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Why South Dakota health care is the nation's second most expensive • South Dakota Searchlight

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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.

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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.  

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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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Here's What I Know: The return of real polling in South Dakota

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Here's What I Know: The return of real polling in South Dakota


The polls are back.

It’s a byproduct of our short attention span, or a fascination with sports metaphors, but every election cycle we get drenched in polling.

This dude versus that dude. Up, down, sideways, trends, subsets, gender, race, age, etc.

Everything you’d want to know on this issue or that.

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It’s all quite fascinating.

And potentially dangerous.

I got my first insight into polling many years ago while working in Des Moines.

The late and legendary Tom Fogarty was a reporter for the Des Moines Register who worked on one of the most influential political polls in the country. The Iowa Poll covered more than politics, however, and had for decades by that point.

I was lucky enough to spend some quality time with Tom during the quiet moments in the Iowa Senate, where we both worked as reporters. I was young and learned a lot just watching him and reading his stories.

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He was smart, funny, a great writer and unimpressed with people in power. It was like getting a master’s degree in how to be a real reporter.

(He also pulled a masterful prank on me, related to the visit of then President Bill Clinton, a story that is retold in some circles to this day. But sadly, not here.)

What I learned from Tom about polling was the importance of the questions, how they are constructed, how the words you use matter.

I took that background into later jobs where I wrote about polls and then supervised them, working directly with professional pollsters to get the most-accurate results possible.

The world has changed immeasurably since those early days.

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There are myriad ways in which groups or politicians gauge sentiment. They use this information to guide their actions and to influence the public.

Which means that accuracy and credibility are more important than ever.

So I’ve been pleased to see the polling conducted in recent months by South Dakota News Watch. News Watch is a nonprofit newsroom founded by a couple of my former bosses at the Argus Leader and staffed by some former colleagues.

Forum Communications, the parent company of Sioux Falls Live, is a supporter and we use News Watch content on our site and the Mitchell Republic.

One of the reasons I’m happy to see News Watch taking up the mission is because of who they choose to do business with, specifically Mason-Dixon Polling & Strategy.

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That’s the same firm we used at the Argus Leader for many years, including through the highly contentious campaigns for U.S. Senate in the early 2000s.

They are thorough, professional and maintain incredibly high standards for independence.

It’s never an exact science, rather polling is just a snapshot of a moment in time. Many factors can and do influence the outcome.

The results have a margin of error, an important footnote when you’re examining the coverage of a poll. If there isn’t information on sample size, margin of error and methodology, don’t trust it.

Also, remember the further you dive into the numbers – the subgroups of geography, gender, age or race, etc. – the less accurate they become.

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There’s a lot of bad information out there, including pollsters experimenting with various digital methods to extract information. We’ve seen time and again wild claims that end up falling flat on Election Day.

I can say without hesitation that Mason-Dixon was solid in service of our reporting and believe them to be so today.

We’ve recently published stories from News Watch on their latest round of polling.

We’ve seen results on ballot measures related to abortion, the sales tax on groceries, recreational pot and open primaries.

The results have prompted responses from politicians and commentators, some dire warnings and other exaltations of glee.

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That’s not to say things won’t take a turn.

Stu Whitney, investigative reporter for South Dakota News Watch.

Contributed

The questions on this year’s ballot have major implications for how South Dakota is run. Direct democracy has been part of the collective heritage in this state since the early days.

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While recent years have seen increasing efforts to thwart voter influence in this way, it remains a powerful tool for change in a state where change is rare currency.

News Watch has stepped into a vacuum of polling in South Dakota. What was once the purview of daily newspapers and broadcasters had fallen into a hole of neglect.

I found it notable enough that I rang up Stu Whitney, my former colleague and reporter for News Watch.

Whitney said working with Mason-Dixon has history in the state and the ability to track trends – such as approval ratings for the state’s top politicians – over time. News Watch partners with the Chiesman Center for Democracy at the University of South Dakota to produce the polling.

“It seemed natural in 2024 with such an impactful election, to gauge some of the candidate races but also the ballot measures,” Whitney told me. “Not just the numbers, but to get inside the polling numbers in South Dakota and talk to both sides and get at some of the intricacies of what the impact would be if a measure were to pass.”

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Polling gives us a guidepost, a starting point for digging into the public consciousness on an issue.

All of us live in a bubble. It’s easy to let yourself plunge down the waterslide of assumption, that what your circle of friends believes is true reflects the facts on the ground.

It’s not always so.

In fact, it’s rarely so.

A well-executed measure of public opinion, we hope, is fodder for a deeper discussion about the issue or candidate at the center of the question.

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Do South Dakotans, for instance, support stringent restrictions on a woman’s right to have an abortion?

Current poll results would suggest no. Why is that?

Should the state reform the sales tax when it comes to consumables – a.k.a. groceries – as proposed on the November ballot?

The News Watch poll indicates that residents do support that.

It’s the next question, the follow-up discussion, that matters, Whitney said.

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“Regardless of the feedback, it’s important to enlighten people on these issues,” he said. “When you see the talk about turnout, the low voter engagement, this is going to be on the November ballot and it’s going to affect your life. We want to give you as much information as possible to go to the polls with. Anyone who reads them will see there is not just pure poll numbers, there is perspective in there as well.”

News Watch has plans to continue polling through this election cycle and beyond. There’s a lot we can learn, not just the head-to-head nature of electoral politics, but what’s at the core of our beliefs in South Dakota.

I’m excited to learn more.





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More than 200 people suing South Dakota for Hideaway Hills sinkhole

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More than 200 people suing South Dakota for Hideaway Hills sinkhole


RAPID CITY, S.D. (KEVN) – Imagine waking up one day to a large sinkhole right outside your house.

For some residents of Hideaway Hills, that’s exactly what happened in April 2020 when a sinkhole formed revealing an abandoned gypsum mine.

Four years later, more than 200 people are involved in a lawsuit against the State of South Dakota and are seeking $60 million in damages.

Since 2020, the sinkhole in the Hideaway Hills neighborhood in Black Hawk has led to anger and fear.

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“There’s no guarantee that a sinkhole won’t open under a school bus or somebody’s bedroom or anything else that’s out there. They’re also afraid they’re going to lose their utilities and they’re going to have to move,” said Kathleen Barrow an attorney with Fox Rothschild LLP.

Now, there is a class action lawsuit against the state of South Dakota as more than 200 people are claiming the area to be too dangerous to live in.

“To the degree that there was an incorrect or inadequate reclamation which is certainly one of the things we’re alleging, it can only be attributable to the state,” said Barrow.

There are currently 12 homes in an evacuation zone and a total of 158 homes are threatened due to their foundations having nothing stable to sit on.

Barrow believes more homes will be added to the evacuation zone.

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“Every time it rains, you get small collapses and subsidence’s and that affects the structures of the homes,” said Barrow.

She feels empathy for those who have lost their homes because of the sinkhole.

“I wouldn’t know what to do because I wouldn’t have the means to buy another house and just vacate the one I’m in. Not very many of us would, but nobody should be living out there, unfortunately, because you don’t know what’s going to happen,” said Barrow.

Barrow says a hearing is expected at some point this summer and a trial is set for damages next spring.

See a spelling or grammatical error in our story? Please click here to report it.

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An anti-abortion group in South Dakota sues to take an abortion rights initiative off the ballot

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An anti-abortion group in South Dakota sues to take an abortion rights initiative off the ballot


An anti-abortion group in South Dakota has sued to block an abortion rights measure from the November ballot.

In its complaint filed Thursday, Life Defense Fund alleged various wrongdoing by the measure’s supporters, as well as invalid signatures and fraud. The group seeks to disqualify or invalidate the initiative.

In May, Secretary of State Monae Johnson validated the measure by Dakotans for Health for the Nov. 5 general election ballot. The measure’s supporters had submitted about 54,000 signatures to qualify the ballot initiative. They needed about 35,000 signatures. Johnson’s office deemed about 85% of signatures as valid, based on a random sample.

Life Defense Fund alleged Dakotans for Health didn’t file a required affidavit for petition circulators’ residency, and that petitioners didn’t always provide a required circulator handout and left petition sheets unattended. Life Defense Fund also objected to numerous more signatures as invalid, and alleged petitioners misled people as to what they were signing.

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“The public should scrutinize Dakotan for Health’s comments and carefully consider its credibility. In the end, the Court will determine whether such unlawful conduct may result in the measure being included on the ballot,” Life Defense Fund attorney Sara Frankenstein said in an email Monday.

Dakotans for Health called Life Defense Fund’s lawsuit “a last-ditch effort to undermine the democratic process.”

“They have thrown everything they could, and now the kitchen sink, to stop the voters from weighing in this November. We are confident that the people of South Dakota are going to be able to make this decision, not the politicians, come this November,” co-founder Rick Weiland said in a statement Friday.

The measure would bar the state from regulating “a pregnant woman’s abortion decision and its effectuation” in the first trimester, but it would allow second-trimester regulations “only in ways that are reasonably related to the physical health of the pregnant woman.”

The constitutional amendment would allow the state to regulate or prohibit abortion in the third trimester, “except when abortion is necessary, in the medical judgment of the woman’s physician, to preserve the life or health of the pregnant woman.”

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South Dakota outlaws abortion as a felony crime, except to save the life of the mother, under a trigger law that took effect in 2022 with the U.S. Supreme Court’s Dobbs decision that overturned the constitutional right to an abortion under Roe v. Wade.

The measure drew opposition from South Dakota’s Republican-controlled Legislature earlier this year. The Legislature approved a resolution officially opposing the measure, and it passed a law allowing petition signers to withdraw their signatures from initiative petitions. The latter is not expected to affect the measure going before voters.

Life Defense Fund is also seeking to ban Dakotans for Health and its workers from sponsoring or circulating petitions or doing ballot initiative committee work for four years.

South Dakota is one of four states – along with Colorado, Florida and Maryland – where measures to enshrine abortion rights into the state constitution will come before voters in November. There are petition drives to add similar questions in seven more states.

Since the U.S. Supreme Court overturned Roe v. Wade and ended the nationwide right to abortion two years ago, there have been seven statewide abortion-related ballot measures, and abortion rights advocates have prevailed on all of them.

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Dura reported from Bismarck, North Dakota. Associated Press writer Geoff Mulvihill contributed to this story from Cherry Hill, New Jersey.



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