Gov. Bryant wants to hold funding for MTAG level, at just under $27 million, but IHL Commissioner Hank Bounds says that’ll leave us $4 million short of covering the legislative mandate.  Bounds says that without more money, IHL would have no choice but to make across-the-board cuts zapping all MTAG recipients at all colleges across the state.

There’s no getting around it.  State financial aid cuts combined with changes (and possible new cuts) to the federal Pell Grant program spell reduced access for low-income Mississippi residents – at just the time that college enrollment is exploding, and a key state goal (see “Blueprint Mississippi”) is to expand the size of our college-educated work force. 

Is this the way forward?

The senator deserves the benefit of doubt regarding his intentions to help, not hurt, public assistance recipients, so let’s give it to him.  At the same time, I would urge Mr. Polk to pay close attention to the possible, indeed likely, unintended negative consequences of his proposed policies.  There are at least three:

• Cost to taxpayers – Drug testing in particular is an expensive proposition.  Is self-funding of a testing program through public assistance savings realistic?
• Regulatory expansion – The new requirements wouldn’t execute themselves.  In addition to oversight of a testing program, who will manage referrals of recipients to community service agencies?   And what happens when problems develop, disputes and appeals need to be resolved, and so on?  Making it all work means government growth, something Republicans generally abhor.
• Misplaced blame – Programs like drug-testing and mandatory work typically lump together “worthy” and “unworthy” poor, and skate dangerously close to the thin ice of “blaming the victim.”  Are people on assistance because they want to be, or because high unemployment rates, poor health, mental illness, or some other damaging life circumstance makes subsistence living their only option?

A far better investment of scarce state resources, it seems, would be enhanced case management services by professional social workers that could weed out malingerers and the “professionally poor” who defraud the system, while providing skilled support to those who genuinely need (and deserve, I would argue) a “hand up,” as well as a “handout.”

A Thursday article in the Clarion-Ledger pointed to a number of new initiatives and focus areas, including:

• “Eat Healthy Mississippi,” a USDA-funded effort to improve eating habits and promote locally grown food.
• A governor-sponsored annual 5K race to promote regular exercise habits.
• Planning for improved medical facilities in synergistic “zones” or “corridors.”
• Inducements for physicians to practice in underserved areas of the state.

We can expect the conservative Bryant (and presumably the majority Republican legislature) to feature personal responsibility as a factor in improving the state’s health profile.  And no doubt individual decision-making is a central component of any comprehensive approach. 

It’s not the only one, however, and arguably not even the most important one, in affecting behavior at a population level.  Smart policy – policy that makes the right choice the easy choice, to paraphrase state public health officer Mary Currier – is at least as prominent a factor.

Yesterday morning it was the Clarion-Ledger’s editorial turn (as reprinted in the Hattiesburg American) to fly the education flag, in this case featuring the policy recommendations of “Blueprint Mississippi,” a report of the Mississippi Economic Council.

Among other things, Mississippi needs, says Blueprint, an early childhood education system, better pay for teachers, and more rigorous preparation of educators.  IHL commissioner Hank Bounds, who chaired the Blueprint effort, contributes the pivotal punch line – “If you want to improve the economy in this state, then the first thing you have to do is improve education.”  No points for novelty, perhaps, but right on the money.

Now let’s see if the new crop of policy makers in Jackson heeds the education message any better than their predecessors have.

Once completed, the 86,000-sq.-ft., three-story, $31 million facility will allow Southern Miss to make a great leap forward in nursing education and community engagement.  The current facility is crimping enrollments and instructional capacity.  The new one will permit up to a 45% expansion in student numbers, and will feature state-of-the-art clinical simulation and computer labs, side-by-side with electronically-enhanced classroom, conference, office, and informal interactive space.

The new building will solidify and significantly advance Southern Miss’ growing reputation as both a practical and visionary leader in nursing and the health-related professions generally.  It could hardly come at a more opportune time, when Mississippi’s and the region’s needs for health care and wellness promotion seem to grow more acute by the day.

There’s no doubt that King cherished the vision of black and white children living and playing together, judged by “the content of their character” rather than the “color of their skin.”  And there’s no more doubt that King was unwaveringly committed to non-violent means of realizing the dream. 

But King harbored no illusions that the vision of a just American society would be achieved without protracted struggle and challenge to prevailing structures of injustice and violence.  Non-violence was linked to love – “agape” love, reflecting God’s active and unconditional love for mankind, and not sentimental love.  Love in turn was inseparable from justice, with direct action and civil disobedience serving as essential elements of the process of healing a radically unjust society. 

Forty-four years after King’s murder, pursuit of the elusive dream continues.  Remembrances are fond of noting that great progress has been made, albeit perhaps not enough.  Certainly the latter observation is true.  While every American in every region of the country now has a right to sit at the lunch counter, fewer and fewer, it seems, can afford the lunch (or housing, or health care, or a secure retirement, or a high-quality education…). 

King himself recognized that political equality without economic justice was insufficient.  Unfortunately, this part of his “iconic” teaching is too frequently forgotten.

As politicians and pundits are fond of pointing out, growing up with a teen mom – notably if she’s already poor, and poorly educated – puts a child at high risk for a wide range of individual and social pathologies: poverty, drug abuse, dropping out of school, delinquency (and eventually adult criminality), among others.

It’s tempting, then, to identify out-of-wedlock births as the cause of so much that ails Mississippi.  And from that to follow with self-evident “solutions” – promote abstinence, self-discipline, conservative social values, marriage and family.

Alas, if only it were that easy.  We have to be careful here to avoid confusing “correlation” with “cause.”  The unfortunate reality is that teen pregnancy and out-of-wedlock birth are at least as much effects of pathology – notably poverty and poor education – as they are causes all the nasty outcomes that comes with it.  (In fact I’m inclined to say that they’re more effect than cause, but then I’m a bleeding-heart liberal social worker, so what do you expect?)

Here’s an alternative notion: Let’s develop and fully fund a truly top-notch educational system – pre-K through higher education, complete with supportive social services – and see what happens to the rate of out-of-wedlock births, as well as all the other dismal statistics dogging us.  Excellent education levels the playing field of opportunity.  With excellent education, we raise Mississippi’s human capital and start making progress that sticks.

Details need not distract us here; suffice it to say that there is detail beaucoup – respectable science, forming an overwhelming consensus among increasingly alarmed environmental scientists – that climate change is not only real, but is occurring more rapidly than predicted even a few years ago.

The consequences of climate change are frighteningly myriad – from rising mean temperatures and frequent severe weather events, to disrupted food production and resultant famine and political upheaval.  But of most concern to students and faculty in the College of Health are the implications for human health and well-being.

The forecast is not sunny.  Of course we can expect to see rising rates of heat exposure and injury and death from severe weather, but also rapid shifts in epidemiological patterns, disease vectors, and most likely the emergence of wholly new air, water, food and blood-borne diseases never before encountered.  The poor, the aged, children, all those already health-compromised, will be hit first, and hardest, as always.  It’s all too easy to imagine already fragile and overtaxed health care systems being crippled to the point of breakdown. 

We are foolish indeed if we sit by idly waiting to be overwhelmed, or, worse, retreat into fantasies of denial (“oh, somehow we’ll manage to muddle through…”) because reality is too terrifying to face.  The time to act to stop the promotion of any further climate change is now.

The problem?  The economy is at a dead standstill, which means (at best) flat revenues, and state agencies have collectively asked for about $1 billion more in funding than is likely to be available for allocation.  So it looks like another cut-cut-and-cut-some-more session in the making.

But is that what Mississippians really want?  Cuts to education, to health care, to mental health, and on and on, with no new taxes on anyone, even those most able to pay?  Here’s an idea – let’s ask them.  I’d bet that they’re not so insistent on the “no taxes” approach as zealous legislators might think.

Now, we’re sure to hear a lot of blather about one or another scheme to rein in costs in an ideologically acceptable (i.e. market-based) manner.  No doubt, some approaches would be better than others.  But any approach that doesn’t effectively address the underlying drivers of health care costs – pharmaceuticals, diagnostic tests, complex equipment and procedures – in the context of aging population dynamics (1.5 million seniors signing onto Medicare per month) is doomed to failure.

So what is to be done?  Here are four starter ideas:  (1) End the current restriction preventing Medicare from using its vast potential bargaining leverage to get low-cost drugs for recipients.  (2)  Make health insurers subject to antitrust laws (they’re currently immune) to promote meaningful competition.  (3) Allow a Medicare-like public option, open to everyone (to label a public option “socialist” is disingenuous in the extreme; private insurers fear the real competition “Medicare for all” would pose).  (4) Encourage/reward plans that emphasize disease prevention over expensive diagnostic and clinical intervention procedures.

We’re not likely to hear any of the leading presidential candidates promoting these ideas (Obama is committed to defending the Affordable Care Act, and Republican presidential contenders are committed to attacking Obama).  But despite the sorry state of our republic these days, citizens still have a voice.  Let’s use it.