Dr. Michael Forster

Can “competition” help public health?

Governor Bryant has signaled that he wants to inject more “competition” into state government generally, and education specifically.  On the surface, the idea seems unobjectionable, even self-evident.  Why shouldn’t state agencies compete “for their piece of the budget pie” (as the Clarion-Ledger put it in an complimentary editorial), or teachers for a shot at merit pay?  In America we like competition, right?

Perhaps.  But Americans presumably also like ideas that actually work, and it’s not at all clear how competition among government agencies or teachers would work, or if indeed it’d work at all to improve performance. 

Just consider for the moment government agency competition.  Leave aside the (very thorny) problems of deciding just what “performance” is and how to measure it, and focus on application of the basic idea.  Agencies that do well by meeting their performance targets (whatever they are) would be rewarded with more funding.  Agencies that perform poorly would have their budgets cut.  So let’s say the Department of Health meets its target of, say, reducing the incidence of West Nile virus – next year it gets more money to, what, slow the AIDS infection rate in the Delta?  And where would the extra money come from?  The Department of Human Services – responsible, among other things, for protecting children from abuse – perhaps?  Try it the other way.  The Department of Health does a poor job inspecting restaurants, which leads to a spike in food poisonings.  What happens?  Is the Department’s budget slashed to “teach it a lesson,” a sliver of its “piece of the pie” handed over to an agency with a better performance record?  What happens to restaurant inspections then?  Do we really think that they would improve?

The biggest single problem facing Mississippi’s public agencies is substantial underfunding, especially for those agencies – like the Department of Health, and education at all levels – that provide services to the poorest and most needy citizens.  No agency has enough money to do the job it’s charged with doing.  “Competition” won’t solve that problem.  The only thing that will is tax reform-based adequate funding, coupled with rigorous performance accountability.

Dr. Michael Forster
Dr. Michael Forster

Comments are closed.