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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Gov. Kristi Noem formally requested Friday a major disaster declaration from the Biden administration for 25 counties due to the severe flooding that occurred in eastern South Dakota between June 16 and July 8.
Noem signed an executive order declaring a disaster exists in the following South Dakota counties: Aurora, Bennett, Bon Homme, Brule, Buffalo, Charles Mix, Clay, Davison, Douglas, Gregory, Hand, Hanson, Hutchinson, Jackson, Lake, Lincoln, McCook, Miner, Minnehaha, Moody, Sanborn, Tripp, Turner, Union, and Yankton.
According to the National Weather Service, the rain event that created this flooding was a 1,000-year event.
“Today, we are submitting our request for a presidential disaster declaration to address the damage from a historic 1,000-year flood that impacted South Dakota,” Noem wrote in a Friday press release. “We have been working with families, local governments and officials, and FEMA for weeks to assess the damage. I am so proud of what South Dakotans have been able to do to start piecing our communities back together.”
A presidential disaster declaration provides a wide range of federal assistance programs for individuals and public infrastructure, including funds for both emergency and permanent work.
The recent flooding inundated communities and damaged infrastructure across eastern South Dakota. The McCook Lake community in North Sioux City was hit by floodwaters diverted from the Big Sioux River on July 23, destroying about 30 homes and eroding roads.
A BNSF railroad bridge used to transport goods over the South Dakota-Iowa border in North Sioux City also collapsed July 23 due to the flooding.
Some parts of Canton also received more than a foot of rain between June 20 and June 22, almost exactly a decade after the 2014 flood that struck the area.
One person died as a result of the flooding. The state Department of Public Safety confirmed the death involved 87-year-old Merlyn Rennich, of Harrisburg, who crashed a UTV on a closed road near Lake Alvin, 5 miles east of Harrisburg. The road was damaged by the floodwaters, and the man died after reversing into the road’s washed-out shoulder while attempting to turn around.
More: DPS confirms fatal crash near Lake Alvin was flood-related
The release from Noem’s Office states that teams from the Office of Emergency Management and the Federal Emergency Management Agency have been on the ground conducting thorough damage assessments across the impacted areas, working closely to assess the extent of the damage and coordinate the necessary response efforts.
“This thorough damage assessment was normal protocol for a presidential disaster declaration, and it’s an important part of the process to make sure all eligible counties and citizens are included,” said Kristi Turman, Director of the Division of Emergency Services at the South Dakota Department of Public Safety.
At least 11 river gauges hit new preliminary record-high levels, according to the Governor’s Office. The Big Sioux River at Sioux City crested nearly eight feet higher than previous records. New record crests were set at the following locations:
- Big Sioux River at Canton, Hawarden, Akron, Richland, Jefferson, and Sioux City;
- Vermillion River at Davis, Wakonda, and Vermillion;
- West Fork Vermillion River at Parker; and
- Turkey Ridge Creek at Centerville.
South Dakota
Suspected pedophile kills himself when confronted by predator hunter at his South Dakota home
A suspected pedophile killed himself moments after he admitted to watching child pornography to a predator hunter outside his South Dakota home.
Donald Letcher, 60, described the graphic detail of the disturbing videos that featured children as young as infants to Predator Poachers founder Alex Rosen, according to footage shared by the “Breanna Morello Show” podcast.
Letcher described his atrocious viewing pleasures, which featured males holding down babies as they “ejaculated” on them.
After hearing enough evidence, Rosen called in a police officer and got Letcher to admit his heinous act to the cop.
As the officer called his supervisor, Letcher walked inside and a “pop” was heard.
The crew outside say they didn’t think much of it because it “wasn’t a loud shot,” but it was later revealed that Letcher shot himself in the head with a .22 bullet.
“The cop breaks the door down and then one of my camera guys goes around the window and sees him (Letcher) on the ground with a hole in his head bleeding out of it,” Rosen said.
Letcher was airlifted to a hospital, where he was pronounced dead, according to Rosen.
The pedophile had reached out to Rosen’s team, who were posing as a preteen girl, and asked for “nudes.”
“This guy messaged us first in April, and all the messages he was pretty sexual, asking us for nudes thinking we were a 12-year-old girl,” Rosen said.
The predator hunter said he had Letcher graphically describe the videos to ensure the creep admitted to the crimes for video evidence.
“When they describe basically everything they see, it leaves no doubt they’re guilty of watching and possessing that stuff,” he added.
Letcher reportedly molested a 9-year-old girl in 1996, a fact unknown to Rosen at the time of his conversation, but the case was overturned by the South Dakota Supreme Court.
“The justice system never held him accountable,” Rosen said.
Letcher was also hit with DUI and hit-and-run charges after he ran over a 6-year-old girl in a “non-pedophile” incident in 2022.
The National Weather Service has issued a RED FLAG WARNING for western South Dakota from Noon to 11 p.m. local time, Thursday, July 25. A Red Flag Warning means that critical fire weather conditions are either occurring now or will shortly. A combination of strong winds, low relative humidity, and warm temperatures can contribute to extreme fire behavior creating ideal conditions for wildland fires to start easily and spread quickly.
Counties within the Red Flag Warning area include Butte, Custer, Fall River, Harding, Jackson, Lawrence, Meade, Oglala Lakota, Pennington, and Perkins counties.
South Dakota Wildland Fire advises extreme caution with any potential fire ignition sources today. Please avoid any outdoor burning during this time, using tools that generate sparks, dragging chains from trailers, throwing cigarette butts out a car window, and parking in tall, dry grass.
If you see a wildland fire call 911 immediately. Be aware that in conditions like these, fires may spread quickly.
For more information about fire prevention visit https://wildlandfire.sd.gov/.
SDWF is an agency of the South Dakota Department of Public Safety.
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