“Rand Paul’s Dangerous Lasik Obsession”: But When It Comes To The Uninsured, Nobody Has A Right To Health Care
Senator Rand Paul has spent much of the August recess engaged in typical political activities—attending a roundtable on school reform, participating in a fundraiser for a fellow Republican, and speaking at a local ham breakfast. But Paul also set aside some time for one more unusual activity: Helping some people to see. Paul, an ophthalmologist, performed several eye surgeries. All of them were for patients who don’t have insurance. And he donated his services for free.
I know what you’re thinking: Paul and his advisers decided to publicize his day of charity care, in order to create the impression that he’s a do-gooder. You’re probably right. I first learned about it from an article by Katrina Trinko of National Review, who was on the scene to write about it. So were some other reporters, including a television crew. They didn’t get there by accident. But who cares? Maybe Paul was looking for good headlines or maybe he was trying to keep up his skills. (Senate rules prohibit him from maintaining a private practice while in office.) Regardless, Paul appears to have a genuine history of charity work: According to his official biography, he helped establish the Southern Kentucky Lions Eye Clinic and has won awards for his humanitarian work. Now, thanks to this latest surgical effort, a handful of people have better sight. Good for them and good for Rand Paul.
Of course, as Trinko’s story makes clear, Paul would have you believe that his good deeds—and his experience as a physician—justify his positions on health care policy. That’s another matter entirely. Paul is a well-known critic of government-run and government-regulated health care programs, starting with the Affordable Care Act. The opposition is in many ways philosophical: Nobody has a “right” to health care, he says, because that would mean people have a right to commandeer the labor of those who provide care. Trinko, in her article, quotes Paul explaining this position during a speaking event:
“As humans, yeah, we do have an obligation to give people water, to give people food, to give people health care,” Paul muses. “But it’s not a right because once you conscript people and say, ‘Oh, it’s a right,’ then really you’re in charge, it’s servitude, you’re in charge of me and I’m supposed to do whatever you tell me to do. . . . It really shouldn’t be seen that way.”
It’s a strange, almost nonsensical argument, for reasons that Paul Waldman notes at the American Prospect:
saying that health care is a right doesn’t mean that doctors have to treat people without being paid, any more than saying that education is a right means that public school teachers have to work for free. Because we all agree that education is a right, we set up a system where every child can be educated, whether their families could afford to pay for it themselves or not. It doesn’t mean that any kid can walk up to a teacher in the street and say, “I command you to teach me trigonometry for free. Be at my house at 9 tomorrow. You must do this, because I have a right to education and that means I am in charge of you and you’re supposed to do whatever I tell you to do.”
Of course, Paul is also making a practical argument. With less government interference and regulation, and more people paying for services directly rather than through insurance, the market would bring down prices on its own—and medical care would become more affordable for everybody. As proof, he points to a procedure ophthalmologists know well: Lasik, the laser eye surgery that eliminates the need for glasses or contact lenses. Via Trinko, again:
“Insurance doesn’t cover Lasik surgery, the surgery to get rid of glasses,” Paul remarks. “So it started at about $2,000 an eye, maybe even $2,500 an eye, and it’s down in some communities to under $500 an eye because competition works and people call on average four doctors to get the price and see how much it’s going to cost.”
Libertarians and conservatives love to cite Lasik. But Lasik tells you almost nothing about the rest of the health care system, for reasons Jeff Levin-Scherz, a physician at the Harvard School of Public Health, has pointed out:
1. Lasik surgery is entirely elective. No one NEEDS it!
2. Lasik surgery is never an emergency. Hence, it’s much more “shoppable” than most health care
3. Lasik surgery is highly automated—the computers actually do a substantial amount of the work. Therefore quality is more uniform than most health care
4. There is very high fixed cost for the Lasik laser—and the low variable cost makes it more likely that providers will price this at “marginal” cost—leading to large discounts. That’s not true of cognitive services.
Ten extra visits with a neurologists cost almost ten times as much as a single visit given the large variable cost of the neurologist’s labor. Ten extra Lasik surgeries cost only a small amount more than a single surgery—since the cost of the ophthalmologist and technician is a relatively smaller portion of the total cost.
And that’s not to mention the fact that the Lasik market has been prone to more problems than promoters like Paul let on. Paul Ginsburg, the economist and president of the Center for the Study of Health Systems Change, testified about this some years ago:
LASIK has the greatest potential for effective price shopping because it is elective, non-urgent, and consumers can get somewhat useful price information over the telephone. Prices have indeed fallen over time. But consumer protection problems have tarnished this market, with both the Federal Trade Commission and some state attorneys general intervening to curb deceptive advertising and poorly communicated bundling practices. Many of us have seen LASIK advertisements for prices of $299 per eye, but in fact only a tiny proportion of consumers seeking the LASIK procedure meet the clinical qualifications for those prices. Indeed, only 3 percent of LASIK procedures cost less than $1,000 per eye, and the average price is about $2,000.
Mostly, though, the problem with Paul’s position on health care reform is the number of people it leaves out. Like every other Republican who has demanded repeal of Obamacare, he’s never proposed anything that would come close to covering as many people, or providing the same level of protection. On the contrary, he’s proposed radical changes to Medicaid that would almost certainly even higher rates of uninsurance than exist today.
According to Trinko’s article, one of the patients Paul treats is a 55-year-old woman. She says she has no insurance because it would cost her $700 a month—money that she doesn’t have. Under Obamacare, people in her position would be eligible for subsidies worth hundreds or even thousands of dollars a month—or they’d have a chance to enroll in Medicaid, as long as their state officials weren’t refusing to participate Obamacare’s expansion of the program.
Paul helped that woman to see. But if he has his way, millions of Americans in similar situations won’t be as lucky. They won’t have the same access to care or they’ll face financial ruin. Ultimately, what Paul does at a surgical center matters a lot less than what he does at the Capitol—or, potentially, the White House.
By: Jonathan Cohn, Senior Editor, The New Republic, August 27, 2013
“Crazier Than His Chronological Age”: Montana Judge’s Comments Show His Ignorance About Rape
Generally, the courts in Montana go about their business without much notice outside the state.
But after 29 years on the bench of the 13th District Court in Montana, Judge G. Todd Baugh has brought the national spotlight to Yellowstone County and is hearing calls from across the country for his ouster after he imposed a 30-day sentence in a rape case, and said the 14-year-old victim was “as much in control of the situation” as the high school teacher who ultimately pleaded guilty. The judge also described the teenager as “being older than her chronological age,” even though the age of consent in Montana is 16.
Perhaps the judge should have just used the words that too many rape victims have heard: “She was asking for it.”
In this case, though, the victim could not hear those words. She killed herself in February 2010.
Plenty of others have heard those words. Tens of thousands of people have put their names on online petitions calling for Baugh to step down. Protesters crowded the lawn of the courthouse Thursday, vowing to campaign against him if he seeks reelection in 2014.
The judge, for his part, has apologized for his comments but not for the sentence he imposed.
In a letter to the Billings Gazette, he wrote: “In the Rambold sentencing, I made references to the victim’s age and control. I’m not sure just what I was attempting to say, but it did not come out correct.
“What I said is demeaning of all women, not what I believe and irrelevant to the sentencing. My apologies to all my fellow citizens.”
The apology was rejected by many people, including the rape victim’s mother, Auliea Hanlon, who told the Associated Press: “He’s just covering his butt. He wouldn’t have said anything if people hadn’t spoken up. He didn’t reverse his decision, so it’s irrelevant.”
While Baugh’s actions have sparked outrage, this is one of many instances of “pushback” that author Susan Brownmiller has seen since the publication of her groundbreaking book “Against Our Will: Men, Women and Rape” in 1975.
She emphasized that in the Montana case, the girl was 14, making her “incapable of giving an informed consent.”
“The consent laws are very clear about that,” Brownmiller said in a telephone interview. “A 14-year-old, by law, is not responsible.”
She added, “There are a lot of guys in positions of authority, like a judge, who really have no idea of what rape is.”
Other examples include former U.S. representative Todd Akin of Missouri, who lost a campaign for Senate after he said that women who are victims of what he called “legitimate rape” rarely get pregnant, and Indiana State Treasurer Richard Mourdock, who said in a campaign for the U.S. Senate: “Life is that gift from God that I think even if life begins in that horrible situation of rape, that it is something that God intended to happen.”
At least some do understand what rape is and are speaking out, including Pete Taylor, a 51-year-old head waiter at a restaurant in Billings who attended the protest wearing a T-shirt on which he had written “14 is 14.”
By: Carla Baranauckas, She The People, The Washington Post, August 30, 2013
“Plan B For Voting Rights”: It’s Time For Congress To Use It’s Authority Under The Election Clause
Voting-rights advocates generally don’t look to Justice Antonin Scalia for comfort. During oral arguments earlier this year in Shelby County v. Holder, the case in which the Supreme Court struck down a central part of the Voting Rights Act of 1965, Justice Scalia called the act a “perpetuation of racial entitlement.”
But a growing circle of legal scholars is focusing on a lower-profile ruling — issued one week before the Shelby County decision and written by Justice Scalia — that may point the way to a new approach to protecting voting rights.
The 7-to-2 decision, in Arizona v. Inter Tribal Council of Arizona, struck down an Arizona law requiring anyone who wanted to vote to provide proof of citizenship. It said the state could not impose a rule that was more restrictive than the federal “motor voter” law, which requires only a sworn statement of citizenship by the voter.
Congress passed the motor-voter law under its power to set the “times, places and manner” of federal elections as authorized by Article I, Section 4 of the Constitution, known as the elections clause. The clause is much less well known than, say, the equal protection clause of the 14th Amendment, and yet Congress’s power under it, Justice Scalia wrote, “is paramount, and may be exercised at any time, and to any extent which [Congress] deems expedient.”
“That sort of woke everybody up again,” said Samuel Issacharoff, a professor at New York University School of Law who has studied the elections clause’s possibilities.
The problem, Mr. Issacharoff said, is that voting laws based on intentional racial discrimination, which the Voting Rights Act has been so successful at blocking, are both rarer and harder to identify today. “A lot of the contemporary problems are not well handled through the 50-year-old mechanism of the Voting Rights Act,” he said.
The elections clause, by contrast, does not speak to racial discrimination at all, but addresses the administration of voting rules. Still, in light of the Supreme Court’s ruling in Shelby County, it could have an important role to play. Strong federal laws enacted under the clause could help ensure voting fairness to all voters, especially when a state law appears neutral but has serious partisan or racially discriminatory effects. For instance, a state’s voter ID law might put up hurdles for poor or young voters, who may be disproportionately minority and Democratic, or for elderly voters, who lean Republican.
The elections clause allows Congress to set rules only for federal elections, but those laws almost always guide state election practices, too. For instance, Congressional legislation could pre-empt voter ID laws like Arizona’s or changes to early-voting laws like those attempted in Florida last year.
The bottom line, said Daniel Tokaji, an election law professor at the Moritz College of Law at Ohio State, is that Congress has much more power to legislate under the clause than it has exercised. It could, for example, liberalize voter registration nationwide, which has been shown to lead to higher turnout.
“I think Congress would be foolish not to look at the elections clause,” Mr. Tokaji said. “If they could do it over again, they might have paid more attention to it back in 2006,” when the Voting Rights Act was reauthorized using data that the Supreme Court in the Shelby County case found to be outdated. (Mr. Tokaji argued in an amicus brief that the justices should rely on the elections clause to uphold the Voting Rights Act, but the court did not address the issue in its ruling.)
Given the apparent direction of the court, even the remaining parts of the Voting Rights Act could be vulnerable to constitutional challenges. That makes it all the more timely for Congress to turn to its expansive authority under the elections clause to protect the right to vote.
By: Jesse Wegman, The New York Times, August 31, 2013
“Last Phase Of The Kabuki Dance”: John Boehner’s Phony New Ransom Demand That He’s Been Saving
Boxed in by his caucus’ demand to defund Obamacare on one side, and a steeled White House on the other, House Speaker John Boehner seems ready to throw in the towel and enter the last phase of the Kabuki dance he’s staged for the benefit of his insolent Republican base.
Of course, he won’t say this, and his recent comments at a fundraiser in Idaho appear on their face to be a doubling down, but, when read correctly, they actually suggest the opposite. “I’ve made it clear that we’re not going to increase the debt limit without cuts and reforms [to mandatory entitlement spending] that are greater than the increase in the debt limit,” he said yesterday.
This entitlement demand is mostly new. While we got hints that Boehner might put Social Security and Medicare on the table back in early July, we’ve hardly heard a peep about it since. Instead, Republicans have been focused defunding Obamacare.
As Josh Barro writes, insisting on entitlement cuts is often Boehner’s last move before capitulation, because he knows it’s a ransom demand that will never be paid. He did it in December, when spokesperson Michael Steel used almost the exact same words: “Any debt limit increase would require cuts and reforms of a greater amount.” (The next month, the House voted overwhelmingly to bypass the debt ceiling and got none of those cuts.) And Boehner did it 2011. That time, he won the overall battle, but he still didn’t get any entitlement cuts.
Cutting the safety net is anathema to Democrats, and in the unlikely scenario that they’d do it, they certainly aren’t going to rush it through in the perhaps 15 legislative work days Congress has before it hits the October debt ceiling deadline. Boehner knows this.
And he’s done nothing to suggest he’s serious about entitlement cuts. There was a brief, peculiar moment this spring when the White House not only was willing to talk social safety net reform, but actually put cuts to Social Security in their budget. And Democratic congressional leaders suggested they’d deliver enough votes to pass something. What did Boehner do? He rejected the proposal out of hand, sight unseen, and called it ”no way to lead and move the country forward.” (That was basically the White House’s expectation all along, they claimed when liberals threatened mutiny.)
If Boehner’s entitlement demand was an empty threat in 2011 and 2012, and he didn’t take up his best chance at it in 2013, then it has to be even more of a bluff today as the landscape has titled decidedly against Republicans, MSNBC’s Suzy Khim notes. The deficit is falling fast and a clear majority of Americans opposed to defunding Obamacare, according to a new Kaiser poll out today, so the White House holds most of the cards. Both they and Boehner know that a government shutdown or default will be worse for Republicans than for Democrats, so this time the president is refusing to negotiate with the hostage takers.
So now, all that’s left is for Boehner to somehow bring his base along. He doesn’t necessarily need their votes, but he needs to drop the pitchforks for moment. Brian Beutler previews how it may go down:
Boehner introduces legislation that both increases (or extends) the debt limit and includes some goodies for conservatives that make the bill a non-starter with Senate Democrats and the President (maybe a year-long delay of the individual mandate — let your imaginations run wild); that bill fails on the House floor; everyone panics; faced with no better option, Boehner breaks the Hastert rule, puts a tidy, Senate-passed debt limit bill on the floor, and we all dress up as Speaker Pelosi for Halloween.
Of course, Beutler notes, plenty of things could go wrong. For instance, Boehner could decide that he’ll refuse to break the Hastert rule (meaning he won’t put anything on the floor that isn’t supported by a majority of Republicans) under any circumstance.
He’s done that when it comes to immigration reform, where he could pass a bill tomorrow if he were willing to use Democratic votes. He knows that every time he breaks Hastert, he enrages the Republican base a little bit more, so it’s possible that he’s been saving it up for this moment, which he must have known would come.
By: Alex Seitz-Wald, The Plum Line, The Washington Post, August 28, 2013
“The Grand Old Party Of Nihilists And Cranks”: The Politics Of Destruction With The Values Of Zealots
Once upon a time, in a galaxy far, far away, Republican Saxby Chambliss, Georgia’s senior senator, was considered a steadfast conservative. The American Conservative Union has given him a lifetime score of 92, while the Club for Growth has scored him at 83. He earns an A from the National Rifle Association.
But a couple of years ago, Chambliss embarked upon an exercise that would merely have cemented his stature as a power broker as recently as the administration of George W. Bush: He joined Senator Mark Warner, a Virginia Democrat, to form a bipartisan group of senators working to come up with a deal to whittle down the deficit. In other words, he considered compromise with Democrats.
In our current warped political universe, that was enough to earn Chambliss a potential challenger from the right, and he decided not to seek re-election. Chastened by Chambliss’ experience, none of the Georgia Republicans running for his vacant seat wants to occupy the same ZIP code with the words “compromise” and “bipartisan.”
This is what the Grand Old Party has come to: It’s now led by nihilists whose only politics are those of destruction and whose only values are those of zealots. There may be reasonable Republicans remaining in office, but they’ve been bullied into compliance and cowed into silence.
If you don’t believe that, listen to the growing drumbeat for the impeachment of President Obama — despite the glaring lack of evidence that he has committed impeachable offenses. (Having the temerity to win a second term is not an impeachable crime.) While such talk was once restricted to the nutters — men like U.S. Rep. Kerry Bentivolio (R-MI), who has said the president’s impeachment would “be a dream come true” — it has leaked into the GOP’s water supply.
Witness the recent off-the-cuff remarks of Senator Tom Coburn (R-OK), who, though a standard-bearer for the hard right, has been considered a thoughtful and rational man. At a recent meeting with constituents, Coburn declared that the president was coming “perilously close” to the standards for impeachment.
Last month, at a tribute in his honor, the retiring Chambliss obliquely urged his party to come to its senses. He didn’t explicitly mention the GOP’s spiral into right-wing madness, but he did speak of the importance of his work with the Gang of Six, according to The Atlanta Journal-Constitution.
“I don’t mind crossing party lines. If Republicans had a patent on all the good ideas, we’d be in power forever. We don’t have a patent on all those good ideas,” he said.
But his intended audience has taken another lesson from Chambliss’ bipartisanship: If you even consider it, you will be labeled a RINO — Republican In Name Only — by the tea party activists who now wield enormous power in the Republican Party. Having chased Chambliss off, they have taken to hectoring Georgia’s junior Republican senator, Johnny Isakson, for his failure to jump with enthusiasm to the idea of shutting down the government over Obamacare.
Tea Party types have also targeted longtime senator Lamar Alexander, Republican from Tennessee. In a letter urging Alexander to retire, they claimed that “our great nation can no longer afford compromise and bipartisanship, two traits for which you have become famous.”
In response, Alexander penned a remarkable op-ed in The Tennessean defending his record as a politician who has occasionally reached across the aisle. “I know that if you only have 45 votes and you need 60 senators to get something important done like balancing the budget and fixing the debt, then you have to work with other people — that is, IF you really care about solving the problem, IF you really want to get a result, instead of just making a speech,” he wrote.
However, such time-honored traditions of governance have little effect on the white-hot rage of radicals who want to toss out any conservative who remembers the lessons of his middle-school civics classes. They have no respect for the basic give-and-take on which representative democracies thrive, no real interest in improving the nation’s fortunes. So, no, Senator Alexander, they don’t care about solving problems.
By: Cynthia Tucker, The National Memo, August 31, 2013
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