Linked and Loaded Evening

Links to what I’ve been reading:

  • Ramesh Ponnurru joins the throng of Paulite shark-bait:

Paul is also more culturally conservative than other libertarians. He opposes abortion, which he considers an infringement of the individual’s right to be free from violence. He has supported the Defense of Marriage Act, and wants to limit the jurisdiction of federal courts so that they can never force state governments to recognize same-sex marriage. On issues such as these, Paul differs with his fellow libertarian Republican Gary Johnson, the former New Mexico governor — which was one reason socially liberal libertarians were glad Johnson joined the presidential race, to present another side of their philosophy.

  • Sarah Kliff asks a question tantamount to political suicide:

It’s become a tenet of conventional wisdom for Republicans and Democrats alike: The government will not cut Medicare doctors’ salaries. For 15 years now, the formula used to determine how much doctors get paid has not kept up with growth in health-care costs. So Congress reliably passes a “doc fix” and appropriates additional funds to cover the shortfall, sometimes giving providers a slight raise.

The latest doc fix is set to run out at the end of the year; a new one is caught up in the debate over over the payroll tax extension. But even so, the working assumption is that doctors’ salaries will remain steady. The federal government will even hold off on processing claims for the first 10 days in January, just to make sure Congress has enough time to get its act together and pass their pay raise.

Should they? American doctors are among the highest paid medical professionals in the world, as well as top-earners domestically. As Congress weighs another patch to doctors’ salaries, it’s worth looking at what it’s buying us.

  • Paul Brodsky risks the ire of goldbugs everywhere:

As gold futures have declined 20% from their peak in September to their low this month, we thought we would reiterate some quick (albeit widely misunderstood) points that justify increasing our concentration of physical:

Gold has always been a monetary commodity and, like dollars and all other paper currencies, has virtually no practical or industrial utility

Gold is not currently a popular medium of exchange among private commercial counterparties, nor is it officially recognized by governments or central banks to be exchangeable in fixed terms with the competing paper currencies they produce […]

  • Sarah Kliff pulls double-duty on Linked and Loaded by interviewing a key person behind health reform:

[…] In health policy circles, Accountable Care Organizations, or ACOs, often get compared to unicorns: Everyone knows what they’re supposed to look like, but nobody has actually seen one. We know ACOs are supposed to bring down health care costs and improve quality, but haven’t quite seen a health care system do that yet.

The Obama administration Monday named 32 health care systems across the country as “Pioneer” ACOs. These will be the first places to test out the new payment model; they’ll provide a bit of a sneak peak at what it could mean for the rest of the country. In other words, we may soon see our first unicorns.

Jim Hinton is the president and chief executive officer of one of those 32 newly-anointed “Pioneers”: Presbyterian Healthcare Services in New Mexico. It’s an integrated care network with 30 clinics and its own health insurance plan with 400,000 subscribers. We spoke this afternoon about what it means for his clinics to become ACOs, the challenges that lie ahead and the future of American health care. What follows is a transcript of our conversation, lightly edited for content and length […]


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