Good news for deregulation!

The W.K. Kellogg Institute released a study yesterday evaluating the success of the Alaskan dental therapist program over the past two years. The results reflected both high patient satisfaction and quality of care. Dental therapists — a topic we’ve discussed on Show-Me Daily before — are mid-level dental professionals that can provide basic and preventive oral health care at a lower cost than traditional dentists. Alaska’s recent results add to a growing body of research showing that deregulation in dental care can improve health by bringing quality care to underserved areas.

For Missouri, this is just further proof that loosening the restrictions on dental practitioners could be beneficial. Of Missouri’s 114 counties, 50 have a shortage of dental professionals, a problem that is most profound in rural areas. This has led to fewer Missourians receiving dental care: Missouri was ranked 47th in the nation for the percentage of its adult population who visited the dentist during the past year.

While rural Alaska reaps the benefits of this dental deregulation, Missouri still only allows dentists certified by the American Dental Association to perform even basic dental care. With the benefits of mid-level practitioners becoming increasingly apparent, Missourians stand to gain from a reconsideration of state dental regulations.

The St. Louis Business Journal wrote a delightful editorial about the state and federal subsidization of broadband access for rural areas. The article quoted our research analyst, Christine Harbin (you have to be a paid subscriber to read her comment on the Business Journal site):

Some will argue the money could be better spent on education, health care, you name it. Indeed, there are many needs but these federal funds were designated for broadband. The state’s in-kind contribution does not impact the dire budgetary situation or projected $600 million shortfall.

Only the Show-Me Institute, the ultraconservative think tank, finds a reason to object. Research analyst Christine Harbin commented: “If an individual desires faster Internet service, he or she can either pay the market rate for the service or relocate to a larger town in order to access a broadband connection that’s less expensive.”

Of course, we received Ms. Harbin’s remarks via a high-speed Internet connection, and we certainly would not have wanted to miss sharing them with you.

The Business Journal could not have illustrated Christine’s point more succinctly. She, and the Business Journal, have both chosen to locate in the city of St. Louis. This decision entails extra costs, like the earnings tax and a higher cost of living, but it also has some cost-saving benefits, like less-expensive broadband access.

It is more expensive to provide Internet access to rural areas. This does not mean that rural areas should not have Internet access, only that they should shoulder the steeper costs of this service if they want to use it. When Internet access is subsidized, it distorts the market because the lower price leads people to consume more without seeing the true cost. If someone opts for the lower general cost of living in a rural town, she should accept that urban amenities may not be available at as low of a price as they are in more populated urban areas. In the same way that rural areas may be loathe to subsidize an urban area’s mass transit, it is reasonable for urban areas to be loathe to subsidize a rural area’s broadband Internet.

People should be allowed to live where they choose, but that doesn’t mean that everyone else should subsidize them.

SEDALIA — I am writing this from the Show-Me Institute booth at the Missouri State Fair! We are talking about individual liberty and limited government with all of the fairgoers.

If you are in Sedalia, stop by the exhibition hall between corn dogs to talk to us about free markets. For those of you who haven’t had a chance to stop by, here is a picture of our booth!

* Title quote: Lenny at the State Fair, from That Thing You Do.

Last Wednesday, Show-Me Institute staff and interns ventured on our third free-market field trip. We went to Busch stadium to interact with one of the freer markets available here in Missouri: ticket scalping.

We assembled into four teams, starting out with either Cardinals tickets (two tickets normally valued at $39, although we bought them for $20 each) or money ($60). We each competed to try to improve our situation by engaging in voluntary market transactions.

Even ticket scalping can leave both parties better off! Without giving too much away, the video demonstrates a few key economics lessons, like information asymmetry — where one party has better information than the other. In this case, the experienced sellers understood the market much better than some of our teams did. Another lesson that comes up in the video is the idea of value: A ticket’s face value does not necessarily reflect how another party will value it, and thus it may be difficult to recoup a ticket’s nominal “worth” when selling it. Issues of supply and demand also came into play, as we were at a game on a hot day when tickets were not sold out.

Further lessons can be gleaned from the free-market explanations interspersed throughout the video. I encourage you to watch it!

Last week, MissouriNet reported on the president’s speech in Kansas City, in which he talked about clean energy:

President [Barack] Obama said in his speech that just a few years ago, the U-S accounted for 25% of the world’s economy, but was only making 2% of the world’s advanced batteries for hybrid and electric vehicles.

“But thanks to our new focus on clean energy and the work that’s taking place in plants like this one, we could have as much as 40% of the world’s market by 2014,” Obama said.

It is true that if we devote a large amount of our resources to clean energy, we could expand our share of the world’s market. If we wanted to, in fact, I’m sure we could devote exorbitant sums to clean energy and capture 80 percent of the world’s market.

Does that mean that it would be a good investment for the U.S. government? When someone invests her own money, she has a stake in that investment working out. Investors who make wise investments have more money to make additional wise investments. No matter how vital government officials think it is to invest in clean energy, they do not have that feedback; whether they invest wisely or not, their cash inflow is not affected. The government does not have the right competitive mechanisms in place, and thus may create more problems for clean energy than they solve.

Why is that? When the government favors certain types of clean energy over others (perhaps yet undiscovered) energy sources, they change the dynamic. As a result, those energy producers make money not because they efficiently produce energy, but because they have curried political favor. Energy producers who receive government monies are also restrained by government regulation and procedure, which stifles innovation.

From the aforementioned speech (emphasis added):

“[...] But my answer to those who don’t have confidence in our future, who want to stop, my answer is come right here to Kansas City see what’s going on at Smith Electric. I think they’re gonna be hard pressed to tell you that you’re not better off than you would be if we hadn’t made the investments in this plant,” Obama said.

I beg to differ. In the cases where clean energy is as good an investment as some proponents claim, private individuals will be willing to put money toward the venture. Many companies want to use efficient, environmentally friendly energy because consumers appreciate that. Clean energy, at its best, will lower costs, a condition necessary for it to become a primary energy source. Cutting the tax rate for all businesses would better promote the move toward clean energy sources than targeting incentives toward specific clean energy plants. If clean energy production is to become sustainable, it needs further exposure to market forces so that the most efficient product can succeed.

The Kansas City School District, in another effort to reform lagging schools, plans to move students into an ungraded primary system,  where students progress based on skill level, rather than age, once a subject has been mastered. From USA Today (emphasis added):

Now, in the latest effort to transform the bedraggled Kansas City, Mo. schools, the district is about to become what reform experts say is the largest one to try the approach. Starting this fall officials will begin switching 17,000 students to the new system to turnaround trailing schools and increase abysmal tests scores.

Richard Innes at the Bluegrass Institute in Kentucky points out that this was, in fact, tried in Kentucky during the 1990s, in a school district five times the size of Kansas City’s district. He reports that it was generally unsuccessful, with only 25 percent of Kentucky schools still in “ungraded primaries” — although it is still on the books:

Even KERA’s most enthusiastic cheer leader, the Prichard Committee for Academic Excellence, now admits that Primary just didn’t work out.

The fact that the education “reform experts” were unaware that this had been tried before, on a large scale, does not bode well. It didn’t work in Kentucky. Can it work in Missouri?

Lessons can be learned from these failed attempts. After all, the reform itself could have some merit when implemented on a small scale, and some states like Alaska and Colorado have had success with the program. Theoretically, it makes sense: A student may have advanced math skills, but need extra time to practice reading. If implemented appropriately, that student could devote more time to skills that need improvement.

Kentucky’s problems may have fallen upon the difficulty of implementation. Innes suggested, in a phone call yesterday, that the teachers would have needed “Solomonic wisdom” to successfully implement the program. Indeed, a skill progression is a difficult thing for a teacher to assess for a few dozen students in multiple subject areas. A 2002 study by CREDE found that the primary program had varied implementation, which might explain some of Kentucky’s problems:

“The study of the implementation and effects of the nongraded primary program in Kentucky revealed that when teachers fully implemented the program, they were also practicing the CREDE standards fully. Teachers across the state, however, implemented the program in a variety of ways, some of which were not philosophically aligned with the original intent.”

Perhaps the advent of more advanced technology will provide the piece that was missing in Kentucky. Some virtual school courses have a modular structure that allow students to progress at their own pace, which might create an easier way to assess a student’s skill progression and readiness to move on to the next subject.

Whatever the case may be, I hope that Kansas City looks at all the research — the successes and failures — before they attempt such a large transformation.

Phase one of the federal health care reform starts today! Those who indulge in a certain activity that could increase the likelihood of cancer will feel the effects on their wallet: tanning salons are now subject to a 10-percent tax that is meant to fund further insurance coverage expansion.

This can be seen as a form of Pigovian tax, which raises the costs of certain activities in order to correct for social costs or negative externalities that are not covered in the market price. In this case though, the externalities of tanning beds are internalized: If I choose to tan, I accept the increased risk that I may get skin cancer. If that were to happen, my insurance company and I would have to pay for the cost of treatment. (And it could be that my insurance company chooses to raise my premium if I indulge in risky behaviors, which is their prerogative.) One could argue that a hypothetical person with tanning bed–induced skin cancer could end up costing others in medical bills, but if that were the issue, the problem would lie in the structure of health care provision, not natural externalities.

What’s next? Should we impose more taxes on roller blades, lest I skin my knee or break my ankle? Or junk food? If we want to really get to the root of what causes skin cancer, shouldn’t we be placing the blame where much of it belongs: the sun? It wouldn’t be the first time someone proposed legislation against the sun.

Today, Show-Me Institute Research Analyst Christine Harbin appeared on the Sarah Steelman Hour radio show in Springfield, talking about tax credits in general and, specifically, the proposed credits for the Ford plant in Claycomo.

Economic development tax incentives, no matter how they are packaged, are not effective. They allow government officials, who have no special knowledge of how to maximize growth, to pick winners and losers in the market. As Show-Me Institute Executive Vice President Joseph Haslag has written before, lowering broad tax rates is a much more efficient method of stimulating the economy than targeted tax credits. This allows everyone to benefit, rather than a few select industries chosen by the state.

Empirically, studies analyzing the benefits that development tax credits deliver in comparison to their costs show that such tax credits have not worked. A recent Missouri state audit report found that tax credits are less effective (and more expensive) than their proponents claim. Yesterday, St. Louis Public Radio broadcast a segment featuring a study that examined another form of tax incentives in Missouri, tax increment financing (TIF). Kenneth Thomas, a political science professor at the University of Missouri–St. Louis, recently coauthored a study that found the use of TIF is not effective in most cases. He noted that the St. Louis area uses TIF more than nearly every other area in the nation. In the interview with St. Louis Public Radio’s Matt Sepic:

Sepic: That’s one longstanding criticism, is that TIF pits communities against one another. A prime example is that tussle between Bridgeton and St. Anne over a Walmart. Is that a bigger problem in the St. Louis area than elsewhere, with this panoply of municipalities that we have here?

Thomas: Oh, yes, certainly having more municipalities makes the competition more intense.

The study argues that, although many economists have found TIF to be ineffective, this method of funding continues to be used because of the competitive nature of tax incentives. When one area offers a tax incentive, other areas nearby often try to “win” a company’s business by offering competitive tax incentives. The result is a bidding war in which the taxpayers lose. This can be seen in the Claycomo Ford tax credit situation, as well — other states, like Kentucky, have offered tax incentives to Ford in an effort to persuade them to relocate their plant. In order to compete, Missouri would have to offer a better deal, while recognizing that this game will be played again the next time the credits run out.

Later in the interview, Thomas notes an important misunderstanding — the idea that tax incentives like TIF “create” jobs:

Thomas: [T]hose estimates never take into account the fact that, well, yes, we are going to create 200 jobs here, but what’s going to happen is we’re going to knock out 180 in the next mall over.

Tax credits and TIF tend to shift economic activity from one area to another, without creating wealth. Missouri’s tax dollars would be much better spent in the hands of individual Missourians than on enticements for companies like Walmart or Ford.

As Milton Friedman pointed out on his PBS TV series “Free to Choose,” even if other nations, states, or localities offer tax incentives to lure businesses, we’re better off if we don’t do the same — because we benefit from the lower prices their subsidy creates. Missouri will experience better economic growth if it unilaterally removes itself from the tax incentive bidding wars.

The Commonwealth Fund published a study comparing the health care system in America to the systems of six other developed nations, and found it lacking in a few of the categories. Many Americans believe that the health care system needs some sort of reform, although they conflict on what type is necessary. While there is definitely room for improvement within the U.S. system, I take issue with some of the Commonwealth Fund’s analysis and conclusions that call for a more centralized, universal system.

First, some of the data relies on physician and patient surveys. Individuals in different countries have different expectations for their health care systems, an important factor that the study’s authors admit might have affected the ratings:

Patients’ and physicians’ assessments might be affected by their experiences and expectations, which could differ by country and culture.

One of the categories I find most objectionable is “long, healthy, and productive lives,” which has a rather ambiguous meaning. The authors used three indicators to determine what constituted a “long, healthy and productive life.” (Table data excerpted from the study):

Exhibit 8. Long, Healthy, and Productive Lives Measures

These three indicators do not fully capture “productive” or “healthy” lives. There are more relevant measures of productivity and quality of life, such as statistics about morbidity, the amount of time spent ill, or disability-adjusted life years (DALYs), which account for degree of sickness as well as length of life. These are sometimes difficult to calculate, but they are standard measures used by the World Health Organization (WHO) and far more relevant for a category about “healthy” and “productive” lives.

The indicators used do not capture the fact that someone waiting 18.3 weeks for surgery in Canada may also be losing four months of work productivity, as well as spending a long time with an impaired quality of life. The United States ranked first in wait times for specialists and nonemergency surgeries. When one includes those factors, a different story emerges from the data.

For the indicator “Health life expectancy at age 60″ the United States ranks sixth, but a closer look at the raw percentages shows a very small range from first to last; whether these differences are even statistically significant was not addressed in the study. Nor does the category capture that Americans work longer — both in their work week and in their lifespan — than the other countries listed, which could explain the slight difference in the raw percentages. American work ethic is a cultural issue, not an implication of the health care system.

Also, infant mortality is a contentious indicator for the success of a health care system. Different countries use different measurements to calculate the statistic. The United States strictly follows WHO guidelines by counting all babies that have shown any sign of life, whereas Germany, for instance, only counts babies that weigh at least one pound at birth. Other countries do not count births earlier than 26 weeks. This disparity in measures of reporting artificially skews the rates, without factoring in cultural differences, like teen births, that also contribute to higher infant mortality.

In developed countries, a large portion of the increase in life expectancy is not attributable to the health care system. During the past century, the average life expectancy in the United States has increased by 30 years; modern medicine can only account for five of those years, while public health measures account for the other 25. Attributing small changes in mortality to medical care is very tricky. Lifestyles can affect health outcomes as much — if not more — than health care. The obesity rates in the United States are much higher than the other countries listed. Holding health care systems equal, that one factor would lead the United States to have lower health outcomes. Again, this is a cultural issue, and not an indication that a universal system would improve U.S. results.

A conclusion some may reach after reading the study is that universal health care is the solution to perceived disparity; this seems to be the conclusion the authors hoped to make. In fact, the study actually suggests that the new federal health care legislation will improve U.S. outcomes:

Newly enacted health reform legislation in the U.S. will start to address these problems by extending coverage to those without and helping to close gaps in coverage—leading to improved disease management, care coordination, and better outcomes over time.

Incentives need to be realigned, but that has more to do with the disconnect between patient and physician — the health care wedge, explained in the Show-Me Institute study “Prognosis for National Health Insurance: A Missouri Perspective.”

The Commonwealth Fund study admits that none of the other nations considered have “ideal” health care systems, and makes some questionable comparisons in order to “prove” that universal health care is the best way to solve problems in health care. Show-Me Institute staff and scholars have discussed better solutions for health care reform in blog entries, op-eds, and policy studies.

The Commonwealth Fund study notes that the largest problem in the U.S. system is affordability of health care; the study thus concludes that universal health care is the solution, rather than making health care more affordable. The Congressional Budget Office has calculated that the recent legislation, lauded in this study, will actually increase the cost of health care. The Commonwealth Fund study suggests a solution that will bring the exact opposite of the problem it anticipated: Health care will become too expensive for some people.

Just because a few countries are getting (questionably) better results by some carefully selected measures under universal health care systems does not negate the fact that market-based solutions are a better solution for Missouri and the whole United States.

Show-Me Institute Research Analyst Christine Harbin will be on the Mike Ferguson show on Columbia’s 93.9 FM “The Eagle” at 5:00 p.m. this evening! She’ll be talking about the proposed tax credits for a Ford plant in Claycomo, in the Kansas City area. Tune in!

Yesterday, Martha King made a liberty-oriented argument against cigarette taxation, noting that cigarette taxes are imposed by a majority (nonsmokers) on a minority (smokers). A study in The Public Opinion Quarterly supports her conclusion; it found that where cigarette taxation is involved, individuals are self-interested. Nonsmokers favored cigarette taxes far more than smokers did. The majority choose to impose a tax on the minority, in many cases using moral or economic arguments that the use of cigarettes leads to poor outcomes.

The Daily RFT blog picked up on her post, but didn’t seemed particularly swayed by an argument for liberty. I had a conversation yesterday morning with my coworker Abhi Sivasailam, who suggested an efficiency argument against taxation, and pointed me to a National Bureau of Economic Research working paper titled “Cigarette Taxation and the Social Consequences of Smoking.” An argument that many people make in their attempts to justify cigarette taxes is that such a tax helps to internalize the additional costs of smokers — but this study concludes that the societal cost is already internalized.

From the study’s abstract:

Detailed calculations of the financial externalities of smoking indicate that the financial savings from premature mortality in terms of lower nursing home costs and retirement pensions exceed the higher medical care and life insurance costs generated. The costs of environmental tobacco smoke are highly uncertain, but of potentially substantial magnitude. Even with recognition of these costs, current cigarette taxes exceed the magnitude of the estimated net externalities.

So, if the costs of smoking are already largely internalized, imposing additional taxes on cigarettes is inefficient. It’s also worth pointing out that cigarette taxes are regressive, and any argument that holds the state should appropriate money from smokers to pay for other programs places an undue burden on a vulnerable group.

Is it horrible that people die from smoking cigarettes? Yes. Is it horrible that people die in automobile accidents? Yes, but that doesn’t constitute a rationale for taxing cars out of existence, or cupcakes, or the many other things that people use and enjoy that can also contribute to future poor health. If free, consenting adults choose to smoke, despite the known risks, it is their prerogative.

In the recent public discussion of the autism bill and health insurance mandates, a recurring question has emerged: can a particular mandate be worth the costs — or, at least, be more worthy than most? If we follow that logic, though, where do we draw the line?

As of 2009, Missouri had 41 mandates for health insurance. Considered singly, no individual mandate had a large impact on premium costs, but they each had a marginal impact. Every incremental increase in the cost of health insurance premiums leads to the possibility that some unknown number of individuals and businesses are no longer able to afford their previous coverage.

Here is a look at mandates in Missouri (data compiled from the Council for Affordable Health Insurance):

As we’ve discussed before here at Show-Me Daily, injecting competition into the insurance market is really the only long-term solution that will both increase coverage and lower health care costs. Sarah Brodsky has also suggested tuition tax credits for autistic children as another alternative to insurance mandates.

Regardless of how one looks at the issue, mandates do not serve as a solution. The list provided by CAHI contained 130 different mandates throughout all of the states and Washington, D.C. Health insurance would be prohibitively expensive for far more people if every policy had to cover all 130 items, and there will still be many other conditions or diseases that are not covered. Does every 20-year-old want insurance against Alzheimer’s disease? Does every 60-year-old want insurance against autism?

With more choice in the insurance market, people can better choose for which illnesses or conditions they wish to be insured. Eliminating the way in which insurance is tied to employment and encouraging health savings accounts would allow individuals to purchase portable, cost-effective policies, saving for foreseeable health-related expenses while hedging against unknown future risk.