According to an economist, Mississippi is one of the top states nationwide for health care openness and access, but improvements could be made.

Robert Graboyes is an economist who is a senior research fellow with the free market-oriented Mercatus Institute at George Mason University and specializes in the economics of health care. 

The Healthcare Openness and Access Project (HOAP) is a 2018 study that Graboyes co-authored with Dr. Darcy Bryan and the Dartmouth Institute for Health Policy’s Jared Rhoads. It ranks the states on the flexibility and discretion that patients and providers have in managing health and healthcare. 

Mississippi finished just outside the top 10 among the best states and the District of Columbia at 11th overall, better than Louisiana (12th), Alabama (20th), Tennessee (34th) and Arkansas (37th). Wyoming was ranked best, while New Jersey was the worst.

Where Mississippi fell short in the index was on pharmaceutical access, which measures the difficulty of obtaining certain classes of drugs, including experimental ones. The Magnolia State ranked 41st. The state also was ranked 44th for the number of taxes on healthcare services and devices.

“Mississippi's actually ahead of the curve on telemedicine, as it should be because it’s the perfect state for that,” Graboyes said. 

He said the state’s regulation of medical practice is one of the nation’s least restrictive.

Graboyes said that two ways the state can improve its healthcare access is to allow nurse practitioners to practice without the supervision of a physician and to end the state’s certificate of need regime. 

Certificate of need laws are designed to restrict competition among medical facilities and require that the building of a hospital or even the procurement of some specialized diagnostic equipment be approved by the state Board of Health.  

“It’s hard to find a virtue to it (CONs),” Graboyes said. “It skews resources. Anything that blocks the supply of quality care, whether it be difficult medical licensing or restrictions or requirements such as a nurse practitioner who can’t hang his or her own shingle, is not productive. 

“You have a couple of counties here that have no doctors and you could get a nurse practitioner or two in there who can do an awful lot that a doctor can.”

Graboyes said that one of the ways that healthcare access can improve and costs can fall nationwide in the future is for the industry to end the Progressive-era practice of eschewing business techniques for the healthcare industry. 

He said the 1910 Flexner report, which eliminated proprietary schools and centralized teaching standards at medical schools, is where the concept of medicine as not a business but a social instrument. 

He said the logic of having the healthcare industry run by doctors is the same as having the airlines being run by pilots.

“Of course medicine is a business,” Graboyes said. “It’s life and death, but so are a lot of other things. Where medicine differs from other professions is there is this terrible intimacy. The corporate practice of medicine isolated the medical field from business practices.” 

He used an example of how surgical patients can remember the name of their doctor and his qualification, yet those who traveled on an airplane were unaware of the pilot’s name and how many hours he’d flown in his career.

Graboyes cites the example of a hospital chain in India which performs heart bypass operations at a fraction of the cost such a surgery would be in the United States. That surgery would cost $100,000 in the U.S., but in India, the surgery only costs $1,000. 

Not only is the surgery in India cheaper, it gets results, Graboyes said, that are equal or even better than those in the U.S. or Europe. 

While just a handful of the 19,000 jobs added in Mississippi over the past year have been in government, it still accounts for an unusually high percentage of all jobs in the state. 

According to the July data from the Bureau of Labor Statistics of nonfarm payrolls, government accounted for 20.5 percent of all jobs in the state. Or more simply, one out of every five jobs are in government. 

How does this compare to other states?

Well, we’re doing worse than most, especially the states with the strongest economic engines. Among neighboring states, government accounted for 18.6 percent of jobs in Alabama, 16.6 percent in Arkansas, 16.4 percent in Louisiana, and 14.1 percent in Tennessee. 

Mississippi’s numbers are down slightly from July 2018 when government accounted for 20.9 percent of jobs. 

There isn’t a clear distinction between the political leanings of a state, nor is size the deciding factor. But this is part of a trend among the poorest states in the country. In West Virginia, 20.3 of all payrolls were in government. In New Mexico, it’s 22.1 percent. Alaska also had a high number – almost a quarter – but it’s in a unique position. 

Does this really matter?

So, while we are constantly debating and entire campaigns are run on the premise of making government larger, we can simply look at other states and see that is not the path to economic prosperity. 

All government can do is redistribute wealth from one person to another as it chooses, whether that’s a social welfare program or a corporate welfare one. Government only moves money around. It doesn’t create new wealth or build a bigger pie. 

Only the private sector can do that. Individual initiative is the most powerful economic engine we have. Wealth is generated when individuals risk their own resources in hopes of meeting a need in the lives of other people or businesses, and do so in a manner that earns them a profit. That need might take the form of a new product, a more efficient service, or fresh, capital needed by a business to start or expand its operations.

It’s very easy, and very tempting, for any government official to give out tax dollars, get their picture taken, and talk about how much they are doing for you and me because of that new government initiative. 

You don’t get a shovel for reducing regulations, freeing up the healthcare industry, or reforming occupational licensing. But the most helpful thing an elected official can do is be serious about pursuing policies that will make it easier for free enterprise. We’ve seen the results of our elected officials trying to manipulate, organize, and orchestrate the economy.

At the end of the day, to generate sustainable, long-term growth, the only option is to grow the private sector through lower taxes and a lighter regulatory burden. It doesn’t make for a sexy campaign slogan and many people who work in government or depend on government for jobs and contracts won’t like to hear it.

Republican Brent Bailey and Democrat De’Keither Stamps recently shared their vision for the public service commission on Monday. 

And despite party labels, it wasn’t terribly different. Both candidates support increased renewable energy, such as wind and solar, and both promise to keep utility rates low while promoting maximum energy efficiency.

They are running to replace Democrat Cecil Brown in the Public Service Commission’s Central District. Brown is retiring after serving one term on the three-person commission. 

The PSC regulates rates with the state’s two investor-owned utilities (Mississippi Power and Entergy) and also regulates telecommunications, natural gas, water and sewer utilities. 

Politically, the central district is split pretty evenly, both racially and electorally, with a slight edge for Democrats. It includes the Democratic strongholds of Jackson and Hinds county, along with the Delta, while also taking in the Republican suburbs of Rankin and Madison counties, along with Lauderdale county as the only other population center in the district.

In August, 108,000 voters chose the Democrat primary and just under 100,000 selected the GOP ticket. That contrasts with statewide numbers where for the first time in state history more voters chose the Republican primary – about 330,000 – than the Democratic primary – about 300,000. Four years ago, the district supported a Republican for transportation commissioner and a Democrat for public service commissioner. But in 2011, a Republican took both the positions. 

Primary voters by party in the Central and Southern District

The central district is not the only district that will see a change. 

The southern district will have a new public service commissioner as voters will choose between Dane Maxwell, the Republican mayor of Pascagoula and former Ocean Springs Mayor Connie Moran, a Democrat.

In August, Republican voters nearly tripled Democrat voters in the first round of the party primaries, illuminating the Republican strength in the district. By every measure, Maxwell is the odds-on favorite to win a four-year term.

Sam Britton, who served one term, passed on a re-election bid and ran unsuccessfully for the Republican nominee for secretary of state.

In the northern district, Democrat Brandon Presley will be the sole returning member as he is unopposed in his bid for a fourth term.

Democratic gubernatorial candidate and state Attorney General Jim Hood has an expensive wish list for K-12 education that could hit taxpayers right in the wallet.

Hood told the Associated Press that he not only wants state-funded pre-kindergarten, but also at least a $3,000 teacher pay hike and full funding for the state’s education funding formula.

Total cost of just those three items could total at least $574.2 million annually and this revenue would either have to come from cuts to other state agencies, tax increases or both.

According to the MDE’s budget request for fiscal 2021, full funding for K-12 education represents about $2.554 billion in general fund revenues. Last year, the legislature appropriated $2.245 billion for K-12 from the general fund, a difference of $332 million. 

Each year, the Mississippi Department of Education uses the MAEP to calculate how much of an appropriation it needs from taxpayers to distribute to local school districts. Fully funding the Mississippi Adequate Education Program funding formula would represent a 23 percent increase in general fund appropriations. 

Hood said that he wanted not only a $3,000 pay increase for teachers phased in over two years, but also percentage increases to the salary raises that most teachers receive every year. 

The legislature passed a $1,500 pay hike in the last session that will cost $76.9 million per year and will have to be fully funded with a deficit appropriation when the legislature returns to session in January. 

A $4,500 pay hike, which includes what the legislature approved last year and Hood is proposing, would cost taxpayers an additional $230.7 million per year once it was completely implemented. 

Pre-Kindergarten, according to Hood, for around 23,000 4-year-olds would cost about $45 million over four years. Several studies have shown that massive spending on pre-K doesn’t guarantee better outcomes for elementary students as compared with those who don’t attend pre-K.

The MAEP amount isn’t legally binding for appropriators, thanks to a 2017 state Supreme Court decision, and it’s only been fully funded twice in the last 20 years. 

The formula consists of average daily attendance times base student cost, plus at-risk component minus local contribution plus 8 percent guarantee. Then, only after add-on programs — transportation, special education, gifted education, vocational education and alternative education — are added to the formula allocation, is the final MAEP funding request calculated.

Put another way, just the increase in K-12 funding alone would exceed the appropriations for:

• Debt service — $385.2 million.
• Corrections — $316.5 million.
• Department of Mental Health — $213.7 million.
• Military, Police and Veterans’ affairs — $120.7 million.

Having one of the nation’s highest gasoline taxes won’t buy taxpayers the best-rated highway system. 

That is according to an analysis that compared gasoline taxes by state and rankings from the Reason Foundation’s recently released annual Highway Report.

None of the top 10 states scored for highway efficiency and cost effectiveness were among the top 10 in the amount of gasoline tax levied on consumers. The top 10 states averaged 25.25 cents in taxes per gallon, just slightly above 24.85 cent per gallon nationwide average from the American Petroleum Institute.

Mississippi has the third lowest gasoline tax nationally (18.79 cents per gallon) and yet its highway efficiency and cost effectiveness was ranked 25th by Reason. 

Out of the five states with the lowest gasoline taxes, only Alaska (49th overall) and Oklahoma (41st overall) were near the bottom.

Conversely, none of the states with the highest gasoline tax scored higher than Mississippi in the overall score, the best being Illinois at 28th. The Land of Lincoln hits motorists with a 54.98 cent tax on every gallon of gasoline.

California has the nation’s highest gasoline tax at 61.20 cents per gallon, yet it only ranked 43rd overall in the Reason Foundation report. Pennsylvania (35th in the report) has the next highest gasoline tax nationally at 58.7 cents per gallon. 

Missouri was ranked third overall and its gasoline tax (17.42 cents per gallon), yet its rural interstate pavement condition was 17th best and it also scored highly for capital and bridge disbursements per mile (second) despite having the seventh-largest state-controlled highway system nationally.

Mississippi was ranked 25th by the Reason Foundation overall, with its score bolstered by high marks for high maintenance disbursements per mile and low urban congestion. 

The Magnolia State’s ranking was dragged down 14 places from last year’s report because of worsening rural interstate pavement condition and a larger number of structurally deficient bridges.

The legislature hasn’t sat on the sidelines, passing the Mississippi Infrastructure Modernization Act of 2018 in last summer’s special session. The bill will send 35 percent of use tax revenues by next year to cities and counties to assist with infrastructure. 

The bill will additionally authorize $300 million in borrowing, with $250 million for the Mississippi Department of Transportation and $50 million for local infrastructure not administered by MDOT.

The other part of the package was the creation of a lottery, the first $80 million in tax revenue annually going to the state highway fund until 2028 and the rest put into the Education Enhancement Fund. Just the highway fund portion alone could add up to $720 million. 

State gasoline taxes are levied in addition to the federal tax of 18.4 cents, which hasn’t been increasedsince 1993.

The two candidates for the Mississippi Public Service Commission’s Central District commissioner position made their pitches to voters Monday and the pair agree on issues far more often than not.

Republican Brent Bailey and Jackson City Councilman De’Keither Stamps, a Democrat who represents Jackson’s Ward 4, will battle in November to replace retiring Central District Commissioner Cecil Brown.

Both candidates support increased renewable energy, such as wind and solar, and both promise to keep utility rates low while promoting maximum energy efficiency. Both also touted their ability to work across party lines.

The Mississippi Public Service Commission regulates rates with the state’s two investor-owned utilities (Mississippi Power and Entergy) and also regulates telecommunications, natural gas, water and sewer utilities.  

Stamps, a former U.S. Marine and Army veteran who owns a farm in Learned, proposed an energy efficiency audit of every state-owned building to provide savings for taxpayers. 

“The actual government of the state of Mississippi, from state government to county governments to city governments to school districts, we spend too much money on utilities,” Stamps said. “The biggest savings we have for our budgets is to make all of our buildings be more energy efficient. We need to reduce those costs across the state.”

He also wants municipalities to partner with cellular providers to erect more cellular towers and improve services as an expansion of public/private partnerships which Stamps said he wants to encourage as part of the PSC.

“When it comes to the utilities, we’re going to be the most aggressive Public Service Commission you’ve ever seen,” Stamps said. “We’re going to be focused on making sure the interests of our ratepayers and our utilities are taken care of. Utilities are very important and provide great service in economic development and providing quality of life.” 

Bailey, a Mississippi State University graduate and engineer in the energy sector, is running on a platform of energy efficiency, ending robocalls and providing cost-effective broadband to rural communities.

Bailey has been an intervenor in many matters before the PSC, including net metering (which allows homeowners with solar systems to sell some of their excess generation back to the grid) and the controversial Kemper Project. 

Bailey was a strong critic against Mississippi Power’s Kemper Project, an integrated coal gasification power plant that was later converted to a natural gas-fueled plant at a massive savings for ratepayers. 

Taxpayers could’ve been on the hook in the form of rate hikes for more than $6.5 billion, later reduced to slightly more than a $1 billion. 

Mississippi Power has yet to decide what it will do with the mothballed gasifer units at what is now called Plant Ratcliffe, a 30-minute drive north of Meridian.

“I’d like to think I’m the candidate with the most experience, the qualifications, the know-how and the independence to really be the voice of the consumer at the Public Service Commission,” Bailey said. “I, and others, sounded the alarm on Kemper. Questioning its justification and the viability of its technology and certainly its impact on rates for consumers. 

“We certainly believe that with simple transparency and an unyielding commitment to due diligence, we could’ve avoided the magnitude of that project that lies in the political lore with the beef plant and the KiOR facility.”

Mississippi Center for Public Policy joined the National Taxpayers Union and numerous other state, local, and federal organizations in opposing an increase to the Passenger Facility Charge.

The letter reads:

While we are open to solutions to address needs relating to infrastructure, we believe that placing additional financial burdens on the traveling public, without corresponding reductions to other government charges on airfares or reforms to how those charges are levied, would be shortsighted and ill-advised. There are more accountable and better-calibrated options for the future of aviation investment than a massive PFC hike.  

As you know, per limits established by Congress, airports are unable to charge consumers a PFC above $4.50 per enplanement, or $18 per round trip ticket. For a family of four, the collective PFC cost can total more than $70, a significant expense added onto an already expensive ticket price. Government mandated taxes and fees can already account for more than a fifth of a “bargain” domestic ticket price, giving air travel the dubious distinction of being one of the highest-taxed activities in the economy. In fact, it is not unusual for a middle-class American to pay a higher tax burden (over 20 percent) on an airline ticket than on a 1040 tax return. 

Some justify their support for a higher PFC due to inflation, which has eroded its purchasing power. However, according to financial reports from the FAA, consumers paid more than $3.5 billion solely in PFCs, more than double what they paid in 2000, and increased nearly 50 percent faster than inflation. Meanwhile, PFC revenue has climbed each year since 2000, save the two years during the great recession. 

Others argue that despite record amounts of cash on hand at airports, and a recent billion-dollar increase in federal Airport Improvement Grants, a higher PFC will offer flexibility to build more gates and other features that will help smaller carriers to compete with legacy airlines. Yet, the head of the association representing ultra low cost carriers (ULCCs) told the House Transportation and Infrastructure Committee that “[i]ncreasing travel costs by raising the PFC is much more of a threat to passengers’ access to air travel than gate availability at airports across the country. Raising the PFC will drive highly price-sensitive customers away, which is the ULCCs primary market.”

Modernization of the American air transportation system can be done in a fiscally-responsible and free-market fashion that does not result in higher ticket prices on consumers. Congress has many options to achieve such a goal, such as reforms to the Air Traffic Control system and the Anti-Head Tax Act of 1973 to make the PFC a truly accountable user fee collected directly by airports. At the same time, public officials should examine remaining impediments to private management of airports; for example, long-term leasing arrangements to private entities are more prevalent in Europe.

Instead of pursuing avenues to squeeze travelers, lawmakers should be doing everything in their power to limit consumer burdens. We stand ready to help deliver reforms that will strengthen passenger air travel, and with it the entire American economy.

Sincerely,

In this episode of Unlicensed, we talk with Dr. Robert Graboyes of the Mercatus Center at George Mason University about the future of healthcare in America. Graboyes is the author of Fortress and Frontier in American Healthcare, a paper that examines the needed mentality shift in healthcare.

This week, the Mississippi Charter School Authorizer Board approved the ninth charter school in the state.

The Board approved Leflore Legacy Academy in Greenwood which will serve grades 6 through 8 when it reaches capacity. This is the second charter school in the Delta. Clarksdale Collegiate Public Charter School opened last year.

For the 2019-2020 school year, six charters are open in Mississippi. Two others, in addition to Leflore Legacy, have been approved and are set to open in future years.

Last year, 14 charter operators began the application process. Four made to the final cut, with just the one receiving the state's blessing.