Forbes is out with a ranking of the healthiest and least healthy states. Not surprisingly, eight of the ten least healthy are in the South (nine if you count Oklahoma). My own home state, Tennessee, comes in at 47th. Only 22 percent of children between 19 to 35 months in the state get immunized, there are only 17 doctors per 100,000 people, and 47 percent of the population is obese.

On one level, these numbers appear to be a ringing indictment of the state’s two-term Democratic governor, Phil Bredesen, a former health-care executive who promised to fix the state’s ailing health care system. But it’s not quite so easy. As Jason Zengerle documented in these pages back in the early 2000s (sorry, the archive isn’t available), Tennessee is a rabidly anti-tax state, where even the mention of a state income tax brought out massive protests in front of the state capitol and destroyed the second-term hopes of Bredesen’s predecessor, Republican Don Sundquist. Instead of income or property taxes, the state relies almost entirely on a punishingly high sales tax—7 percent on general goods, and 5.5 percent on food. Most states don’t even tax food, and only Mississippi has a higher levy. Predictably, this means lots of people buying high-calorie, low-nutrition junk food, with all its attendant health and social problems.

But even this isn’t enough revenue; Bredesen has had to make dramatic cuts in the state’s Medicaid supplement program, TennCare, and liberal critics say he cut too far. (Of course, they’re outnumbered by conservative critics, who think he didn’t cut far enough.) It was painful enough to watch him to have gut TennCare, but it was even more painful to watch most of the state cheer him on.

The irony is that Tennessee, and in particular Nashville, is home to a robust health-care industry, most notably the Frist family’s Columbia/HCA and Vanderbilt’s enormous health care center. The result is a Dickensian health care sector, driven entirely by profit. As my brother, a high school counselor, puts it, Tennessee is a great place to live if you can afford health care, and an absolutely horrible place to live if you can’t.

--Clay Risen