My recent blog on Minnesota governor — and potential Republican vice presidential nominee — Tim Pawlenty brought a great deal of e-mail from Pawlenty partisans. Most of their criticism was of the “definition of ‘is’” variety. Governor Pawlenty doesn’t support “price controls” for the Medicare prescription drug program, he merely wants the government to “negotiate” prices. (Anyone who thinks that distinction is a difference should read this article by Robert Goldberg or this piece by Benjamin Zycher). And, while he supported one increase in the state’s minimum wage, he opposed a second increase. (So he only abandons conservative principles and basic economics sometimes.) However, in fairness to Governor Pawlenty, two of my criticisms do deserve clarification.

On SCHIP: Governor Pawlenty did not specifically oppose President Bush’s veto of the Democratic expansion of SCHIP. He did praise the bill for “increasing” SCHIP funding, and both individually and as head of the National Governors Program urged the program’s renewal, while the Democrats were trying to override the president’s veto. But he did not specifically call for overriding the veto.

And, on an individual health insurance mandate: Governor Pawlenty’s Health Care Task Force endorsed such a mandate. Although the governor initially hailed the task force report and called it “a framework” for reform in Minnesota, he did later distance himself from the recommendation for a mandate.

I don’t think any of this makes him less of a big-government conservative, but I want to make sure my criticism is as accurate as possible.

The Washington rumor mill has Minnesota Governor Tim Pawlenty as the leading candidate to be John McCain’s running mate. If so, that would be a clear slap in the face to small-government conservatives.

Pawlenty, who reportedly coined the term “Sam’s Club conservative” to describe his political philosophy, has been an economic populist and big-spender generally. Among other things, he:

• Supported government subsidized health care for all children as the first step toward universal health insurance, and opposed President Bush’s veto of a Democratic bill that would have expanded the State Children’s Health Insurance program (SCHIP) to families earning as much as $83,000 per year;
• Supports Massachusetts-style health care reform, including a “health care exchange” and an individual mandate;
• Has called for banning all prescription drug advertizing, and seeks government imposed price controls for drugs offered through Medicare;
• Proposed a $4000 per child preschool program for low-income children;
• Pushed a statewide smoking ban smoking ban in workplaces, restaurants and bars;
• Increased the state’s minimum wage;
• Imposed some of the most aggressive and expensive renewable energy mandates in the country;
• Was an ardent supporter of the farm bill;
• Received only a “C” ranking on Cato’s 2006 Governor’s Report Card, finishing below such Democrats as Iowa Governor Tom Vilsack and tied with Democratic Pennsylvania Governor Ed Rendell.

It was the Republicans’ big-spending, big-government ways that helped ensure their defeat in the 2006 midterm elections. Suburbanites, independents, and others who were fed up not just with the war and corruption, but also with the Republican drift toward big-government who stayed home, or even voted Democratic, on election day 2006. That night, more than 65 percent of voters told a pollster they believed that “The Republicans used to be the party of economic growth, fiscal discipline, and limited government, but in recent years, too many Republicans in Washington have become just like the big spenders they used to oppose.”

John McCain cannot hope to win this fall without the support of economic and small government conservatives. Many are attracted to what appears to be McCain’s genuine fiscal conservatism. But many others are suspicious of McCain’s populist, big-government tendencies on issues from energy and the environment to civil liberties, the war and campaign finance. McCain needs to reach out to Reagan/Goldwater small-government conservatives. Vice President Pawlenty would be sending a very different signal.

Today’s Washington Times has a long interview with former House Majority Whip Tom DeLay in which he talks about the problems facing the Republican Party and his efforts to help rebuild it. As I have written, there is no doubt that the GOP is facing many problems today, many of them due to the big-government conservatism brought about in part by…Tom DeLay.

This is after all, the same Tom DeLay who:

• Presided over an unprecedented spending binge by Congressional Republicans. In fact, DeLay was a cheerleader for using earmarks to buy votes for Republican candidates in competitive districts;
• Twisted arms and threatened dissenters in order to pass the Medicare prescription drug benefit, the first new entitlement program in 40 years;
• Helped sidetrack Social Security reform;
• Helped start the “K Street Project,” a cynical exercise in vote buying that led to much of the corruption that plagued Republicans in recent years;
• Once said that “there is simply no fat left to cut in the federal budget.”

If Republicans and/or conservatives really want to recapture their small government credentials, the might start by ignoring Tom DeLay.

Health Affairs has just published a new study of the Massachusetts health care plan by Urban Institute scholar Sharon Long. Media coverage has generally been positive, hailing the Massachusetts experiment as a success. But a closer look leads to a far less sanguine conclusion. Among other things, the study shows that:

• Slightly less than half of Massachusetts’ uninsured population actually complied with the mandate. True, the number of people without health insurance was reduced from 13% of the state’s population to 7%, but when the bill was passed, advocates promised that “all Massachusetts citizens will have health insurance.” Perhaps it depends on your definition of “all.”
• Most of those who are signing up are low-income individuals, whose coverage is fully or partially subsidized, proving once again that if you give something away for free people will take it. It certainly appears that it is the expensive and generous Massachusetts subsidies (up to 300% of the poverty level), not the unprecedented individual mandate that is responsible for much of the increased coverage.
• Adverse selection remains a big problem, with the young and healthy failing to comply with the mandate. The state refused to change its community rating laws which drive up the cost of insurance for young, healthy individuals. Not surprisingly, they don’t find this a good deal.
• The program is far exceeding its projected costs, with at least a 33% budget overrun in its first year.
• The program has increased demand for health care services without increasing the supply of providers. As a result, patients are having trouble finding providers and waiting lists (Canada here we come) are beginning to develop.

If this is success, I would hate to see failure.

A few thoughts in the wake of last nights elections:

Winners:

John McCain. He is clearly the front runner now. He might not have won big, but he won all the big states. And he benefits even more because his putative rival, Mitt Romney, was such a big loser. Now, can he mollify conservatives?

Mike Huckabee. He kept his vice presidential ambitions alive with a surprising showing. And he got to thumb his nose at Romney besides. But he is still a regional candidate with little appeal outside the south or evangelical circles.

Hillary Clinton. She held off the Obama wave (again), and won in the big states where she had to. The terrain going forward looks pretty good for her, with big states like Texas (Latino vote) and Pennsylvania (the Rendell organization) leaning in her direction.

Barack Obama. Both Democrats were winners. Obama won more states and may actually have won more delegates. The race will go on, which means there is more time for voters to reconsider the possibility of a Hillary (and Bill) presidency.

Losers:

Mitt Romney. He lost every contest he needed to win. Apparently, if you want to be the conservative alternative it helps to actually be a conservative. On issues ranging from health care to government spending, Romney was actually more liberal than McCain. Voters noticed.

Talk Radio. They said vote for Romney. Voters didn’t. They said a vote for Huckabee is a vote for McCain. Voters didn’t care.

Xenophobes. Once again the anti-immigration candidate didn’t win. The issue may play well on talk radio (see above) and on the far right of the Republican Party, but it doesn’t seem to move voters.

The Democrats. While attention has been focused on the divide in the Republican Party, Democrats are beginning to see fractures in their party. Exit polls showed that half of both Clinton and Obama supporters would be dissatisfied if the opposing candidate won. Michelle Obama says that she would “have to think about” whether she would support Hillary. If this goes the convention, it could get really nasty.

Pollsters. Obama with a 13 point lead in California? Romney leading by 7? Clearly, they need to go back and rework their models.

Limited Government. OK, John McCain is a fiscal conservative. But after that its pretty dismal. The choice on the Republican side was between three versions of big-government conservative. (Ron Paul was not a factor in any state). The Democrats seem to move further left every day. For those of us seeking limited government, it looks like a long election.

As voters go to the polls on this Super Tuesday, conservatives are reportedly rallying around former Massachusetts governor Mitt Romney in an effort to stop Arizona Senator John McCain. Now, there are certainly many reasons to dislike John McCain. I’ve blogged about them here, and my colleague John Samples has raised even more concerns here. But the idea that Mitt Romney is the conservative alternative baffles me.

For example, one would expect a conservative to be opposed to government-run health care. But, as governor, Romney signed—and still says he supports—a health care plan virtually indistinguishable from the one put forward by Hillary Clinton and Barack Obama. Romney’s plan, like the Democratic plans, includes an individual mandate, heavy insurance regulation, middle class subsidies, and a bureaucratic new pooling mechanism. Like the Democrats, Romney believes that goal of health policy should be “universal coverage.” So far, his plan has not only failed in that regard, but it has limited consumer choice, cut reimbursements to providers, driven up insurance premiums, and run deficits of $150-$400 million.

And, one would expect the putative conservative alternative to want to cut government spending. But Mitt Romney has called for spending an additional $20 billion in corporate welfare to bail out the auto industry. He wants to increase farm price supports. He supports George Bush’s Medicare prescription drug benefit and calls for more federal education spending. Indeed, he wants the federal government to buy a laptop computer for every school child in America. Like George W. Bush running in 2000, Romney has not called for cutting or eliminating a single government program—and we know what that meant for a Bush presidency.

Romney has also abandoned the conservative belief in free trade. As my colleague Dan Griswold has written, Romney has adopted a protectionist bent, taking up the “fair trade” mantra, and worrying about the threat to jobs from India and China.

And, while he now talks a good game on taxes, his record as Massachusetts governor was mediocre at best. The Cato Institute’s annual governors’ report card gave him only a “C,” noting that he raised business taxes and fees by some $500 million.

This is not to say whether McCain or Romney would be a better choice for conservative voters. But it does raise questions about what it means for the state of modern conservatism when Mitt Romney becomes the conservative savior.

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Faced with rising costs that threaten to put the program $150–400 million per year over budget, the Massachusetts Connector Authority is now adopting a number of changes to RomneyCare. They include:

1. Pressuring insurers not to increase premiums (ie. premium caps).
2. Ordering insurers to cut reimbursements to hospitals and physicians by 3–5 percent.
3. Reduce the choices available to consumers.

The Authority postponed a vote to increase co-payments and other payments by patients.

Ah, the wonders of government-run health care.

With his victory in Florida, Sen. John McCain has become the clear front runner for the Republican nomination. It’s worthwhile, therefore, to take a closer look at what kind of president he might be.

The Good: While Rush Limbaugh and Sean Hannity sometimes portray McCain as a virtual clone of Ted Kennedy, the fact is that he is a true fiscal conservative—certainly more of a fiscal conservative than, say, Mitt Romney. He is well known as an opponent of earmarks and pork barrel spending. But perhaps more importantly, he has long been an advocate of entitlement reform. He was early an ardent support of personal accounts for Social Security, and has pushed for serious Medicare reform, including means-testing. Almost alone among Republicans, he opposed the disastrous Medicare prescription drug benefit.

He has offered the best health care reform plan of any of the candidates. While Mitt Romney has embraced the basic tenants of HillaryCare, McCain would change the tax code to equalize the treatment between employer-provided and individually-purchased health insurance. This is a vital step in moving away from our employment-based health care system toward a more consumer-oriented system. And, he would allow the purchase of low-cost insurance across state lines, avoiding regulation and mandates.

During his time in the Senate, he has never voted for a tax increase. While he has taken much heat for voting against the Bush tax cuts, he now calls for making those tax cuts permanent (although he would retain a vestige of the estate tax at a reduced rate and increased exemption). And, McCain is right that cutting taxes has too often become an excuse for republicans to avoid the hard task of cutting spending. Cutting taxes reduces the pain of government spending (at least for now), allowing Congress to avoid difficult choices. While taxes need to be cut—and McCain supports a number of tax cuts including reductions in the business tax rates and capital gains taxes—future tax cuts should be linked with spending cuts. As I argue in my book, Leviathan on the Right, it’s the size of government, stupid.

He is a strong and unapologetic free trader.

The Bad: John McCain frequently makes Dr. Strangelove look like a peacenik. Its not just his desire to remain in Iraq “for a hundred years.” It’s his bellicosity toward every enemy and perceived enemy from Iran to North Korea. He’s a true believer in the neoconservative goal of remaking the world to fit our desires and beliefs. At best on foreign policy he would be a competent Bush. At worst, he appears a recipe for perpetual conflict.

On domestic policy, he has shown a disturbing predilection for elevating every personal pet peeve, from steroids in baseball to airplane service quality, to a federal issue. And, he has embraced heavily regulatory environmental policies and compulsory national service. Like George W. Bush, he tends to support federal power over federalism, executive authority over legislative, and generally leans toward the imperial presidency.

The Ugly: John McCain appears to have little more than contempt for the First Amendment and free speech generally. He is the principal author of a campaign finance bill that severely restricts political speech. Not content with those restrictions on political speech, he has continually sought to expand regulation to other groups. He has said that he “would rather have a clean government than one where, quote, First Amendment rights are being respected, that has become corrupt. If I had my choice, I’d rather have the clean government.” Any candidate who believes that respect for First amendment rights needs to be qualified by “quote,” raises serious concerns. Moreover, his general attitude appears to be that criticism of the government, the war, and in particular himself, is somehow unpatriotic.

Most worrisome of all appears to be McCain’s basic philosophy, which is unapologetically statist, as Matt Welch points out in his new book McCain: The Myth of a Maverick. McCain once said “each and every one of us has a duty to serve a cause greater than our own self-interest.” McCain believes that cause to be the good of the collective, often defined as the nation or the national community.

For believers in individual liberty and limited government, it’s a decidedly mixed bag. But, then again, aren’t they all?

Mitt Romney’s victory in Michigan’s Republican primary last night throws the GOP race for president wide open. But it should also end once and for all the idea that Romney is the heir to Reagan-style conservatism.

For some reason, Romney has been able to claim the Reagan mantle despite his support for:

• A health care plan virtually indistinguishable for the one proposed by Hillary Clinton;
• Support for No Child Left Behind, calls for increased federal education spending, and a proposal to have the federal government give a laptop computer to every schoolchild in America;
• Calls for increased farm price supports;
• Support for the Medicare prescription drug benefit; and
• An undistinguished record on taxes and spending as Massachusetts governor, earning a C on Cato’s governor’s report card, and including support for $500 million in increased fees and corporate taxes.

But in Michigan, Romney pulled out all the big government stops with a call for $20 billion in corporate welfare to revive the state’s struggling auto industry. Romney, who called his proposal “a work-out, not a bail-out,” also promised that as president he would develop “a national policy to help automakers.”

George W. Bush once said, “When somebody hurts, government has got to move.” Mitt Romney echoes that, “A lot of Washington politicians are aware of it, aware of the pain, but they haven’t done anything about it. I will.”

Ronald Reagan must be spinning in his grave.

The voters of Iowa have had their say and the 2008 presidential election campaign is now officially underway. While the Iowa dust (or snow) is just beginning to settle, it’s already possible to pick out winners and losers.

WINNERS

Barack Obama: He not only won, he won big. If he had lost in Iowa, the Clinton inevitability train might have been unstoppable. But now he has vaulted into possible frontrunner status. The race is far from over, but Obama has shown that his upbeat message of change and opportunity resonates with voters. Two big questions remain: What will happen when scrutiny moves beyond his positive generalities to his very liberal record? And can he survive the coming attacks from the Clinton machine?

John McCain: He finished in a rough tie for third despite putting in little effort in Iowa (and opposing ethanol subsidies). More important, Mitt Romney took a big hit. McCain was already surging in New Hampshire. With Romney wounded and Huckabee having little New Hampshire traction, a win is now a very realistic possibility. The media would love a McCain comeback story. But where doers he go next?

Mike Huckabee: A win is a win is a win. But Huckabee built his win almost entirely on a turnout by evangelical Christians who ignored his big-government positions. It’s hard to see how he can compete in anti-tax New Hampshire or socially moderate states like California that vote on Super Tuesday. Remember Pat Robertson surprised everyone by finishing second in the Iowa Caucuses in 1988.

LOSERS

Mitt Romney: He built his entire strategy on winning early in Iowa, New Hampshire, and Michigan. Now, despite spending $7 million in Iowa, that strategy is in tatters. He lost in Iowa and is trailing in New Hampshire polls. If he loses next Tuesday, it becomes very hard to see how he comes back. Perhaps money and perfect hair doesn’t overcome a lack of core political beliefs after all.

John Edwards: He had to win in Iowa to be viable. He had campaigned there virtually nonstop for four years. After all that time and effort, second place just isn’t good enough. Obama is now the anti-Hillary candidate. Edwards appears ready to limp on, at least until South Carolina, but if he does it will be more as spoiler than as potential nominee.

Hillary Clinton: Third place? For the inevitable, unstoppable candidate? For a campaign whose entire rationale was built on the idea that she was going to win, she now looks suspiciously like…well…a loser. Still, she has the money, organization, and determination to fight back. There is no more ruthless politician in America. Obama had better be ready.

Fred Thompson: The whole idea of his campaign was that he would unite the party and give all stripes of conservatives someone to rally around. A distant third place tie doesn’t suggest much of a rally. And, he is running even worse in New Hampshire polls. It’s hard to see why he will stay in a race he never really seemed to want to be in.

IT COULD HAVE BEEN WORSE

Ron Paul: His supporters were hoping that Paul’s fundraising prowess, internet popularity, and the zealousness of his followers would translate into a third place finish. Instead, he finished a disappointing fifth. Still, 10 percent of the vote is not bad for a previously unknown congressman from Texas with minimal media exposure. His limited government message clearly touched a chord and has inspired a new generation of libertarian activists. It’s hard to see where he goes after New Hampshire, but he can take satisfaction in what he had already accomplished.

Bill Richardson: He kept his vice presidential hopes alive with a respectable showing. Reports suggest that he actually received some 10 percent of the first round vote, although Iowa’s complicated system ended up giving him only about 2 percent of the regional delegates.

Rudy Giuliani: His Iowa showing was dismal, he trails in New Hampshire, and he has lost his lead in national polls. But the Republican race is now wide open. With no one likely to win all the early primaries, it may be that Giuliani’s strategy of playing rope-a-dope until Florida and the Super Tuesday primaries may be viable after all.

For anyone who still believes that the debate over expanding the state Children’s Health Insurance Program (S-CHIP) is really about health care for poor children, the New York Times reports that 8 Senate Democrats have signed a letter saying they will oppose any compromise that doesn’t allow the program to continue covering adults.

Currently, 12 states currently use S-CHIP funds to provide taxpayer-funded insurance for adults. According to data released by the Department of Health and Human Services in July, Wisconsin covers almost twice as many adults as children — and spends 75 percent of its S-CHIP funds on them. Minnesota spends 63 percent of its S-CHIP funds on adults. In New Jersey, it’s 43 percent.

Let’s keep that in mind the next time we see ads featuring adorable little kids pleading for those mean, nasty Republicans to give them health insurance.

Several blogs, including the one over at the New Republic have taken me to task for my last post pointing out that with the deadline looming for complying with the Massachusetts individual health insurance mandate, more than 100,000 people still haven’t purchased the required insurance. I suggested that this proves a mandate is unlikely to achieve universal coverage. But, the blogs say, no one ever claimed that the Massachusetts plan would insure everyone.

Except that is exactly what the plan’s supporters claimed. When the bill was signed, the media, state lawmakers, and health care reform advocates hailed it as achieving “universal coverage.” As Mitt Romney himself wrote in the Wall Street Journal, “all Massachusetts citizens will have health insurance.”

There’s no doubt that the Massachusetts plan has reduced the number of people without health insurance in the state. But that is largely because of the plan’s enormously generous (and costly) subsidies. The mandate, with its infringement on individual liberty and invitation to greater government regulation, has had little positive impact.

The latest reports from Massachusetts warn that with just seven weeks left until the state’s mandate for individual health insurance goes into effect, more than 100,000 residents have failed to buy the required insurance. That represents nearly 20 percent of the state’s uninsured population and more than half of the uninsured with incomes too high to qualify for subsidies.

According to insurance industry insiders, the plans are too costly for the target market and the potential customers — largely younger, healthy men — have resisted buying them.

How could anyone know that an individual mandate for health insurance would be unenforceable? Oh yeah, we told them.

Today’s Washington Post takes Rudy Giuliani to task for a radio ad in which he claims that the chances of surviving prostate cancer are roughly twice as high in the United states than under Britain’s system of socialized medicine. The Giuliani campaign cited as its source an article by Manhattan institute scholar David Gratzer, which the Post pointedly notes “provides no source for its assertion.” However five minutes of research might have shown the Post that the numbers actually come from a Commonwealth Fund study by Gerard Anderson and Peter Hussey.

Moreover, the Post’s own figures, using more recent numbers and a different methodology, show that the five year survival rate for prostate cancer to be 98 percent in the U.S. and 74 percent in Great Britain. Not quite as good as Rudy’s numbers, but still a clear advantage for the U.S.

The Post also suggests that the better U.S. outcome is a reflection of “different philosophies about how to treat the disease.” Indeed! I think that is Rudy’s point.

The one valid criticism of Rudy’s point is that prostate cancer might not be the best example of outcome disparities between the two systems. Because prostate cancer is a slow-growing cancer, the disparity may reflect more aggressive testing and screening procedures in the U.S. That is, we catch many cancers that would go undetected in other countries. As, Robert Ohsfeldt and John Schneider concede in their book, The Business of Health:

[Many] cancer survival rate estimates…do not adjust for cancer stage at diagnosis. This could result in survivor time bias – those with cancers detected at an earlier stage would exhibit longer post diagnosis survival times, even for cancers that are essentially untreatable.

Survivor time bias, however, should not be a significant concern for cancers that respond well to treatment if detected early. For such cancers, early detection makes a substantive contribution to survival time – the longer survival time associated with early detection thus is not a spurious effect of early detection. An example is thyroid cancer. In the United States, virtually all females with thyroid cancer survive for at least five years. The lower survival rates for thyroid cancer in European countries suggest some underperformance in either early detection or post diagnosis management in these countries. In contrast, the differences in survivor rates are less pronounced for cancers that are more difficult to treat, such as lung cancers.

U.S. outcomes beat the U.K not just for prostate cancer, but for a wide variety of cancers and other diseases, where survivor time bias is not at issue. According to a study published this year in the British medical journal, The Lancet, for all types of cancer, the U.S. ranks number one among industrialized nations: 62.9 percent of women with cancer survive for 5 years, 66.3 percent of men. Britain ranked 16th for women (52.7 percent) and 15th for men (just 44.8 percent).

Besides, one of the most common arguments for socialized medicine is that it would lead to more testing, screening, and preventive care. Proponents of government-run health care can’t have it both ways.

For this one, it looks like the Post deserves “four Pinocchio’s.”

Former Massachusetts governor Mitt Romney has denounced Hillary Clinton’s health care plan for being a European-style socialized medicine plan” of “government managed insurance.”

Hmmmm…. HillaryCare 2.0 calls for an individual mandate to purchase health insurance, a collectivized insurance pool, huge subsidies for low- and middle-income families, and new regulation of the insurance industry. Why, that sounds like…the plan Governor Romney signed into law in Massachusetts.

As if John Edwards proposal for mandatory preventive care wasn’t proof enough that national health care means less freedom, the Tories have now proposed that the UK’s National Health Service monitor Britons to ensure they are living “healthy lifestyles.” Those who don’t measure up could be denied treatment under the NHS (which could be a blessing in disguise). Those who lose weight, give up smoking, and make other healthy changes can have the government pay for their gym memberships and even buy them fresh fruit and vegetables.

Sometimes politics is beyond parody.

Democratic presidential candidate John Edwards has announced that preventive care and regular check ups would be mandatory under his new health care plan. Every American would be required to get an annual physical and tests, such as mammograms and colonoscopies as frequently as the government deemed prudent. Although he didn’t spell out the penalties, we can look forward to Americans being hauled into court for failing to provide proof of a blood test.

The Nanny State marches on.

The Census Bureau today released the latest figures on poverty in the U.S, showing that 12.3 percent of Americans (roughly 36.5 million people) live below the poverty line. Nothing could better illustrate the continued failure of the American welfare state. Despite spending more than $477 billion on some 50 different programs to fight poverty last year, the actual reduction in poverty was trivial. Indeed, since Lyndon Johnson declared war on poverty in 1965, the U.S. government has spent more than $11 trillion fighting poverty without success.

One definition of insanity is doing the same thing over and over and expecting different results. Perhaps its time to try something different.

Observers have known for a long time that the surest ways to stay out of poverty are to finish school; not get pregnant outside marriage; and get a job, any job, and stick with it. That means that if we wish to fight poverty, we must end those government policies—high taxes and regulatory excess—that inhibit growth and job creation. We must protect capital investment and give people the opportunity to start new businesses. We must reform our failed government school system to encourage competition and choice. We must encourage the poor to save and invest.

More importantly, the real work of fighting poverty must come not from the government, but from the engines of civil society. An enormous amount of evidence and experience shows that private charities are far more effective than government welfare programs. While welfare provides incentives for counterproductive behavior, private charities can use their aid to encourage self-sufficiency, self-improvement, and independence. Private charities can individualize their approaches and target the specific problems that are holding people in poverty.

The big question is how much more money–and how many more lives–will we waste until we realize that, as Ronald Reagan used to say, “government isn’t the solution; government is the problem.”

The Lance Armstrong Foundation will host forums for presidential candidates today and tomorrow in Cedar Rapids, Iowa. The forums, Democrats today, Republicans tomorrow, will focus, not surprisingly, on health care and the fight against cancer.

As a cancer survivor, this is an issue of great concern to me. Unfortunately, we can expect both the questions and answers to focus around more federal spending for research and the Democrats support for a government-run national health care system. I wish Chris Matthews, who will moderate this forum, would point out to them that cancer survival rates in the U.S. have been rising, and that one reason for this is the free-market health care system that these candidates love to criticize.

The one common characteristic of all national health care systems is that they ration care. Sometimes they ration it explicitly, denying certain types of treatment altogether. More often, they ration more indirectly, imposing global budgets or other cost constraints that limit the availability of high-tech medical equipment or imposes long waits on patients seeking treatment. In the U.S. there are no such limits, meaning that the most advanced treatment options are far more available. This translates directly into saved lives.

Take prostate cancer, which I suffered from, for example. In most countries with national health insurance, the preferred treatment for prostate cancer is…to do nothing. Prostate cancer is a slow moving disease. Most patients are older and will live for several years after diagnosis. Therefore it is not cost-effective in a world of socialized medicine to treat the disease too aggressively. The approach saves money, but comes at a more human cost.

Even though American men are more likely to be diagnosed with prostate cancer than their counterparts in other countries, we are less likely to die from the disease. Less than one out of five American men with prostate cancer will die from it, but 57 percent of British men and nearly half of French and German men will. Even in Canada, a quarter of men diagnosed with prostate cancer, die from the disease.

Similar results can be found for other forms of cancer. For instance, just 30 percent of U.S. citizens diagnosed with colon cancer die from it, compared to fully 74 percent in Britain, 62 percent in New Zealand, 58 percent in France, 57 percent in Germany, 53 percent in Australia, and 36 percent in Canada. Similarly, less than 25 percent of U.S. women die from breast cancer, but 46 percent of British women, 35 percent of French women, 31 percent of German women, 28 percent of Canadian women, 28 percent of Australian women, and 46 percent of women from New Zealand die from it.

Even when there is a desire to provide treatment, national health care systems often lack the resources to provide it. In Britain, for example, roughly 40 percent of cancer patients never get to see an oncology specialist. Delays in receiving treatment under Britain’s national health service are often so long that nearly 20 percent of colon cancer cases considered treatable when first diagnosed are incurable by the time treatment is finally offered.

But the advantages of free-market health care go far beyond an absence of rationing. With no price controls, free-market U.S. medicine provides the incentives that lead to innovation breakthroughs in new drugs and other medical technologies. U.S. companies have developed half of all the major new medicines introduced worldwide over the past 20 years. In fact, Americans played a key role in 80 percent of the most important medical advances of the past 30 years. Eighteen of the last 25 winners of the Nobel Prize in Medicine either are U.S. citizens or work here.

Obviously there are problems with the U.S health care system. I am sure we will hear plenty about that during these forums. But it is important to understand that for all its faults and all the criticism that it has received, the United States’ free market health care system has made it the place you want to be if you have a serious illness. Millions of cancer patients have discovered that. It would be nice if Lance Armstrong, Chris Matthews, and the candidates would stop to think about this.

Mitt Romney unveils a new health care proposal today that completely abandons the plan he signed into law as governor of Massachusetts and has defended on the campaign trail. His new proposal is a vast improvement, focused on changing federal tax law in order to empower individuals to buy health insurance outside their employer, and incentives for states to deregulate their insurance industry. He is also expected to block grant both Medicaid and federal uncompensated care funds to encourage greater state innovation. There will be no provision for either an individual mandate or a managed-competition style “connector,” both central features of his Massachusetts plan.

Of course Romney runs the risk of this being seen as another flip-flop, but on health care it is much better to be John Kerry than Hillary Clinton.

When Mitt Romney signed the Massachusetts health care plan into law, he bragged that it would provide universal health care coverage. In fact, he still says that on the campaign trail. After all, the plan does mandate that everyone in the state buy health insurance. The state has done pretty well at the welfare aspects of the bill, signing up some 150,000 people for subsidized insurance (families of four earning as much as $62,000 are eligible for subsidies). But the latest reports from Massachusetts indicate that of 170,000 people who are uninsured but have incomes too high for subsidies, only 17,500 have complied with the mandate so far. Someone should have pointed out that the Massachusetts mandate is probably unenforceable and almost certainly not going to achieve universal coverage. Oh, that’s right, we did.

In defending his health care plan, former Massachusetts governor turned presidential candidate Mitt Romney never fails to call it a “free market” plan or to denounce “HillaryCare,” the presumed alternative. In the most recent Iowa debate, he proclaimed: “This is a country that can get all of our people insured with not a government takeover, without HillaryCare, without socialized medicine…. We [in Massachusetts] didn’t expand government programs.”

In reality, as my collegue Michael Cannon has pointed out, RomneyCare is virtually indistinguishable from HillaryCare. But don’t take our word for it.

Joe Conason of the New York Observer is the latest liberal advocate of national health care to note the similarities. As Conason says, “Actually, his fabulous Bay State plan is based entirely on governmental action, from mandating insurance coverage and minimum coverage requirements to subsidizing insurance and imposing fines on those who fail to comply.”

Romney has been trying to position himself as the “conservative” alternative to Rudy Giuliani and John McCain. But being a conservative Republican should be about more than abortion policy and the War on Terror. At the very least, supporting a government take over of one-seventh of the U.S. economy should disqualify one from being anything but the biggest of big-government conservatives.

Just when you thought partisan idiocy in Washington couldn’t get any worse, the House voted last night to cut off the salary of Andrew Biggs, the new Deputy Commissioner of Social Security. No one doubts Biggs’ qualifications for this position. But his sin is having supported proposals to allow younger workers to privately invest a portion of their Social Security taxes through individual accounts. Apparently holding a position that Democrats disagree with is now so abhorrent that it disqualifies you from public office.

I have written before about how the U.S. surgeon general has become the national nanny, nagging us to stop smoking, lose weight, exercise more and never leave home without a condom. James W. Holsinger, a surgeon and cardiologist from Kentucky, is President Bush’s latest nominee for the post. His nomination has been in trouble because of some retrograde comments and writings on homosexuality. But it is also worth noting that Dr. Holsinger testified yesterday he also supports:

1. Universal health insurance;
2. Banning pharmaceutical advertising;
3. Banning the advertising of sugary cereals and other “junk food” on television;
4. Federal regulation of vending machines in schools; and
5. Increasing tobacco taxes as part of a campaign to “make America a tobacco-free nation.”

All in all, a perfect national nanny, and another example of President Bush’s big-government conservatism at work.

The Washington Post has a story today gushing over how “pragmatic” and “moderate” Democratic presidential candidates are being in pursuit of universal health care. Moderate in comparison to Michael Moore maybe, but let’s look at what those candidates are actually proposing:

1) An individual mandate requiring every American to purchase a specific government-designed insurance plan or face financial penalties. (Edwards and Clinton). Such a mandate, however unenforceable in practice, is an unprecedented (except for Massachusetts) infringement on individual liberty and sets the stage for further regulation of the insurance industry.

2) A “play or pay” mandate on businesses, requiring them to provide employees with health insurance or pay additional taxes (Obama, Edwards, Clinton). Such a mandate would raise the cost of employment resulting in a loss of jobs and lower employee compensation.

3) A government-mandated minimum benefits package for insurance (Obama, Edwards, Clinton). Rather than true insurance—spreading catastrophic risk—the government would require a “Cadillac” policy, leading to a feeding frenzy for special interests representing providers and disease constituencies.

4) Community rating and guaranteed issue, raising the cost of insurance for young and healthy individuals. (Obama, Edwards, Clinton).

5) Price controls on insurance premiums (Obama) and prescription drugs under Medicare (Obama, Edwards, Clinton).

6) Huge tax increases, ranging from $65 billion per year (Obama) to more than $120 billion per year (Edwards).

7) Massive expansion of government health care programs like Medicaid (Obama, Edwards, Clinton). Edwards would also create a new government-run health care program like Medicare to compete with private insurance.

8) Managed-competition-style regional insurance pools or “connectors.” (Obama and Clinton).

The fact that Massachusetts governor Mitt Romney and the Heritage Foundation also support many of these proposals doesn’t make them any more moderate. These proposals would radically increase government control over one seventh of the US economy, would increase taxes, destroy jobs, and slow economic growth, and most importantly would lead to worse health care for millions of Americans.

First it was Mitt Romney supporting a HillaryCare-style health care reform in Massachusetts. Now Tommy Thompson, who as secretary of health and human services was responsible for the Medicare prescription drug debacle, is attacking Missouri governor Matt Blunt for cutting Medicaid spending. Thompson told the Associated Press that states should expand access to Medicaid because the federal government pays most of the cost.

Thompson apparently has not read Michael Cannon’s terrific paper, Medicaid’s Unseen Costs, that shows how increased Medicaid spending drives out private health insurance, increases dependency on government, and drives up costs.

With Republicans like this, who needs Democrats?