In this morning’s Washington Post (man, I need to do my blogging earlier in the day), business columnist Steven Pearlstein dings Sen. Hillary Clinton (D‑N.Y.) for “demonizing the drug companies and health insurers, and turning them into opponents” when she should be enlisting their support for health care reform.

Pearlstein’s column includes this gem:

[Y]ou have to have a pretty finely calibrated moral yardstick to see how drug companies and insurers are any worse than hospitals and doctors, who profit just as handsomely from the current system and have been just as dogged in opposing reasonable reform. And you could add to that list the medical-equipment makers, laboratories and nursing-home operators.

Yes, there are plenty of bootleggers behind government control of health care. Here’s hoping they don’t start making nice-nice with the Baptists.

Former House majority leader Dick Armey is guest blogging at Time magazine’s Swampland blog about health care and other issues.

When Armey argued against government subsidies and price regulation, Time’s Jay Carney asked a couple of good questions. Here’s how I would have answered them.

“Would we really be better off if we could shop around for the best price on a quadruple bypass? Or chemotherapy?” 

I suggest Carney ask Howard Staab, a 56-year old uninsured contractor in North Carolina who needed a heart valve repaired in 2004. Durham Regional charged $200,000, which Staab couldn’t possibly afford. So he went to India, where a former associate professor of medicine from NYU performed the surgery in a quality hospital for just $10,000. (Mike Tanner and I wrote about Staab and patients with similar stories in our delightful book.)

We don’t need every quadruple bypass candidate to shop around, or to shop internationally, or to shop just on the basis of price. If only a few of them do so — economists call them the “marginal consumers” — we will establish the kind of competition that reduces prices and improves quality even for patients who don’t have the luxury of time.

“Wouldn’t that lead to even greater disparities between the quality of care received by rich and poor?” 

Personally, I’m mostly concerned with developing better medical care, and making those innovations available to the poor as quickly as possible. Market competition is the best tool for doing so. Other approaches either stifle innovation or keep prices way too high for the poor to afford.

I watched the Republican presidential candidates’ debate last night, and darn it if that Mitt Romney isn’t an attractive speaker. If you didn’t know anything about health care or the reforms he enacted in Massachusetts, you’d think he had that problem licked. 

So here’s a reality check. What Romney said about health care (according to the New York Times) appears in bold italics.

“[In Massachusetts,] we said: ‘You know what? We [have] got to find a way to get everybody insured.…’ ”

Here, the candidate reveals his desire to do something that is 100 percent impossible. To be clear: It is impossible to give everyone health insurance. 

Some people with known, high-cost conditions are uninsurable. So even if you claim you are providing “insurance” to an uninsurable person, you are not, because it’s only insurance if there is uncertainty about whether a subsidy will be needed. If there’s no uncertainty, it’s just plain subsidy — not insurance. 

Markets don’t provide “insurance” to uninsurable people. Only government does that. So when people say they want to “get everybody insured,” rest assured, they are about to propose more government.

“And the last thing we want is to have the government take over health care, because anything they take over gets worse, not better.…”

I agree with this sentence, because it completely contradicts the sentence that came immediately before it. 

“We’re not going to turn to Washington, because Washington makes a mess.…”

Actually, a significant portion of the funding for RomneyCare came from Washington. Indeed, it was because Washington was about to yank $385 million in Medicaid funding that Massachusetts turned to Washington with a plan to keep that money flowing. Sure did make a mess, though — no argument there.

“We said: ‘We need to find a way to get everybody in our state insured with private insurance.…’ ”

Funny, that’s exactly what Hillary Clinton tried to do in 1993. 

“The half a million who didn’t have insurance, all the people worried that if they lost their job, they’d lose insurance — we said we got to find a way to get them insured without raising taxes.…”

RomneyCare imposed a slew of new taxes. Romney’s defenders like to claim that the plan did not include a broad-based tax increase. But it did increase government spending, which is essentially the same thing. 

“…without a government takeover…”

The government can take over your health care by taxing you and spending your money itself, or by forcing you to spend your money how it wants. The latter is what Romney did. Either way, the government is taking over.

“…and that’s what we did.”

Really? And here I thought the Massachusetts “Connector” bureaucracy explicitly and unanimously decided not to cover 20 percent of the Bay State’s uninsured.

“It relies on personal responsibility.…”

Personal responsibility means that you bear the cost of your decisions. But RomneyCare allows people to push the cost of their bad decisions (smoking, poor diabetes prevention and management, etc.) onto others. RomneyCare thus relies on collective responsibility. Romney consistently confuses the two.

“Every Democrat up there’s talking about a form of socialized medicine, government takeover, massive tax increase.…”

True enough. But it’s not just the Democrats.

“We get people that were uninsured [covered] with private health insurance.…”

Nominally private health insurance, yes. Just like Hillary proposed.

“We have to stand up and say the market works. Personal responsibility works.…”

If they work, why abandon them?

“We’re going to have insurance for all of our citizens they can afford, that’s theirs, that’s portable. They never have to worry about losing it.…”

Not quite. The only good thing about RomneyCare is that it may give workers more health insurance choices, and let them keep their insurance when they change jobs. The federal tax break associated with job-based coverage traditionally has made that impossible. 

But insurance would not be so portable for those who don’t get another job. In that case, RomneyCare will let you keep your insurance, but the cost could rise 80 percent because you’d lose that tax break. Losing your insurance would be really easy under those circumstances.

Romney’s defenders would say (1) that’s always been the case, and (2) you can’t change that problem at the state level — only Congress can change the federal tax code. But that’s exactly the point. 

The whole premise of RomneyCare and its “Connector” is that a state can undo the damage wrought by federal tax laws. An honest appraisal of RomneyCare belies the folly of that premise. For Massachusetts to mitigate the damage done by federal tax laws — even slightly — required (A) creating a new government bureaucracy, (B) increasing government spending, and (C) imposing new taxes. 

The fundamental flaw of RomneyCare is that conservatives tried to use state law to fix problems created by federal law. The Constitution just doesn’t work that way. RomneyCare is a net minus for freedom because it expanded government at the state level and distracted free-market advocates from pushing for real reform at the federal level. It continues to do so.

I was glad to see that the New York Times’ transcript picked up the comment of an unidentified candidate who responded to Romney’s claim of having covered all the uninsured with: “I’m told that’s not true. Actually, Wolf, that’s not true.” Watching the debate, I thought it was Rudy Giuliani who said it. That would make sense: he had the soundest approach to health care of all the candidates.

In an essay published this week by the Economist magazine, outgoing British Prime Minister Tony Blair shared “What I’ve Learned” during his decade in office. I’ll leave it to others to dissect what he said about the transatlantic alliance, the Iraq War and the National Health Service, but his words of wisdom on the importance of an open global economy are worth quoting.

Declaring that “‘Open v closed’ is as important today in politics as ‘left v right,’” Blair wrote:

Nations do best when they are prepared to be open to the world. This means open in their economies, eschewing protectionism, welcoming foreign investment, running flexible labour markets. It means also open to the benefit of controlled immigration. For all nations this is a hugely contentious area of policy. But I have no doubt London is stronger and more successful through the encouragement of targeted migration.

Isolationism and protectionism now cut across left and right boundaries. They are easy tunes to play but pointless in anything other than the very short-term.

I wish more members of the U.S. Congress would learn the same lessons.

Yesterday the Center on Education Policy (CEP), a DC-based think tank, released a report that U.S. Secretary of Education Margaret Spellings declared “confirms that No Child Left Behind has struck a chord of success with our nation’s schools and students….We know that the law is working.”

Not to rain on the secretary’s parade, but the CEP study doesn’t even come close to confirming that NCLB is working. In fact, once the authors took into account data limitations and the myriad changes that states had made to their standards and testing programs since passage of NCLB, they had usable pre- and post-NCLB achievement data – which is essential for getting any idea if NCLB is working – for only 13 states, and were able to make complete analyses for only seven. In addition, the authors noted that:

We cannot say to what extent test scores have gone up because of NCLB. It is always difficult to tease out a cause-and-effect relationship between test score trends and any specific education policy or program. With all the federal, state, and local reforms that have been implemented simultaneously since 2002, it becomes nearly impossible to sort out which policy or combination of policies is responsible for test score gains, and to what degree.

So Spellings declared a report in which the authors were only able to get complete data for seven states, and made quite clear that their findings are absolutely not proof that NCLB is working, as confirmation that the law is working.

Feel like you’ve heard this before?

Of course you do, because this has been the standard Bush administration response to almost any news in education since NCLB was passed. Either new studies or achievement results have been proof that the law is working, or proof that we need to expand the law. But as I and others have pointed out numerous times, the best, most straightforward evidence that we have about NCLB suggests that the law is not working. The National Assessment of Educational Progress – which evaluates American students on consistent tests, not the constantly changing and gamed state assessments driven by NCLB – has shown stagnant or dropping reading scores in the period covered by NCLB, and slowing growth in math scores.

Now, just as the CEP findings are far from proof that NCLB is working, the NAEP scores aren’t proof that NCLB is a failure. They are, however, clear evidence that no one who is even remotely objective could say that NCLB is a proven success. Yet the U.S. Secretary of Education has repeatedly been doing exactly that.

And people wonder why, when given the opportunity, so many parents jump at the chance to leave government schools behind.

The Fairfax County Taxpayers Alliance, here in the Washington suburbs, complains that property taxes have soared over the past seven years. The typical Fairfax homeowner is paying $4830 a year in property taxes. The FCTA points out that “if during the past seven years the Supervisors had held real estate tax increases to the rate of inflation, which averaged three percent per year, the typical homeowner would be paying $3,079.” Home values have been rising fast in the Washington area (at least until the past year), so taxes have also increased sharply.

Taxpayers urge the supervisors to cut taxes. The supervisors–in Fairfax County and everywhere else–respond, “Would you have us close fire stations or fire teachers or throw widows out in the snow?” Somehow they never discuss, as another item in the FCTA newsletter does, the fact that salaries and benefits have increased far more than population growth or any other measure over the past seven years. Just hold county employees’ salary increases to the rate of inflation, and you could save the taxpayers a lot of money.

Or maybe, just maybe, Fairfax County’s $3.3 billion annual budget contains some low-priority items, like this one that was the subject of a charming article in the Washington Post:

This group of 12 kids, ages 6 to 10, are in the otherwise empty cafeteria of Anthony T. Lane Elementary School in Alexandria for the last of their eight Saturday morning classes on manners, offered through the Fairfax County Park Authority.

John McCain’s share price at the Iowa Electronic Market lost 40 percent of its value yesterday. It opened at 17 cents and closed at 11:59pm at 10 cents.

Since May 17th, McCain’s share price has lost almost two-thirds of its value.

If no one is buying futures on McCain’s nomination, we might suspect that relatively few people will be giving him campaign contributions. Without funding, of course, the McCain effort is doomed.

So go to the Iowa Market and invest a dime. You might get a dollar in a year’s time. You’ll find plenty of people there willing to sell you a futures share on McCain.