"[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.