"[O]ne of the fundamental flaws in the pricing of U.S. health care"

The Washington Post ran a story Saturday about how the American Medical Association's "assumptions about procedure times" distorts how much doctors are paid. A key excerpt:

Take, for example, those colonoscopies. In justifying the value it assigns to a colonoscopy, the AMA estimates that the basic procedure takes 75 minutes of a physician’s time, including work performed before, during and after the scoping. But in reality, the total time the physician spends with each patient is about half the AMA’s estimate — roughly 30 minutes, according to medical journals, interviews and doctors’ records. Indeed, the standard appointment slot is half an hour. To more broadly examine the validity of the AMA valuations, The Post conducted interviews, reviewed academic research and conducted two numerical analyses: one that tracked how the AMA valuations changed over 10 years and another that counted how many procedures physicians were conducting on a typical day. It turns out that the nation’s system for estimating the value of a doctor’s services, a critical piece of U.S. health-care economics, is fraught with inaccuracies that appear to be inflating the value of many procedures.

A giveaway for readers of this blog

I have made a few plugs for Ben Domenech's The Transom on this blog before. So I figured I might give away a few trial subscriptions to it. So the first ten to e-mail me at joshgosser @ gmail.com will be given a month's subscription free. My way to try to thank everyone for supporting this blog over the last couple of years.

Win for Hobby Lobby (and religious freedom)

"Hobby Lobby Stores Inc. won a temporary reprieve on Friday from federal penalties as much as $1.3 million a day for failing to offer insurance coverage for emergency contraceptives to its more than 13,000 employees."

A little background:

Heaton earlier this year denied the company's motion for an injunction against potential penalties, but that ruling was overturned last month by a federal appeals court....The panel of eight appellate court judges who heard arguments in May ruled unanimously that Hobby Lobby and its affiliated Christian bookstore chain Mardel have the right to sue over the Affordable Care Act. “A religious individual may enter the for-profit realm intending to demonstrate to the marketplace that a corporation can succeed financially while adhering to religious values,” the judges said in the ruling.

Also, another terrific piece by Michael Cannon laying out the problems Obamacare has ran into. He concludes: "So the question this supposed exposé really answers is: aside from that, Mrs. Lincoln, how’s ObamaCare implementation going?"

I attended a presentation Friday by Beverly Gossage, who is running for Kansas Insurance Commissioner. It was very in-depth and showed her expertise. A true proponent of free-market reforms. She did a podcast with Ben Domenech last year that can be heard here. She's been endorsed by Newt.

The true story of New York's health insurance premiums

The New York Times ran a story on Wednesday highlighting how Obamacare would cut premiums in half for the Empire State.

Avik Roy took a sledgehammer to it, explaining why New York premiums are already so high (hint: not because it's too much of a free market) and how Obamacare will actually affect price.

From that piece:

People who aren’t familiar with Empire State’s unique circumstances have been quick to presume that rate reductions in New York under Obamacare mean that the law will bring down rates nationwide. The Times was content to leave its readers with this misunderstanding. 

I’m told that President Obama will even give a speech today at 11:30 a.m. ET to tout the New York results. But lower rates in New York is hardly a surprise; as Obamacare advocate Timothy Jost put it, “If there was any state that the ACA could bring rates down, it was New York.”

Elsewhere, Michael Cannon shows how President Obama is effectively saying that only he -- not Congress -- can amend his health care overhaul.

Liz Cheney vs. Mike Enzi

The big news today was that Dick Cheney's daughter is, after weeks of speculation, going to challenge incumbent Senator Mike Enzi in the Wyoming Republican Primary.

My view is that Enzi is a basically an average Republican. The biggest priority of the 2014 elections he isn't. But because he's from a very Republican state, I can understand the urge to upgrade from him.

What drives me crazy is the type of thinking exemplified by Chris Cillizza of the Washington Post here.

The National Journal can say he's the eight-most conservative senator if they want, but Heritage Action and the Club for Growth -- who are both more influential among conservatives and, you know, knowledgable of what makes someone conservative -- beg to differ. Heritage Action says he's the 23rd most conservative, while CFG says 26th.

His main offense was being a main sponsor of the Internet Sales Tax that passed the Senate earlier this year.

Again, there are bigger priorities than unseating him -- and I'm not entirely sold on Liz Cheney -- but the idea that Enzi has unchallenged conservative credentials needs to be done away with.

(Completely unrelated, but what Paul Pierce did on Tuesday is exactly why Instagram was created.

I don't post many pictures, but I'm on Instagram if you want to follow me there.)

Tom Cotton needs to be in the Senate

I first heard of Cotton, as I'm guessing most did, when the Club for Growth endorsed him last year. He hasn't wasted anytime in showing why the group was so enthusiastic about him.

Robert Costa of National Review -- who is a great reporter and a must-follow on Twitter -- wrote a terrific article about the Arkansas freshman and Iraq War veteran the other day.

Cotton’s rapid ascent as a charismatic, brainy voice for Steve King’s coalition has surprised several leadership staffers, who had planned for months to use Ryan, one of the chamber’s more popular conservatives, as a means of wooing the right flank toward a modified path to legalization. They didn’t think a mostly unknown freshman would be competing with Ryan for the spotlight, both inside and outside the Capitol. Now, with Cotton regularly slamming immigration reform with the poise of Bill Clinton but the politics of Rush Limbaugh, their calculus has changed.

RealClearPolitics.com also ran a recent profile on Cotton, calling him a "key House voice on immigration reform."

The question is whether Cotton will enter the 2014 Senate race, in which incumbent Mark Pryor is seen as vulnerable. Cotton would fit in very well with Ted Cruz, Mike Lee, and Rand Paul in the Senate, and I hope he runs.

(In a related note, the Club for Growth made their first 2014 endorsement today, entering the Republican Primary in Idaho-2. I recommend reading why they are endorsing Bryan Smith in the race.)

D.C. Council flunks Econ 101

In his post about the terrible decision by the D.C. Council to pass the LRAA, Andrew DeLeon quotes from a classic economics book:

A mere recital of the economic policies of governments all over the world is calculated to cause any serious student of economics to throw up his hands in despair. What possible point can there be, he is likely to ask, in discussing refinements and advancements in economic theory, when popular thought and the actual policies of governments…have not yet caught up with Adam Smith? –- Henry Hazlitt, Economics in One Lesson.

The whole post is very good in pointing out how mis-guided (to be charitable) the decision was.

A setback for religious liberty

A federal judge has ruled that a "secular for-profit company" essentially has no religious freedom. Another example of the idea that you are free to exercise your beliefs in your chosen house of worship -- and nowhere else.

Obamacare news roundup

I really like the way Paul Ryan frames this:

“Do they really want to defend a position to let big-government contractors off the hook, but not a family of four living in Ohio?” Ryan says. ”Do they want to let big banks off the hook for Obamacare, but not the single parent trying to make ends meet? Good luck defending that position.”

How will Obamacare be promoted? For starters, at bourbon festivals and (possibly) on porta-potties. Heritage had some fun with all the different ways supporters of the act are trying to promote it, asking: "No word yet on whether Senator Max Baucus (D-MT) has suggested state exchanges partner with Amtrak, given his recent comments about the state of Obamacare implementation."

Five other odd promotions.

Another union is complaining of how Obamacare will affect its members. Frankly, if you bought the line about being able to keep your insurance and doctor if you like them -- not to mention some of candidate Obama's other promises -- it's tough to feel too sorry for you.

A British company that just received a $1.2 billion contract from the U.S. government is "under investigation by British authorities for overbilling government contracts."

How will Obamacare affect your dental coverage?

Virginia health centers will get $2.5 million in federal taxpayer money to promote the act.

Michael Cannon writes: "For once, Republicans have the advantage on health care." Oregon gets...creative to encourage people to sign up.

"By postponing the employer mandate, Obama has given millions of Americans the legal standing to sue."

The editors of National Review's take on how Republicans should proceed.
Many are worried California is "falling short in ensuring that the people hired as counselors are adequately screened and monitored." The state has hired 21,000 to work as "enrollment counselors."

Two years ago Monday

Tomorrow, or today if you are reading the morning e-mail, makes two years since I first went to Iowa. Except for my wedding (fun location!), if the Celtics 2018 championship is won on a Saturday or Sunday, and, I suppose, my kids are born on either of those days, I can't see a better weekend. (That's in jest, of course -- the Celtics obviously would outrank any of those.)

If you haven't read them before, here and here are the entries I wrote from that weekend. When I get time, I need to write another with some of the missing details. One of which was the sore ankle I had from injuring it playing basketball a week or two before the trip. It hurt like heck, but nothing would have stopped me that weekend.

What works in health care

One of the silliest talking points many on the left have is that Republicans and conservatives do not have a solution to replace Obamacare with. Ben Domenech explains why that is wrong here. 

Yesterday, Mark Perry wrote of another example of how price competition can lead to better outcomes at lower costs. Obamacare, it probably doesn't need to be said, goes in the opposite direction with its further reliance on third-party billing. Writing of a medical center in Oklahoma City, Perry explains how it works:

Unlike most other medical providers, the Surgery Center posts transparent pricing and offers deeply-discounted, payable-in-advance, cash-only medical procedures. The center does accept private insurance, but it does not accept Medicaid or Medicare — government regulations won’t allow them to post transparent prices online. If any competitor offers a lower price, the Surgery Center will match or beat it, so patients can be guaranteed of getting the lowest price possible. ... And it’s working — other hospitals, both locally and nationally, are being forced to compete with the center’s low-cost surgery fees — which are typically one-sixth to one-eighth less than what most other hospitals and clinics are charging for the same procedures. For example, the Oklahoma University Medical Center charges $23,934 for an ankle arthroscopy, while the procedure will cost only $3,740 at the Surgery Center of Oklahoma.

In other Obamacare-related news, Michael Cannon says the Fourth Circuit court dealt a "hidden blow" to the overhaul.

Are religious schools intolerant?

The Wall Street Journal opens their terrific piece:

On President Obama's recent visit to Ireland, he offered a surprising explanation of the enduring tensions there: "If towns remain divided—if Catholics have their schools and buildings, and Protestants have theirs—if we can't see ourselves in one another, if fear or resentment are allowed to harden, that encourages division. It discourages cooperation." Given his use of the word "we," it is hard to avoid the conclusion that this is also how the president views religious "schools and buildings" in the United States.

Of many Democrats' opposition to allowing parents to use school vouchers to place their kids in religious schools:

Perhaps the president and other Democrats oppose vouchers because they fear—as the president's remarks in Ireland suggest—that religious schooling undermines social cohesion. The belief that religious schools erode civic goals has a long history. In the mid-19th century, religious schools, Catholic schools in particular, were accused of reinforcing separate identities rather than shared American values. Much has changed in education since then, but a suspicion lingers in some quarters that church-operated schools breed intolerance.

The results:

I conducted two of those 21 studies, and others were produced by researchers at institutions including Harvard, Notre Dame and the University of Chicago. The studies varied in whether they looked at national or local samples of students and whether they examined secular, religious or all types of private schools. Of those studies, only one—focusing on the relatively small sector of non-Catholic religious schools—found that public-school students are more tolerant. Eleven studies, examining both secular and religious private schools, found that private-school students are significantly more likely to be tolerant, and nine found no difference.

Of course that shouldn't be a surprise. Ironically, those who think the religious are more likely to be intolerant are often themselves the actual intolerant ones.

A populist critique of Obamacare

Populism is a dirty word to many conservatives, but there is a difference between class warfare -- what many think of when they hear the word populism -- and attacking crony capitalism. The House GOP is going after Obamacare in the latter way. From National Journal:

The argument goes like this: By delaying last week a requirement that employers with a workforce of 50 or more offer their workers insurance, the White House gave a break to big business. But it isn’t granting a similar reprieve to ordinary Americans by postponing the law’s unpopular requirement that individuals obtain health insurance or face a fine. The approach, developed in the wake of the White House’s decision to delay implementing the employer mandate, is designed to force Democrats to take tough votes on the law that could be used against them in close 2014 elections. 

“The White House says it’s listening to the concerns of our nation’s businesses. But are they ignoring the voices of American families and taxpayers?” Rep. Kevin Brady, R-Texas, who chairs the House Ways and Means Health Subcommittee, asked at a Wednesday hearing. His remarks echo similar talking points from House Speaker John Boehner, R-Ohio, and House Majority Leader Eric Cantor, R-Va. 

It’s unusual rhetorical territory for Republicans, who are frequently criticized for favoring business interests over those of people, a common theme in the 2012 Obama campaign. It’s even a quick switch on health care; in the weeks leading up to the administration’s announcement about the employer mandate, congressional Republicans were attacking the provision as one that stifled business growth and hiring. 

But the fairness argument could be a winner in next year’s races, says Andrea Bozek, a spokeswoman for the National Republican Congressional Committee. “Any time a president is seen picking winners and losers is politically toxic,” she said.

(First, National Journal misses the mark on a couple of points. Most Republicans, and certaintly those elected since 2010, are not pro-business but pro-free enterprise. And the employer mandate would stifle business growth and hiring. House Republicans did not change their tune on that but rather the way the administration circumented Congress to delay it and the unfairness in granting businesses with large lobbying budgets a reprieve but not every American citizen.)

But I think this is exactly the right approach for the GOP. Acting and being seen as the party of markets and free enterprise -- ecschwing both big business and big government -- is not only the right policy but good politics as well. President Obama is no opponent of big business; he has worked with them on health care, on the auto bailouts, on financial regulation.

While I would prefer getting rid of Obamacare in one fell swoop, there is no chance of that until January 2017 at the earliest. Death by a thousand cuts -- or a few big ones -- is the way to go. And pushing the fact that this White House thinks that individual Americans should have to be forced to buy health insurance while businesses are exempt is a big cut.

And in other news, Nancy Pelosi is really, really confused.

Jail time for exercising religious freedom

Another case illustrating the need for religious liberty protections in those states that allow gay marriages or civil unions.

The owners of a Colorado bakery could face up to a year in prison for refusing to make a cake for a gay couple. Dave Mullins, 28, and Daniel Craig, 33, filed a discrimination complaint against Jack Phillips, one of the owners of Masterpiece Cakeshop, for denying them a cake for their Massachusetts wedding.

And to show the difference between the two parties:

Republican lawmakers in Colorado have pushed the addition of religious protection for businesses to the civil union law, but Democrats argue that such a provision would merely be a cover for discrimination.

"Why The White House Is Panicking About ObamaCare"

John Goodman has a great piece for Forbes.com, explaining why the administration has been searching high and low -- "Actors. Actresses. NFL football players. Baseball players. Librarians. Mayors. City councilmen. Members of AARP." -- to try to encourage people to sign up for Obamacare.

He points out that only a quarter of those currently eligible for Medicaid sign up. Goodman posits -- correctly, I think -- that the reason that is the case is the outcomes are the same for those on Medicaid and the uninsured. (A study from Oregon released in May concluded the same.)

James Capretta testified in front of the House and Ways Committee about the employer mandate delay. He concluded: "Therefore, this committee should seriously consider legislation that couples delays in the employer and individual mandates with a simultaneous delay in the entire exchange roll-out." The Weekly Standard has his full testimony here.

In other news: "Today, U.S. Senator Tom Coburn and U.S. Representative Charles Boustany -- both practicing physicians -- sent HHS Secretary Kathleen Sebelius a letter asking serious questions about 'ongoing significant weaknesses in HHS’ financial management' outlined in HHS's FY2012 financial audit."

And another article from the mainstream media pointing out the recent troubles with implementation have been predicted by those in charge for months now.

"We will root out the waste and fraud and abuse"

Michael Cannon of the Cato Institute looks at how President Obama has changed his tune on getting rid of the waste in health care.

Vehemently opposed to it in 2009 and 2010, the President often said waste and fraud could only be ended by passing Obamacare. (Of course, at the time, the question was: why not just end the fraud and abuse right now?)

Now, to help implement the overhaul, fraud and waste are not such urgent concerns, and there will not be any verification of eligibility for subsidies.

"Barack Obama used to oppose health care fraud—up until the moment that opposing fraud conflicted with his goal of preserving ObamaCare," writes Cannon. "And why not? It’s just other people’s money."

Heritage looks at other cases of the administration not following the legislation as it was written, including HHS spending $150 million on an unauthorized program.

“President Romney is openly defying the laws of the United States"

During the campaign, Mitt Romney pledged to grant each state a waiver from Obamacare on day one of his Presidency. I panned the idea, as I didn't believe he would have the authority. Liberals agreed.

But whereas I think neither Romney nor President Obama has the authority to ignore the laws passed by Congress, almost every liberal believes Obama can do what they said Romney couldn't.

Enter Phil Kerpen, who writes what a news story would have looked like had Romney been elected and went about ignoring parts of the law he didn't like. It's worth reading the entire thing, but here's an excerpt:

Under pressure from large corporations, the Treasury Department quietly announced the provisions of the law requiring employers to provide health insurance coverage will not be enforced. The law contains no language granting Treasury discretion for such a move and has a clear effective date of January 1, 2014. Nonetheless, Treasury official Mark Mazur announced in a blog post that penalties for employers who fail to meet the law’s requirements will simply not be enforced in 2014.

Guy Benson: "Surprise: White House Has Known Obamacare Implementation Would Collapse For Months."

Six Inconvenient Truths About Obamacare.

Yuval Levin wrote of how Republicans should proceed.

"Servile and Licentious Tenancy"

In a break from Obamacare, I was struck by a blog post on acton.org highlighting Alexis de Tocqueville's writing on those who waver "between servitude and license."

There are some nations in Europe whose inhabitants think of themselves in a sense as colonists, indifferent to the fate of the place they live in. The greatest changes occur in their country without their cooperation. They are not even aware of precisely what has taken place. They suspect it; they have heard of the event by chance. More than that, they are unconcerned with the fortunes of their village, the safety of their streets, the fate of their church and its vestry. They think that such things have nothing to do with them, that they belong to a powerful stranger called “the government.”

Having been around people like that, those words really struck me. Empty existences, adults happy as long as they have a place to get drunk at on Friday or Saturday (or both) and whatever they consider entertainment. (Not a slam at those who enjoy video games, silly movies or shows, or who like going out on the town, as I enjoy all those. But when that is all you have in your life, and it consumes all your time, and you like it that way...)

No sense of a greater purpose -- whether religious or simply trying to pass off a better country to your kids. A total lack of awareness of anything besides who is on Us Weekly. I'm not looking for everyone to know the ins-and-outs of NAFTA, but let's try to know a little about how we are being governed and who our representatives are.

Another quote, long a favorite of mine, comes to mind:

Contemplate the mangled bodies of your countrymen, and then say "what should be the reward of such sacrifices?" Bid us and our posterity bow the knee, supplicate the friendship and plough, and sow, and reap, to glut the avarice of the men who have let loose on us the dogs of war to riot in our blood and hunt us from the face of the earth? If ye love wealth better than liberty, the tranquility of servitude than the animated contest of freedom — go home from us in peace. We ask not your counsels or arms. Crouch down and lick the hands which feed you. May your chains sit lightly upon you, and may posterity forget that you were our countrymen!

The beer guy said that one.

Positive news for Obamacare (just joking)

Headline from WaPo: "I wish we had one more year:" States are struggling to launch Obamacare on time

From that article:

At a monthly board meeting of Connecticut’s health insurance exchange, members of the standing-room-only crowd got a reminder that they, too, were behind schedule. The insurance marketplace they were working on nights and weekends won’t be completely ready on time. “It is highly complex, it’s unprecedented and it’s not going to be smooth,” Kevin Counihan, chief executive of the state’s exchange, Access Health CT, told the group. That’s why Connecticut — like other states across the country — has lowered the bar, doing what it can in the time it has left before the health-care law’s major programs are launched Oct. 1. Although the states are promising to provide new marketplaces for individuals to compare and buy health insurance plans, the Web portals will be a bare-bones version of what was initially envisioned.

Oregon us implementing this law that is at the breaking-edge of technology and innovation the same way my grandma keeps track of tuna casserole recipes:

How will brokers keep track of potentially thousands of customers in the interim? Cover Oregon’s executive director, Rocky King, suggested that they might use “index cards.”

The Wall Street Journal: "Blows to Health-Care Law Pile Up, Cutting Its Sweep."

From that piece, referencing the latest news surrounding the implementation: "You've got three body blows toward expansion of coverage," said Paul Keckley, executive director of the Deloitte Center for Health Solutions, a research unit of Deloitte LLP. "It's three punches in a row."

A Congressman from my state: "Much like Humpty Dumpty, Obamacare had a great fall and all of King Obama's bureaucrats cannot put it back together again," said Rep. Tim Huelskamp (R., Kan.).

Elsewhere, Michael Cannon of Cato shoots down the idea that the administration can legally delay the employer mandate.

Philip Klein writes on the opening this presents the GOP.

George Will rips the "never mind Presidency" we've seen lately.

Heritage details the "Dirty Dozen Implementation Failures."

When $100 million is the same as $1 million

The New York Times breathlessly reports that a group funded in part by the dastardly Koch Brothers is spending $1 million on an anti-Obamacare ad campaign.

Meanwhile, Enroll America -- staffed with former Obama White House officials -- is trying to raise $100 million to promote the implementation of the bill. In order to do that, they are hitting up executives in the health care industry -- many of whom stand to gain from the law -- to pitch in.

The exact way HHS Secretary Kathleen Sebelius asked for donations is up for some controversy. She called up companies her and her agency have regulatory authority over in order to -- her words -- "suggest the entities look at the organization [Enroll America]."

Guy Benson: "She 'voluntarily decided not to make fundraising appeals' to companies over which she wields enormous power -- but she did, er, phone them up and 'urge' them to support the cause? How exactly does that work?"

That kind of cozying up of big business and bigger government doesn't have the Times worried, but two private citizens  -- with no stake in the health care industry that I'm aware of -- spending a tiny fraction in comparison is huge news.

At some point this becomes a parody

"Obamacare subsidies will be operating on the honor system until at least 2015."

From The Washington Post:

The Obama administration announced Friday that it would significantly scale back the health law’s requirements that new insurance marketplaces verify consumers’ income and health insurance status.

Instead, the federal government will rely more heavily on consumers’ self-reported information until 2015, when it plans to have stronger verification systems in place.

Heck of a week for Obamacare. And for rule-by-regulators, who are becoming more important than Congress every day.

Look what these crazy pro-lifers are doing

Wisconsin Governor Scott Walker signed an abortion bill today that requires an ultrasound before the procedure. "That’s just the medical standard. To confirm the gestational age of the pregnancy, before any procedure is done, you do an ultrasound."

Unbelievable, right? Only a crazy, right-wing troglodyte would require an ultrasound be done. Oh, that's actually a quote from a Planned Parenthood official, confirming to Commentary the abortion provider's policy.

Not surprising, of course, but the media's stories today say nothing about that, making it seem like Walker and the Republican legislators are somehow inventing a need for an ultrasound. The articles do, however, talk up the lawsuit Planned Parenthood and other pro-abortion groups are planning.

"The coming of a new life always excites our interest."

I recommend reading the entire speech Calvin Coolidge gave on the 150th anniversary of the Declaration of Independence, but here is my favorite paragraph:

We are obliged to conclude that the Declaration of Independence represented the movement of a people. It was not, of course, a movement from the top. Revolutions do not come from that direction. It was not without the support of many of the most respectable people in the Colonies, who were entitled to all the consideration that is given to breeding, education, and possessions. It had the support of another element of great significance and importance to which I shall later refer. But the preponderance of all those who occupied a position which took on the aspect of aristocracy did not approve of the Revolution and held toward it an attitude either of neutrality or open hostility. It was in no sense a rising of the oppressed and downtrodden. It brought no scum to the surface, for the reason that colonial society had developed no scum. The great body of the people were accustomed to privations, but they were free from depravity. If they had poverty, it was not of the hopeless kind that afflicts great cities, but the inspiring kind that marks the spirit of the pioneer. The American Revolution represented the informed and mature convictions of a great mass of independent, liberty-loving, God-fearing people who knew their rights, and possessed the courage to dare to maintain them.

I hope everyone had a great Fourth of July.

The Obama Administration says President Jindal or Walker can ignore Obamacare

Not exactly, of course, but if the employer mandate can be delayed by executive fiat, why not the entire bill in January 2017?

Aside from being another sign of how ham-handed the writing of Obamacare was, getting more people to buy their own insurance -- and not getting it through their employers -- is a good thing. Conservatives have long argued for that.

"If the employer mandate were to ultimately be repealed, or never implemented, today’s news may turn out to be one of the most significant developments in health care policy in recent memory," Avik Roy writes.

This also has implications for the immigration bill. Why should any House Republican believe President Obama will enforce a bill as it is written? He could -- and would -- just ignore the part(s) he doesn't like.

(Update: A theory from Scott Gottlieb on why the delay was announced:

The Obama team’s stated purpose seems superficial. It’s doubtful that reporting requirements alone drove this decision. If it was just a problem with reporting requirements, some of those provisions could have been delayed without nixing the entire provision. Perhaps the administration was seeing the effects of the insurance requirement on new hiring. Perhaps they’re staring at a bad jobs report later this week.

Hospitals ditching Obamacare program

"Over the weekend, Bloomberg reported on the latest challenge to Obamacare: hospitals leaving one of the law’s signature attempts to contain health costs," writes James Kidd on Heritage.org. He quotes from a piece on Bloomberg.com:

Almost a third of 32 hospitals and health systems involved in an experiment aimed at changing the way medical providers are paid may exit the program, a potential threat to [Obamacare’s] ambitious cost-saving goals.

While reminding readers of then-candidate Obama's promise that if you like your health care, nothing will change (except it becoming less expensive), Kidd adds

One of the reasons hospitals are leaving the ACO program involves government red tape. In order to manage their patients most effectively, hospital systems want access to real-time medical claims data—but Medicare’s lumbering bureaucracy can provide information on health claims six months after the fact. As the CEO of one hospital organization told Bloomberg, “We’re asking for more agility than the system is really set up to produce.” The other reason for the ongoing ACO struggles centers around the euphemistically termed “clinical control”—in other words, patients’ ability to see the doctor they want. The Bloomberg article notes that right now, hospitals in the ACO program “can’t forbid the patients from seeing doctors or other health providers who aren’t part of the Pioneer system.” Hospitals believe this restriction on their ability to manage patients has prevented them from containing costs as much as originally hoped.

WSJ looks at Obamacare premiums

Another day, another article about how much higher insurance premiums will be under Obamacare:

In Richmond, a 40-year-old male nonsmoker logging on to the eHealthInsurance comparison-shopping website today would see a plan that costs $63 a month from Anthem, a unit of WellPoint Inc. That plan has a $5,000 deductible and covers half of medical costs. By comparison, the least-expensive plan on the exchange for a 40-year-old nonsmoker in Richmond, also from Anthem, will likely cost $193 a month, according to filings submitted by carriers.

Ben Domenech responds in an e-mail sent out by the Heartland Institute (sign up for free here):

As much as the left is prepared to move the goalposts on this issue, the American people remain most concerned about the costs of premiums. Failure to address this problem is Obamacare’s Achilles heel, and it represents the primary reason that those who have discussed repealing the law continue to do so. Will Americans react vociferously to these rate increases? That depends on how much they connect it to the president’s law – and if opponents have any say in it, they will.

Going by my posts the last week, I should probably rename this blog "Obamacare and thoughts on Religious Liberty," but there hasn't been much campaign news. And those are two of the biggest challenges facing this country right now. I hope to keep updating after my semi-vacation ends, and as always you can follow me on Twitter @joshgosser.

Tim Carney on the threat to religious liberty

"Try to live your own life according to traditional values, and the state will come after you, and compel you live according to its values." He details how wedding photographers and florists are being attacked for their worldview, with the key part being:

How does Ferguson justify using the power of the state to impose his morality? "If Ms. Stutzman sells flowers to heterosexual couples," the Seattle Post-Intelligencer quotes Ferguson saying, "she must sell them to same-sex couples."  But obviously Stutzman did sell flowers to same-sex couples, happily - that's why this particular client was a long-time customer. What she refuses to do is participate in a ceremony that the state calls marriage, but which she doesn't consider to be marriage.

That's just the tip of the iceberg. As Ben Domenech notes, churches will essentially be roped off from doing anything but services in some states that do not pass strong religious liberty protections. Even in Illinois, a gay marriage bill was opposed in the legislature precisely because of how restrictive it was of those rights. Europe has largely eschewed any protections:

In contradiction of this view, the Council of Europe affirmed in 2007 that “states must require religious leaders to take an unambiguous stand in favour of the precedence of human rights, as set forth in the European Convention of Human Rights, over any religious principle.”

$600 MRI

Mark Perry has a very interesting story about a Milwaukee center that has the low-cost scan. Amazingly, the price has not changed in six years. "Over that period, writes Perry, "overall consumer prices increased by about 12% and the CPI for medical services increased by 22.65%."

How are they able to keep costs down? "With an increasing population of patients with high-deductible insurance plans or Health Savings Accounts (HSA), it was clear that the world of medicine was changing."

Obamacare, of course, took a wrecking balls to HSAs and its proponents don't like high-deductible plans that resemble, you know, insurance plans.

Yesterday, Gallup found 47% of the people believe Obamacare will make worse "the healthcare situation in the U.S," while 34% believe it will make it better.

Acton: Can America Remain the Land of Religious Liberty?

"A few examples of current threats to religious liberty (a partial list) are the HHS Mandate, discrimination against Christians in public schools and universities, new restrictions on Christian adoption agencies, and a New York City ban on churches renting public schools for worship space," writes Ray Nothstine at acton.org.

Thursday saw a (hopefully not temporary) victory for Hobby Lobby, as the 10th Circuit ruled that during the business' challenge of the HHS mandate, it will not have to pay millions in fines. True victory, of course, will only occur if they and others are allowed to practice business according to their religious beliefs.

(Yesterday, when I linked to The Transom newsletter, I had the wrong address. I put transom.org, and it should have been thetransom.org. Again, highly recommend subscribing to it.)

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Not surprising but still a sad night.

Newt Judges You is back!

Wednesday brought some exciting news for Newt, as it was officially announced he would host CNN's "Crossfire."

With him back in the news, the hilarious Tumblr "Newt Judges You," which was shut down after Newt exited the race, will see updates again.

I stumble back across it every couple of months, and when I do, I nearly re-read the entire site.

Here are some of my favorites: Stephanopoulos, debate promise, when Dan Kotman showed him the site last year, and Biden.

It's written by Ben Domenech, who is very sharp and who writes a daily newsletter, The Transom. I can't recommend it enough. You can subscribe here. (Update, had wrong link earlier.)

Here's a recent piece of his -- a great example of what you get by subscribing -- on religious liberty.

You can follow him on Twitter, @bdomenech.

Record number wants Obamacare repealed

(A brief aside: since posting it Sunday. I've had to relay the story to another person.)

The latest bit of bad news for the law:

A record number of voters want the 2010 Affordable Care Act repealed entirely, while sizable majorities say they are worried about their health care under the new law and expect their medical costs will go up, according to a new Fox News poll. The poll, released Wednesday, finds that 58 percent of voters favor repealing all (39 percent) or some (19 percent) of President Obama’s signature legislative achievement.

More from the poll: "The 39 percent who want to repeal the health care law entirely is a record high, up from 30 percent who felt that way in March 2013." This on the heels of a report Tuesday saying a "top administration aide in charge of implementing Obamacare said on Tuesday that he would be 'surprised' if it starts perfectly."

Combined with the recent bad news surrounding the implementation -- skyrocketing premiums, its principal author warning of a "trainwreck," fundraising scandals involving my former governor, and an administration official hoping the rollout isn't a "third-world experience" -- it's tough to see how they get enough young, healthy people signed up. Without whom it has no chance of surviving.

This joy goes live in just over three months.

Why August 2012 Mattered

In August of last year, the GOP primaries here in Kansas was a battle between liberal Republicans -- who had essentially caucused with the few Senate Democrats to stop conservative legislation -- and conservatives.

Much of the media attention -- both nationally and here in the state -- wanted to frame the election as moderates versus conservatives. That was nonsense. If you receive an F from the NRA and support economic freedom 25% of the time, you are not a moderate. A moderate, it would seem to me, would receive a C and an economic freedom score closer to 50%.

When the results came in on August 7th, it was a clear resounding victory for conservatism.

In 2012, the average state senator received a -3.5 economic freedom score from the Kansas Policy Institute. Twelve Republicans had a negative score, with one pulling in the lowest score of the entire senate, minus 30.

Only two of those twelve would return, some losing their races and others retiring to avoid a likely defeat.

In 2013, only four Republicans registered a negative score. The average senator's score was 9.7. (2013 scores haven't been officially finalized, and if they change considerably once they are, I will make a note here.)

The result was that Kansas' income tax is now on a "glide path to zero" and spending controls were put in place. Besides the economy, other needed reforms made possible by the influx of conservatives included a pro-2nd Amendment bill that is among the best in the country and a strong pro-life bill.

After years of a growing government, holding back job creation, Kansas is now firmly headed in the right direction.

The Best Therapy

As you can probably tell, my hope to blog about the elections didn't quite work out. I was volunteering quite a bit in the second half of 2012, and then this year a new job and relationship have taken time up.

But if you don't mind, I wanted to write again about what Newt 2012 meant to me. For two reasons.

The first is that many -- including a few of my family members, who like to jest (I think?) -- see those in politics as shady (at best). When those in my family, friends, or other people I know have said that recently, I have started to try to explain to them -- using the following -- how that reputation is often the farthest thing from the truth. (Though, after finally getting around to House of Cards and binge-watching that this weekend, I doubt that idea is going away anytime soon.)

Last year, at the end of Newt 2012, I wrote here about my mom. Several people, both staffers and those I was lucky enough to come across in those months, wrote to me. That was the first anyone from the campaign had heard of my mom being sick. As silly as it may sound, I didn't want to distract from the purpose of getting Newt elected, even if it would have been a very short distraction.

I will always be grateful for those I met during the campaign, and I'll always consider them friends. You'd be hard-pressed to find a stereotypical heartless operative in that bunch.

Besides my first political love -- to borrow a phrase -- I think the campaign meant so much because of what was happening in my life. Just a few days before the infamous consultant exodus of June 9th, my dog Bucky, who had been shot about fourteen months earlier, passed away. (That's reason number two, as we just passed the two-year mark.) He was a tough SOB, who fought like crazy but just was never able to fully recover. To show how stubborn he was, he insisted on crawling to the car when I found him. I was able to hurry up and pick him up before he went too far, but he was going to give it his all. (Maybe he thought a crying mess like myself might have trouble trying to lug his butt too far.) Not to mention fighting his mom -- to the point of me having to separate them -- not two weeks after coming home. Stubborn.

Six months after my mom passed, my uncle -- her brother -- who had been in and out of the hospital for a few weeks, died. Once again, working helped ease the loss.

What would I have done had I had a job that I didn't love so much? I don't know, but I'm glad I did.

On a final note, relating just to my mom and not the campaign, a friend I've known since Kindergarten was scheduled to go overseas just days after my mom's funeral. While over there, she -- unbeknownst to me at the time -- flew a flag on my mom's birthday.

After we finally got together after she came back, she gave me it to me for my birthday. I was stunned for a moment, not knowing what the proper response to that is. She was such an awesome help during the last couple of months of my mom's life, and between that and everything else, I don't know how I could ever pay her and her family back.

You really learn a lot about people in tough situations -- for good or bad. And I feel blessed to have those people in my life.