Why Nebraska's Health Future is America's Health Future

America spends over $4.5 trillion each year on healthcare — more than four times our defense budget. We pay more than any other country on Earth, yet our life expectancy lags behind our peers, chronic disease is exploding, and rural states like Nebraska carry some of the nation’s heaviest health burdens. Why? Because our systems — federal, state, community, environmental, and family — interact in ways that trap people in cycles of illness, cost, and despair.

Understanding these connections is the first step toward breaking them.

Federal Systems: Decisions That Echo in Every County

Federal agencies like CMS, NIH, and CDC shape the scaffolding of healthcare. Funding streams, payment rules, and research priorities all start in Washington. When CMS launches the Rural Health Transformation Fund, Nebraska cannot simply choose how to spend — it must work within federal categories, deadlines, and formulas.

At the same time, federal choices about regulation, conflicts of interest, and transparency shape public trust. When taxpayers fund research but royalties flow back to individuals, it may be legal but it corrodes faith in the system. Trust matters in rural Nebraska; if people don’t believe the system works for them, they disengage, and disengagement costs lives and money.

State Systems: Translating Money Into Action

Nebraska must decide how to turn federal dollars into programs. Will it fund prevention — reducing obesity, taxing high-sugar beverages, cleaning up nitrates in water — or will it pour money into patching up hospital finances? The state’s choices will decide whether Nebraska simply sustains a broken system or builds something transformative.

This is urgent. Nebraska has one of the highest cancer incidence rates in the nation, rising faster than almost anywhere else. Agricultural exposures (nitrates, pesticides, radon), combined with rural distances and provider shortages, make the state a frontline example of how environment and geography translate into poor health.

Community Systems: Where Policy Meets Daily Life

In rural communities, health outcomes are shaped less by what happens in Washington and more by whether a family has a reliable car, internet service, or food that doesn’t come from a convenience store. This is where intersectionality becomes real: being rural, low-income, female, and justice-involved doesn’t just add up — the disadvantages multiply.

Adverse Childhood Experiences (ACEs) make this even more stark. Childhood trauma — abuse, neglect, parental addiction, incarceration — rewires stress responses, increases risk for heart disease, diabetes, depression, and substance use. An ACE score of 4 or higher raises the odds of serious chronic illness several-fold. Trauma doesn’t just leave emotional scars; it leaves biological ones.

Generational Systems: Health Written Into the Body

The Dutch Hunger Winter famine of 1944–45 proved a shocking truth: malnutrition and stress during pregnancy altered children’s risk for heart disease, obesity, and depression decades later. Epigenetic changes — chemical switches on DNA — meant the environment in the womb predicted health across the lifespan.

Nebraska’s equivalent isn’t famine but nitrates in groundwater, pesticide drift, and chronic financial stress. When mothers drink nitrate-contaminated well water during pregnancy, when families face toxic stress from poverty and ACEs, they pass risk to their children. Health inequities are literally written into the next generation.

A Nebraska Story: The Cost of Doing Nothing

Picture a Nebraska family. The father returns from war with PTSD and untreated trauma. He turns to alcohol, loses stable work, and cycles in and out of the justice system. The mother struggles with diabetes and poor access to prenatal care. They have a daughter, Emma, born into poverty, her ACE score already high before kindergarten.

Emma grows up exposed to trauma, poor nutrition, and environmental risks. By adolescence, she battles depression and anxiety. By her twenties, she develops type 2 diabetes. By thirty, she has her first psychiatric hospitalization after a suicide attempt. By forty, her kidneys are failing. By fifty, she is disabled, reliant on Medicaid, and in and out of hospitals for complications of obesity, diabetes, and depression.

Emma’s lifetime healthcare costs may exceed $3 million — most paid by taxpayers. Add the costs of lost productivity, justice system involvement, and intergenerational trauma if she has children, and the bill multiplies.

Now multiply Emma by tens of thousands of Nebraskans. Multiply that across America. This is why we spend $4.5 trillion per year on healthcare.

What If We Changed the Systems?

Now imagine if Emma’s father had access to trauma-informed care when he returned from war. If her mother had safe water, prenatal nutrition, and a community health worker during pregnancy. If Emma’s school screened for ACEs and offered counseling early. If her town had healthy food, safe housing, and affordable mental health respite services instead of only ER and jail.

Emma’s trajectory changes. She thrives in school, avoids diabetes, manages her mental health with outpatient supports, never enters the justice system, and becomes a working, tax-paying adult. Her lifetime healthcare costs might be $300,000 instead of $3 million.

Multiply that by tens of thousands in Nebraska, millions across America, and the savings climb into the hundreds of billions annually. That is how prevention, equity, and intersectionality aren’t just moral imperatives — they are fiscal ones.

Conclusion: Why It Matters

America’s health crisis is not about individual choices alone. It is about systems — federal laws that prioritize profit over prevention, state policies that underfund public health, community barriers that trap families, and generational trauma that encodes risk before birth.

Intersectionality explains why rural, low-income, minority, and justice-involved Nebraskans face the steepest barriers. Adverse Childhood Experiences show how trauma fuels chronic illness. The Dutch famine study proves that health inequities are inherited, not just experienced. Together, they reveal why the U.S. spends four times more on healthcare than on defense — not because our people are weaker, but because our systems are sicker.

If Nebraska uses the Rural Health Transformation Fund to invest in prevention, clean environments, sugar reduction, trauma-informed care, and community-based supports, it can break the cycle. Healthy children become healthy adults, who build healthy families, who no longer pass risk across generations.

The stakes are bigger than Nebraska. America’s $4.5 trillion healthcare bill is the symptom of broken systems. Fixing those systems — aligning federal and state policy with prevention, equity, and trust — is the cure. If we get this right, the next Emma won’t be a lifetime patient; she’ll be a thriving Nebraskan, and the nation will be stronger and wealthier because of it.

Lifetime Cost Analysis: Emma’s Story

To understand the financial impact of health systems, we compared two possible life paths for Emma — one high-risk path shaped by trauma and poor access to care, and one prevention path supported by early intervention, safe environments, and trauma-informed services. The costs are shown in present-value dollars (2025), meaning all future spending is adjusted to today’s value using a 3% discount rate.

Scenario - Present Value Lifetime Cost (USD, 2025)

Healthy / Prevention Trajectory - $117,507

High-Risk Trajectory - $546,760

Difference per Person - $429,252

Nebraska (5,000 youth prevented) - $2,146,261,934

National (1,000,000 youth prevented) - $429,252,386,834

What does this mean for everyday people? The table shows that if Emma follows a high-risk path, her lifetime costs to the healthcare system, justice system, and lost productivity reach over half a million dollars in today’s money. If Emma instead follows a prevention path, those costs are closer to $120,000. That’s a savings of about $429,000 per person. For Nebraska, if 5,000 children like Emma could be shifted from the high-risk path to the prevention path, the state could save over $2.1 billion. Across the United States, shifting one million children would save $429 billion. These numbers highlight how prevention, trauma-informed care, and healthy environments are not just morally right but fiscally responsible.