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On today’s edition of Coffee and Markets, Brad Jackson and Ben Domenech talk about the latest news about Spain’s bank bailout, how it’s likely to impact the United States, and whether the European Union has a future.

We’re brought to you as always by Stephen Clouse and Associates. If you’d like to email us, you can do so at bjackson[at]coffeeandmarkets.com. We hope you enjoy the show.

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Joe Stiglitz on the Bailout
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Winston Churchill on the European Union

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On one side of this battle is a small band of dedicated activists and think tank policy wonks from conservative and libertarian organizations. On the other side is the White House, the bulk of industry, most insurers, and former Bush HHS Secretary Michael Leavitt – the man who, according to Politico, is likely to become Mitt Romney’s chief of staff. He’s lobbied across the country for states to implement Obamacare exchanges, while his consultancy, Leavitt Partners, has reaped the financial benefits:

Leavitt has said some relatively positive things about certain elements of Obama’s health reform law, suggesting earlier this year that “Obamacare” empowers the HHS secretary “to do certain things that are clearly aimed at trying to move us in the right direction.”

McKeown, who still works with Leavitt at his Utah-based health care consultancy, acknowledged that the former governor does not want to undo one key part of the controversial legislation.

“We believe that the exchanges are the solution to small business insurance market and that’s gotten us sideways with some conservatives,” he said.

The exchanges are not only a matter of principle for Leavitt — they’re also a cash cow. The size of his firm, Leavitt Partners, doubled in the year after the bill was signed as they won contracts to help states set up the exchanges funded by the legislation.

Leavitt’s status as one of the few Republicans supporting Obamacare implementation has been a matter of significant concern for those on the right, as he and his consultancy represent the most prominent figures in the party urging states to bow to Washington’s wishes in this regard. I wrote about his work here, but here are a few examples:

• Last year he spoke to the National Governors Association, urging “the governors not defend their ‘partisan flags’ over the interests of their states.”
• A month later, Leavitt wrote: “I’m surprised that many states are waiting for the political stars to align and produce repeal or a major revision. Some are doing little of substance, hoping that the federal government will relax the calendar. Both approaches are a mistake. Smart states will proceed to develop exchanges based on a strategy of self-determination and the benefits that come from enhancing insurance offerings within their states.”
• It’s little surprise Leavitt and his staff decried the conservatives arguing against implementation. “In recent weeks health insurance exchanges have become the target of those who oppose Obamacare. This is very unfortunate as exchanges make sense for a number of reasons and exchanges should not be used as a scapegoat to defeat Obamacare… Regardless of your opinion of Obamacare, exchanges just make sense.”
• They suggested that “Resistance to exchange establishment also seems to come from a general aversion to change.” They scoffed at the policy wonks: “When you work at a think-tank, it’s really easy to come up with these really high-risk plans.”

On the day Obamacare was passed, Leavitt Partners weighed in: “There are tremendous opportunities for innovators in the market to shape how the massive legislation is implemented.” And they set about doing so, building a team to profit from the hundreds of millions of taxpayer dollars in grants sent to states to set up these exchanges. It’s a living – but the fact that Leavitt and his allies failed to note their financial stake in implementation in any of the aforementioned speeches or columns was a tendency which attracted the criticism of many in the health policy space.

Thankfully, most Republican legislatures and governors have rejected Leavitt’s approach outright. Today, there is little question that opponents of Obamacare exchange implementation have won the battle. But it is concerning that this was a battle won over the heavy opposition of someone who may end up determining Obamacare’s replacement.

For Mitt Romney’s part, his campaign reiterated his commitment to repealing the health care law when reached for comment. But this isn’t about repeal. It’s about what comes next.

You can ask them tomorrow at an event moderated by Rob Bluey, Director of the Center for Media and Public Policy at the Heritage Foundation, focusing on tax reform, the Buffett Rule, and other news of the day. I’ve embedded the livestream here:

Live stream by Ustream

Here’s the details:

Date: Tuesday, April 17, 2012
Time: 1:30 PM EDT
Location: U.S. House of Representatives Visitors Center, Room 201
Who: National and District Media, Bloggers

Refreshments will be served, and wireless Internet will be provided. Questions may be submitted via Twitter using the hashtag #CWC. You can also watch a livestream of the event here.

For more information, contact:

Ellen Carmichael (Labrador): (202) 225-6611 or ellen.carmichael@mail.house.gov
Millard Mulé (Landry): (202) 225-4031 or millard.mule@mail.house.gov
Karen Steward (Huelskamp): (202) 225-2715 or karen.steward@mail.house.gov

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On today’s edition of Coffee and Markets, Benjamin Domenech moderates a super-sized panel with Guy Benson, Matt Lewis, and Pejman Yousefzadeh on their reactions to last night’s debate.

We’re brought to you as always by Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

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Let’s back up a moment to explain why. There’s one line that Romney used in Florida during the most recent debate which is still sticking in my craw today, and I’m having a hard time shaking it. Excerpt – in response to a question from Chris Wallace about Perry referring to Romney’s Massachusetts’ reforms as “socialized medicine”:

“I don’t think [Perry] knows what he was talking about in that — in that regard. Let me tell you this about our system in Massachusetts: 92 percent of our people were insured before we put our plan in place. Nothing’s changed for them. The system is the same. They have private market-based insurance. We had 8 percent of our people that weren’t insured. And so what we did is we said let’s find a way to get them insurance, again, market-based private insurance. We didn’t come up with some new government insurance plan.”

Now, there’s a factual criticism here regarding the latter part of his comments, and the way people get that insurance under Romney’s plan – namely, the overwhelming number of those newly covered are subsidized by other taxpayers, and are on Medicaid, not private market-based insurance. This is directly the opposite of Romney’s case for his plan in 2007 and 2008, where he explicitly framed the matter not as a Massachusetts-specific solution, but as he said on the day he signed the bill into law, the “Republican way of solving a problem which we face as a nation.” He’s continued to maintain his approach is a “Republican way to reform the marketplace” which ensured personal responsibility, as opposed to “expecting someone else to pay” for your own care.

This is ironic, given that the effect of his plan has been to shift health care costs for the newly covered (reducing the number of uninsured from a little over 9% to 4.4%) to the taxpayers. Of the 412,000 people added to the insurance rolls in Massachusetts since 2006, 47% are on Medicaid, and only 7,000 of them have coverage not subsidized by other taxpayers.

The same subsidy-driven flaw is at the heart of Obama’s federal law and Romney’s Massachusetts law – a profound disincentive to increase your self-sufficiency, to work more and to earn more, given that you stand to lose out on significant taxpayer funded subsidies:

“For example, a family earning $33,000 pays no premium at all under Commonwealth Care. But if their pay goes to $46,000, they’re obligated to contribute about $2,400. That’s an effective tax rate of 18.5% on that $13,000 raise.”

As you can tell, Romney’s policy is inherently redistributive, disincentivizing success and placing the overwhelming burden for the newly insured onto other taxpayers while doing little or nothing to leverage market forces to drive competitive costs. As Cato’s Michael Tanner pointed out in that piece: “It’s a situation where the entire escalation in costs is paid by the government, not the people receiving the care.”

But let’s put all that aside, because that’s not really the line that irks me from Romney’s statement. It’s the “nothing’s changed for them” line, which evokes so much of the misplaced optimism on Obama’s part that his national reform wouldn’t change things for the majority of Americans who like their insurance plans. Because things have changed for the 92% of insured people in Massachusetts in the five years since Romney’s reform passed. Namely: everything costs more.

Since Romney’s law went into effect, the cost of Massachusetts premiums have increased dramatically, at a much faster rate than the rest of the country. Today, the health insurance premium cost for the average family in Massachusetts is the highest in the nation. It is double the national average. And yes, that counts as a change.

This gets us back to SCOTUS and the individual mandate. When Romney originally passed his reform, he maintained that it – and the individual mandate within it – would become in time a model for the country. His first line in the 2010 edition of his book on this point was thus consistent with his past remarks of his solutions in Massachusetts becoming the basis for a nationwide approach.

But before I looked into this, I had assumed that – given Romney’s expressed opposition to the federal individual mandate – he would logically support its repeal. This is, surprisingly, not the case. When Romney was asked on his book tour in 2010 about whether he’d repeal the individual mandate, he apparently said “No.” Has he shifted away from this? Has anyone followed up on this point since he officially began his 2012 campaign? It seems like a rather relevant question.

Here’s an interview he gave while on that book tour:

NEWSWEEK: Back in February 2007, you said you hoped the Massachusetts plan would “become a model for the nation.” Would you agree that it has?

ROMNEY: I don’t … You’re going to have to get that quote. That’s not exactly accurate, I don’t believe.

NEWSWEEK: I can tell you exactly what it says: “I’m proud of what we’ve done. If Massachusetts succeeds in implementing it, then that will be a model for the nation.”

ROMNEY: It is a model for the states to be able to learn from. During the campaign, I was asked if I was proposing that what I did in Massachusetts I would do for the nation. And the answer was absolutely not. Our plan is a state plan. It is a model for other states—if you will, the nation—it is a model for them to look at what we’ve accomplished and to better it or to create their own plans.

One wonders what elements of this “model for other states – if you will, the nation” Romney is referring to. Is it the redistribution of costs? Is it the costly subsidies? Is it the skyrocketing premiums? Is it the price controls? Is it the individual mandate?

If the activity of Romney’s campaign is any indication, it seems unlikely that Romney’s view has shifted on any of these points. Just last week, they took time to bash yet another health care study illustrating how his reforms in Massachusetts raised premium costs and cost the state jobs, the second negative study in as many weeks. Rather than laying out Romney’s plan for health reform as president, they give all the indications of still fighting the last war.

In debates, Romney always cites his intention to grant waivers to all the states from Obamacare. That’s fine. But waivers are temporary, and do nothing to solve the long term problems of health care. Romney is essentially using the waivers as a substitute for proposing an actual reform, and should SCOTUS rule against the individual mandate, his utility in namechecking waivers will likely dissipate.

What really matters – and this is true of all the Republican candidates – is what he’d do next to fix the system. This issue is currently clouded, but will enter the forefront if Obamacare is gutted or if the individual mandate is maintained. Whether Romney’s plan in Massachusetts is a model for the nation or not, it is all we have to go on when it comes to evaluating his model for reform as president. And his continued defense of his Massachusetts’ law, including the individual mandate, long past the point where more honest supporters have backed away slowly from its well-evident mistakes, indicates that as much as Romney has shifted over the years across the gamut of policy positions, there is one area where he will not budge: wherever he is on health policy at the moment you ask him a question, he is never wrong.

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On today’s edition of Coffee and Markets, Bruce Walker talks about the government’s attempt to stop the AT&T/T-Mobile merger, and Elizabeth Blackney and Benjamin Domenech walk through the HPV vaccine issue in response to Rick Perry and Michele Bachmann.

We’re brought to you as always by BigGovernment and Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

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Bachmann on Today Show: mental retardation “very real concern” for HPV vaccine
Bachmann: Crying mother shared HPV story
Heartlander: Vaccine Fearmongers Exposed
Heartlander: Customers, Not Government, Determine Competitiveness
AT&T: T-Mobile is Awful, Please Let Us Buy Them

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On today’s edition of Coffee and Markets, Elizabeth Blackney and Benjamin Domenech walk through the latest poll numbers for Barack Obama. Hint: They’re really, really bad.

We’re brought to you as always by BigGovernment and Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

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NBC/WSJ Poll (PDF)
WaPo/ABC News Poll
The Atlantic: The Freelance Revolution
Hoffa: “Let’s take the sons of bitches out.”

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On today’s edition of Coffee and Markets, Francis Cianfrocca and Ben Domenech talk about the Eurozone in crisis and why computer makers want to get out of the computer making business and into the software/services business.

We’re brought to you as always by BigGovernment and Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

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HP Plans to Spin Off PC Business
The European Crisis Deepens
France Eases Short Selling Ban

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On today’s edition of Coffee and Markets, Francis Cianfrocca and Ben Domenech talk about Rick Perry’s comments on the Fed, and Florida’s Adam Hasner talks about his run for the Senate.

We’re brought to you as always by BigGovernment and Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

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Perry Doubles Down on Fed: Open Up and Be Transparent
GOP Field Launches Sharp Attacks on the Fed
Florida Senate Race Heats Up Early
Adam Hasner Speaks at Redstate

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On today’s edition of Coffee and Markets, Hillsdale professor and author Burt Folsom joins Pejman Yousefzadeh and Kevin Holtsberry to discuss his book, New Deal or Raw Deal? How FDR’s Economic Legacy Has Damaged America

We’re brought to you as always by BigGovernment and Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

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Professor Burt Folsom
Buy the Book: New Deal or Raw Deal? How FDR’s Economic Legacy Has Damaged America
Mackinac Institute
Hillsdale College

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I was rather amused last night when I read one of his posts, in which he was discussing whether government spending helps or hurts economic performance. He took the view that a bigger public sector stimulated growth, and criticized those who wanted to reduce the burden of government spending, snarkily observing that, “The notion that Herbert Hoover was right has become quite a dogged meme on the reality-challenged right.”

Since I’m one of those “reality-challenged” people who prefer smaller government, I obviously disagreed with his analysis. But his reference to Hoover set off alarm bells. As I have noted before, Hoover increased the burden of government during his time in office.

It turns out that Hoover actually increased government spending by 47 percent (50 if you adjust for falling prices). Mitchell has the audacity to back this claim up with numbers and everything. There’s even a convenient chart!

It’s so hard to be reality based when the facts get in the way.

Ryan makes the case for empowering consumers and Medicare patients versus Obama’s bureaucracy and rationing based solution. It’s one we’ve heard before, but we’ve never seen it encapsulated in such an easily shareable form.

Side note: For more than three years, I’ve been arguing that conservative groups needed to take this video approach in creating graphically appealing walkthroughs which explain complex problems in straightforward ways. Groups haven’t responded to the need to do this, for the most part. It’s great to see Ryan pushing forward along these lines.

Read more about the facts on Medicare at the House Budget website: “The Facts on Medicare and How to Save It”.

When George W. Bush declined President Barack Obama’s invitation to a ceremony at New York City’s Ground Zero after Osama bin Laden was killed, the former president cited his desire to keep a low public profile.

But Bush has been high profile on the private, paid speaking circuit: he has raked in millions of dollars since he left office by making scores of speeches that typically earn him six figures a pop.

Are the folks at CPI really suggesting that Bush not wanting to give a prominent public appearance in the wake of the killing of Osama bin Laden – a choice that has been roundly applauded in the national media as a classy move – is a hypocritical act? They really can’t make the distinction to saying no to this appearance because of the politics of the moment, while giving speaking tours like all former presidents (who we all know give speeches for flowers and fruit baskets, not dirty dirty money)?

This is just the latest ridiculous attack from CPI’s new poorly-named “iWatchNews” portal, which recently launched a vile slander of Gov. Mitch Daniels’ time at Eli Lilly – which established no connection between Daniels and the marketing-focused lawsuits against Lilly during the 1990s, falsely depicted Daniels’ role within the company as having any responsibility for the matters they were sued over (Daniels was in charge of Lilly’s number crunching, not their ad campaigns), and prominently quoted employees of Ralph Nader without sharing that fact.

In reaction to my piece detailing CPI’s failure to build a rational or balanced case on their Daniels assault, their communications director commented – calling the Nader employee an “industry analyst” – that the piece had merit because:

“Daniels is running for president.”

While this is certainly possible, one Indiana emailer responded: “Really? Wow, they’re all about breaking news at the Center for Public Integrity!”

At least they’re consistent in their ridiculousness.

This is a timely and well-done walk-through on the real choices we face for this system. “Would you be a cost-effective shopper if you were told I’d pay 80% of the cost the next time you buy a new car?” Watch and learn!

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On today’s edition of Coffee and Markets, we’ll discuss what’s driving gas prices and other environmental issues with James Taylor of the Heartland Institute.

We’re brought to you as always by BigGovernment and Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

Related Links:

James Taylor at Forbes
Bloomberg: Consumer Comfort Declines as Gas Prices Rise
WSJ: In Washington, Oil CEOs on the Hot Seat
Environment and Climate News

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On today’s edition of Coffee and Markets, we’re talking commodities, the debt ceiling, and the unemployment rate with Francis Cianfrocca.

We’re brought to you as always by BigGovernment and Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

Related Links:

WSJ: Unemployment Rate Rises
Bloomberg: Trichet on ECB and Inflation
Gokhale: Why We Must Freeze the Debt Limit
Harsanyi: What Debt Ceiling?

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On today’s edition of Coffee and Markets, we’re joined by D.B. Grady, a correspondent for The Atlantic, author, paratrooper, and veteran of Afghanistan, to discuss the regional fallout from the death of Osama bin Laden in Pakistan.

We’re brought to you as always by BigGovernment and Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

Related Links:

D.B. Grady’s Website
The Atlantic: Veteran’s Day
DC Examiner: Pakistan’s Role as Bin Laden’s Protector
RCW: Pakistan’s Osama Problem
RCW: In Osama’s Death, a Vindication of Obama’s Choices
RCW: Should Obama Have Captured Bin Laden?

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In regards to your recent blog post maintaining that “patients are not consumers,” and what’s more that such a depiction of a relationship is “sickening” — your romantic image of health care, apparently garnered from too many viewings of ER, House M.D., or perhaps General Hospital, apparently consists of handsome wisecracking surgeons facing a barrage of patients bleeding out or dealing with obscure, life-threatening conditions.

Medical care is an area in which crucial decisions — life and death decisions — must be made; yet making those decisions intelligently requires a vast amount of specialized knowledge; and often those decisions must also be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping… There’s a reason we have TV series about heroic doctors, while we don’t have TV series about heroic middle managers or heroic economists.

This is both ludicrous and incorrect, painting a picture where visits with a medical professional are always preceded by a call to 911 and a trip on a blaring ambulance — which is the experience for approximately zero Americans, anywhere. I would be eager to learn of any of your research showing otherwise.

A simple glance at a cost breakdown of the American health care system eradicates your fanciful depiction. According to the U.S. Department of Health and Human Services and the Agency for Healthcare Research and Quality, as much as 75% of health care costs in the United States are due to chronic conditions. Administrative costs alone take up nearly 10% of the national pie chart. As the U.S. population ages, the management of these long-term conditions takes up the overwhelming portion of responsibility for the rising costs of care — according to the Kaiser Family Foundation’s research, the average American over the age of 64 spends vastly more on health care services than any other age group, roughly $9,000 per year — and despite the massive increase in taxpayer subsidies, private health insurance remains the largest source of health spending.

Your incorrect view of the nation’s health care reality is, in fact, one of the chief reasons for problems with the current system, which was originally designed in the 1930s to cover catastrophic events, not chronic conditions, predictable treatments, and long-term care. As a 2009 report in McKinsey Quarterly notes, “The fundamental nature of medical risk in the United States has changed over the past 20 to 30 years — shifting away from random, infrequent, and catastrophic events driven by accidents, genetic predisposition, or contagious disease, and toward behavior- and lifestyle-induced chronic conditions. Treating them, and the serious medical events they commonly induce, now costs more than treating the more random, catastrophic events that health insurance was originally designed to cover.”

Employer-based insurance, which made sense when people had one or two employers in a lifetime, now separates consumers from price signals and eliminates transparency in the marketplace, and results in a situation where people are overinsured for some risks and underinsured for others. America today is burdened with a nonsensical health care system where government-driven incentives warp the decision-making process of individuals, and doctors are expected to work essentially for free.

The small steps taken toward market approaches which allow for expanded individual choices have shown positive results, and progress toward cost-reduction without sacrificing coverage, as individuals make decisions based not on artificial systems constructed by agencies, but on their own priorities and needs. Yet these positive examples were completely ignored under President Obama’s new nationalized health care regime.

There is some irony in your mistake and in his, in that the government-managed coverage systems you favor are perhaps at their worst in providing responses to the life-threatening illnesses you apparently think all of us are faced with on a daily basis. In fact, in the absence of on-demand treatment of consumers, they turn serious yet treatable illnesses into death sentences. The United Kingdom, under CMS director Donald Berwick’s beloved National Health Service (he openly confesses “I am a romantic about the NHS”) in which consumer power is extremely limited by law, has created a cancer mortality rate more than 38 percent higher than America’s. For example, in the UK, women with breast cancer have a 46 percent mortality rate, compared with only 25 percent in the U.S., and while only 19 percent of men in the U.S. who get prostate cancer die of it, in the U.K. it kills 57 percent.

Of course, the U.K. was recently touted by the Economist Intelligence Unit for ranking at the top in one category, thanks in large part to the abundant provision of painkillers as opposed to extended treatment: quality of death. That’s what the beau ideal of government-run health care gets you, Mr. Krugman — a system in which patients have no ability to act as consumers, where providers do not have to compete for their business, where individuals are treated too late and all that the system will allow is to give them some painkillers to make them comfortable before they die.

Such approaches might make for good television scenes, but they make for terrible policy.

Best Regards,

Benjamin Domenech
Research Fellow, The Heartland Institute

P.S. A colleague suggests that you ought to try re-reading what you have written, replacing medical care with, say, aviation, and then repeat your conjecture.

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On today’s edition of Coffee and Markets, Brad Jackson and Ben Domenech are joined by John J. Miller to discuss his new book, The Big Scrum: How Teddy Roosevelt Saved Football. Then Nick Ayers stops by to discuss Tim Pawlenty’s 2012 presidential campaign.

We’re brought to you as always by BigGovernment and Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

Related Links:

The Big Scrum: How Teddy Roosevelt Saved Football
John Miller’s Website: Hey Miller
TR’s Goal-Line Stand
Tim Pawlenty lands a presidential campaign manager

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On today’s edition of Coffee and Markets, Brad Jackson and Ben Domenech are joined by Francis Cianfrocca to discuss the Tim Pawlenty’s hiring of Nick Ayers and the budget compromise that was reached on Friday night.

We’re brought to you as always by BigGovernment and Stephen Clouse and Associates. If you’d like to email us, you can do so at coffee[at]newledger.com. We hope you enjoy the show.

Related Links:

Tim Pawlenty lands a presidential campaign manager
Erick Erickson: The Compromise
It’s as if millions of voices suddenly cried out in terror, and were suddenly silenced.”
Democrats will yield on everything but abortion
Obama Puts Taxes on Table

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