed anywhere.”
“Then, as nature would have it,” Weigum said, “she got pregnant.”
“A friend called,” Little Shield said. “She said, ‘Can you come check on this dog?’”
It was Lola, and she was having her puppies outside of the friend’s house.
“She had dug a little hole right where the vent comes out to the dryer, maybe because it was warm there,” Little Shield said.
“When she started to deliver there was literally no manger and no room in the inn,” Weigum said. “She started having her puppies out in the open.”
Little Shield brought Lola and her litter a dog house for shelter, a protected space away from other dogs and curious children, but Lola quickly disappeared.
“And then, about a week later, my sister called me,” he said. “She said, ‘There’s a dog under my porch and it has puppies.”
It was Lola, again. Unfortunately, only five of her nine puppies had survived.
This time, Little Shield was able to get Lola into a kennel with the help of pieces of chicken.
Soon, Lola and four of the surviving pups were on their way to St. Paul with PUP, where our story continues.
“I just hope they get a home,” Little Shield said.
The fifth pup already found a home — with Little Shield.
A new life
Temperatures were falling in St. Paul on Dec. 10, but Lola and her puppies didn’t seem to notice as they romped around Weigum’s backyard.
“Look how happy she is,” Weigum observed of Lola.
It’s a big change, having shelter and food and companionship.
“She has gained weight and her coat is no longer dull and rough but beautifully shiny,” Weigum says.
There are still challenges, though.
“She is learning to associate treats with hands and is starting to like human company at least a wee bit,” says Weigum.
With her puppies weaned and three of them adopted, Lola has been placed in foster care with Katie Holmes of Minneapolis, a new volunteer.
“I was at Petco during their adopt-a-puppy event and chatting with somebody there,” Holmes said. “I said, ‘I’m just looking, I can’t take on the financial responsibility of a puppy right now.’ They said, ‘The mom of some of the puppies is going to need a foster, do you want to meet her?’ Let’s go drive over to Jeanne’s house.’ So we did and when I saw Lola’s stupidly large ears and her sweetness, I just kind of fell in love.”
So far, Holmes has learned that Lola loves car rides but does not love being left home alone. She is also willing to tag along to Holmes’ dog-friendly office, where she has made a friend, a dog/mentor named Mishka. Back at her foster home, she enjoys sleeping on a futon and tolerates Holmes’ cat.
After a “chill” Christmas with Holmes, there’s work to be done before Lola is ready for adoption.
“The foster will work on socializing and desensitizing to the frightening things from the past,” Weigum says. “We are at the middle of this story, with much yet to come.”
Joy
Sara Janssen and her family were reeling this fall after losing both of their dogs in the span of a week: Bella was 15 years old, but Frida — adopted through PUP — died at age five from a rare autoimmune inflammatory disease.
“Jeanne was the first person I called,” Janssen said after Frida’s death. “I hadn’t spoken to her since I adopted Frida, but I needed to talk to her. She is such a warm and loving person, representing all the best things about the adoption and rescue community.”
Weigum knew what Janssen needed: She needed to cuddle some puppies; she needed to hold new life in her hands.
That’s just what she did, after Weigum brought Lola and her puppies 400 miles from South Dakota to St. Paul.
Soon, one of those puppies — Cricket — was driving a few more blocks, to Janssen’s home.
“If there are people out there like myself, people who have lost a pet who left a hole in their heart and they don’t know where to turn to regain what their heart is missing, what I want to share is how it felt when Cricket was in my lap as we drove the four blocks home from Jeanne’s.
“The joy that comes from having a puppy next to you,” Janssen says, “it’s an unadulterated joy you regain that day.”
A joy that feels like Christmas.
PUP adoption event
Two of Lola’s puppies, Stash and Shirley, are available for adoption and still waiting for homes. Learn more about them at https://pupmn.org/.
The puppies will attend a Pooches United with People adoption event from 6 to 8 p.m. Friday, Jan. 3 at Arbeiter Brewing, 3038 Minnehaha Ave., Minneapolis.
Follow updates about Lola in foster care on PUP’s Facebook page at facebook.com/PUP.MN).
Originally Published:
South Dakota Medicaid will soon cover birth and postpartum doula services. Doulas can support families as part of a broader healthcare team during pregnancy and through the year following birth.
South Dakota Medicaid will directly reimburse doulas as Type 1 healthcare providers starting in the new year. Kelsie Thomas is board president for South Dakota Doulas, the nonprofit that worked with the state Department of Social Services to add this new coverage. She said doula services can include gathering personalized resources for families, patient advocacy and home-visits after birth.
“The doula role is special in this sense that it’s hired by families as an advocate, as a resource position, as a voice for you in the process,” Thomas said.
The most recent Medicaid Report from the state Department of Social Services notes around 40% of South Dakota children rely on Medicaid or the Children’s Health Insurance Program in their first year of life. Thomas hopes partnering with the state Medicaid program will make doula services more accessible, thereby improving postpartum outcomes.
“We haven’t had that kind of financial support, and families have had to make room for that,” Thomas said. “Now being able to have that, add that insurance—which is trending nationwide. Insurance is covering birth and postpartum work just due to the impact we’re seeing and statistics for labor and birth and the proactive measures that it’s creating in lives.”
Various studies suggest doulas can help improve birth experiences for mothers and reduce the likelihood of postpartum depression, among other potential benefits.
Thomas said doulas are not a replacement for the clinical care provided by obstetricians or midwives, but instead serve as part of a pregnancy care team.
South Dakota Medicaid coverage of doula services begins January 1.
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