“Standing With Mitch”: Is Rand Paul A Secret RINO?
Rand Paul (R-KY) was one of the 18 senators who voted against the deal brokered between Senate Majority Leader Harry Reid (R-NV) and Senate Minority Leader Mitch McConnell (R-KY) that ended the government shutdown and raised the debt limit — but that deal would likely never have happened if not for Paul’s alliance with McConnell.
Less than four years ago, Paul easily defeated Secretary of State Trey Grayson, McConnell’s choice to replace Senator Jim Bunning, in a GOP primary. The minority leader quickly moved to make amends with Paul as the Tea Party favorite cruised to a win in the general election.
Since 2010, the two men have formed a relationship of equals that’s worked to the advantage of both. “You know, I think when we call people a ‘mentor,’ I think that overstates,” Paul said when asked about the nature of their bond earlier this year. “We are colleagues, and I do respect him.”
McConnell backed Paul’s “drone” filibuster of future CIA director John Brennan. Paul has not only endorsed McConnell’s re-election, he’s lent out his campaign manager Jesse Benton to the senator. A hot mic caught the two senators discussing tactics for how to avoid blame for the government shutdown.
It’s impossible to imagine McConnell being able to swoop in at the last moment to negotiate a deal if he weren’t leading his primary opponent — Tea Partier Matt Bevin — by as much as 40 percent. And it’s impossible to imagine McConnell crushing a hardline opponent so handily if Paul had decided to back said hardline opponent.
In the wake of the McConnell-Reid compromise, Speaker John Boehner (R-OH) has gotten most of the grief from the Tea Party. You can get a sampling of the vile things he’s being called on his Facebook page from this Tea Party Insult Generator. The Speaker is much more deserving of grief because he let the shutdown happen and refused to even hold a vote on the “clean” continuing resolution that McConnell let pass the Senate.
However, Sarah Palin said on Thursday that she’s ready to fight in Kentucky in order to “shake things up in 2014.”
McConnell has already said there will not be another shutdown over Obamacare. He also refused to comment on the ascent of Senator Ted Cruz (R-TX). To those who have embraced the junior senator from Texas as the new leader of the conservative movement, this makes the minority leader a member of the “Surrender Caucus.”
It used to be a big deal when a former member of a national Republican ticket threatened to support a primary challenge to the GOP’s leader in the Senate. But that was back when Republican congressmen didn’t accuse former GOP standard-bearers of being in league with al Qaeda.
Palin’s threat would be a much bigger problem for the senator if Rand Paul weren’t standing with Mitch. And if you’re wondering where Paul’s loyalty is coming from, ask the man both men have employed — Jesse Benton. If he doesn’t know he’s being recorded, Benton might tell you, “I’m sorta holdin’ my nose for two years, cause what we’re doin’ here is going to be a big benefit for Rand in ’16…”
By: Jason Sattler, The National Memo, October 17, 2013
“A Love Story For The Ages”: Republicans And The Sequester
The deal allowing the government to reopen today included a mandate that the House and Senate engage in a new round of budget negotiations, with the lawmakers involved facing the unenviable task of reconciling the different tax and spending plans passed by each respective chamber. One contentious issue right off the bat is whether or not to preserve the spending levels under the so-called “sequester,” which were a byproduct of the 2011 debt ceiling debacle.
To review, when Republicans took the debt ceiling hostage two years ago, the deal crafted to avoid default – known as the Budget Control Act – mandated the creation of a “supercommittee” that was supposed to come up with a budget compromise. The sequester was meant to be the stick that would force a deal, as it included cuts that were supposedly so painful to each party that they would have no choice but to agree on something else.
Except that’s not what happened. The negotiations fell apart where they always fall apart: with Republicans refusing to accede to one dime in new revenue. The sequester went into effect and is now cutting an indiscriminate path through the budget.
Democrats, then, have made some noise about undoing the sequester, for at least a short period of time, during this new round of budget negotiations. But Senate Minority Leader Mitch McConnell, R-Ky., made clear on the Senate floor yesterday that he is not interested in such an idea.
“I’m also confident that we’ll be able to announce that we’re protecting the government spending reductions that both parties agreed to under the Budget Control Act, and that the president signed into law. That’s been a top priority for me and my Republican colleagues throughout this debate. And it’s been worth the effort,” McConnell said. “Some have suggested that we break that promise as part of the agreement. … But what the BCA showed is that Washington can cut spending. … And we’re not going back on this agreement.” Rep. Jim Jordan, R-Ohio, called sequestration, “one of the good things that has happened” and “an important thing that we have achieved.” Rep. Kevin Brady, R-Texas, even threatened another debt ceiling standoff in the new year should Democrats try to undo the sequester.
But when the sequester first went into effect, Republicans did everything they could to blame it on Obama. They even tried to call it the “Obamaquester.” In fact, here’s what McConnell had to say about the sequester back in February: “Take the Obama sequester as just one example. The president had a chance last night to offer a thoughtful alternative to his sequester, one that could reduce spending in a smarter way. That is what Republicans have been calling for all along.”
So in just eight short months, those spending cuts went from “the Obama sequester” to a “top priority” for the GOP. How the times change.
During his floor speech, McConnell also excoriated Obamacare for “killing jobs.” Not only is that false, but if McConnell wants to see a real job killer, he needs to look no further than his precious sequester spending levels. As I noted last week, the sequester has not only been gutting important programs, but is slowly strangling economic growth. According to the Congressional Budget Office, the spending levels under the sequester will cost up to 1.6 million jobs through fiscal year 2014.
Of course, the GOP to this point has been impervious to the mountain of evidence showing that cutting spending in a weak economy just makes for a weaker economy. So perhaps it’s best that McConnell and co. are just owning up to the fact that the sequester is something they desire and admire. It’s a love story for the ages: the sequester, once spurned, is now the one thing Republicans want to ensure will be staying around forever.
By: Pat Garofalo, U. S. News and World Report, October 17, 2013
“Unnecessary And Replaceable”: It’s Time To Take The Debt Ceiling Gun Off The Stage
There’s long been an expression that’s common in theater: if there’s a gun on the stage, it has to go off. It’s a loose translation of something called “Chekov’s Gun,” and I’ve long believed it’s a helpful metaphor for the debt-ceiling law.
The debt ceiling is a gun that’s been on the stage for nearly a century, and from time to time, we’ve seen lawmakers pick it up, play with it, wave it around, and even make threats with it, though thankfully it’s never gone off. But if we want to make sure no one ever pulls the trigger, there’s really only one logical course: it’s time this gun leaves the stage once and for all.
Now that Congress has approved a “clean” debt-ceiling extension, Democrats hope they’ve re-established a governing norm: extortion schemes using the full faith and credit of the United States will no longer be tolerated. When President Obama said last night, “One of the things that I said throughout this process is we’ve got to get out of the habit of governing by crisis,” I took this as a subtle reminder to GOP lawmakers: this particular gambit is over.
Whether Republicans intend to hold the debt ceiling hostage again remains an open question. Last night, Rep. Tom Massie (R-Ky.) conceded, “I’m going to commit candor here: I think we’ll have less leverage on the next CR & the next debt limit.” Around the same time, however, a Senate Republican leadership aide told a Washington Examiner reporter that the party has “no intention of allowing the next debt limit hike to be ‘clean.’”
Let’s consider that sentence, pause for a moment, and collectively bang our heads against our desks.
Policymakers can end the extortion, the economic uncertainty, and the threat of economic calamity by taking this gun off the stage – or at least unloading it. Josh Green recently talked up one of the more sensible solutions.
Back in 1979, the Democratic House Speaker, Tip O’Neill, handed the unhappy job of lining up votes for a debt-ceiling raise to Representative Richard Gephardt, then a young Democratic congressman from Missouri. Gephardt hated this, and, realizing he’d probably get stuck with it again, consulted the parliamentarian about whether the two votes could be combined. The parliamentarian said they could. Thereafter, whenever the House passed a budget resolution, the debt ceiling was “deemed” raised.
The “Gephardt Rule,” as it became known, lasted until 1995, when the new House Speaker, Newt Gingrich, fresh from the Republican triumph of the 1994 midterms, recognized the same thing that Tea Party Republicans recognize today: The threat of default could be used to extort Democratic concessions. Gingrich abolished the Gephardt Rule, and within the year the government had shut down.
Long story short, under the Gephardt Rule, Congress maintains its power of the purse and approves federal spending. If expenditures are greater than receipts, as they nearly always are, it’s simply automatic that the Treasury will have the borrowing authority to pay the nation’s bills. Gingrich ended the practice, but there’s no reason contemporary policymakers can’t bring it back.
If Congress doesn’t like the Gephardt Rule, there are other alternative solutions. Senate Minority Leader Mitch McConnell (R-Ky.), for example, floated a related idea in 2011 in which the debt ceiling would remain in place, but the legislative burden would shift – the White House would have the authority to extend Treasury’s borrowing, and instead of going to Congress for permission, Congress would only have the power to proactively block Treasury. In other words, instead of needing a “yes” from Congress, lawmakers would only have the ability to say “no.”
There’s also the possibility of a constitutional challenge – there’s a credible argument to be made that the debt-ceiling statute itself violates several provisions of the Constitution, including the 14th Amendment, so it should be struck down in the courts. If not, University of Chicago Law School professor Eric Posner recommends a constitutional amendment to prevent disaster in the future.
There are options. The point, though, is simple: the status quo shouldn’t be left in place.
It doesn’t even have to be seen as a partisan issue – Dean Clancy, who works on policy for the far-right FreedomWorks group, recently endorsed scrapping the debt ceiling, too. Everyone from Tim Geithner to Warren Buffett to Alan Greenspan has reached the same conclusion.
Most modern, industrialized countries don’t have a statutory debt limit for exactly this reason – it’s simply too dangerous. It’s time for the United States to catch up and eliminate this weapon before someone – which is to say, us – gets hurt.
By: Steve Benen, The Maddow Blog, October 17, 2013
“Cloaked In Secrecy”: The Myth Of The Medical-Device Tax
In the last few days of negotiations in Congress, repeal of the Affordable Care Act’s tax on medical devices emerged as a key Republican demand. The medical-device industry waged an intense lobbying campaign — even garnering the support of many Democrats who favored the law — arguing that the tax would stifle innovation and increase health care costs.
This argument is doubly disingenuous. Not only can the medical-device industry easily afford the tax without compromising innovation, but the industry’s enormous profits are a result of anticompetitive practices that themselves drive up medical-device costs unnecessarily. The tax is a distraction from reforms to the industry that are urgently needed to lower health care costs.
The medical-device industry faces virtually no price competition. Because of confidentiality agreements that manufacturers require hospitals to sign, the prices of the devices are cloaked in secrecy. This lack of transparency impedes hospitals from sharing price information and thus knowing whether they are getting a good deal.
Even worse, manufacturers often maintain personal relationships (sometimes involving financial payments like consulting fees) with physicians who choose the medical devices that their hospitals purchase, creating a conflict of interest. Physicians often don’t even know the costs of the devices, and individual physicians often choose devices on their own, which weakens a hospital’s ability to bargain for volume discounts.
Such anticompetitive practices help generate a wide variation in the prices of medical devices — and contribute to higher prices in general. For example, the Government Accountability Office found that prices for cardiac implantable medical devices in the United States vary by several thousand dollars. And even the lowest-priced devices in the United States are expensive compared with those in other developed countries. According to the consulting firm McKinsey & Company, the United States spends about 50 percent more than expected on the top five medical devices, compared with Europe and Japan. McKinsey calculates that this amounts to $26 billion in excessive spending each year. Medicare, private health insurers and patients end up paying these inflated prices.
Excessive prices fuel enormous profits — profits that dwarf both the medical-device tax and the industry’s investments in research and development. Consider the device division of Johnson & Johnson, which in 2012 had an operating profit of $7.2 billion. By the company’s own estimate, the device tax would amount to at most $300 million, and its investment in research and development amounts to only $1.7 billion.
There are several ways policy makers could lower device costs. The first step would be to end the anticompetitive practices that prevent hospitals from getting the best deals. Senator Charles E. Grassley, Republican of Iowa, has sponsored legislation that would foster transparency by posting online price information for implantable medical devices.
In addition, instead of simply paying hospitals based in part on what they have spent on devices, Medicare should force manufacturers to compete for business based on a product’s price and quality.
Medicare should also pay hospitals a single lump sum for all of the associated costs of a given procedure (like a hip replacement). This approach, known as “bundling” the costs, would create incentives for hospitals to lower device costs. Savings should be shared with the physicians, so that their incentives are aligned with the hospital’s.
Bundling has been used successfully in pilot programs. Under Medicare’s Acute Care Episode Program — which bundled payments for cardiac and orthopedic procedures — physicians worked together to choose high-quality, cost-effective devices. Baptist Health System in Texas, which participated in the program, used clinical evidence to choose devices and negotiated lower prices for both Medicare and non-Medicare patients.
States could adopt similar payment reforms for private insurance and their Medicaid programs. In Arkansas, the Medicaid program and private payers — including Walmart — have collaborated to adopt bundled payments for several procedures, including hip and knee replacements.
To complement these efforts, the new Patient-Centered Outcomes Research Institute, a nongovernmental body created by the Affordable Care Act, should pay for research that compares the effectiveness of devices so physicians can make informed choices. (Three years into its existence, the institute has initiated few, if any, studies of medical devices.) Medicare or the Food and Drug Administration should also require the use of registries that track when devices fail.
Currently, medical-device manufacturers allocate only a sliver of profits to research and development and often focus on “tweaks” to existing devices, without providing any evidence that they are of better quality. Competitive pressures from public and private payers would provide incentives for the industry to become more innovative, producing technologies that actually lowered costs and offered truly advanced breakthroughs.
Instead of using its clout to lobby against the device tax — which helped foment opposition to the Affordable Care Act — the medical-device industry needs to share the responsibility of lowering costs for patients, businesses and taxpayers.
By: Topher Spiro, Op-Ed Contributor, The New York Times, October 16, 2013
“Republican Collapse”: They Picked A Goal They Couldn’t Achieve And A Means They Couldn’t Sustain
Congress has finally worked out a deal to end the government shutdown and dodge default, but not before the Republican Party demonstrated to Americans just how conflicted and dangerous it is.
Benjamin Wittes, a senior fellow in governance studies at the Brookings Institution, this week described our current Congress as a greater danger to national security than Al Qaeda, writing, “We don’t tend to talk about Congress as — at this stage — what it plainly is: the clearest and most present danger in the world to the national security of the United States.”
That is what the G.O.P.-led House has brought us. Conservatives outside the chamber know defeat when they see it, and want to live to fight another day. But they beat their chests in vain as their laments fall on the deaf ears of the far-right political death squads.
On Tuesday, the conservative Wall Street Journal editorial pages blasted:
“This is the quality of thinking — or lack thereof — that has afflicted many GOP conservatives from the beginning of this budget showdown. They picked a goal they couldn’t achieve in trying to defund ObamaCare from one House of Congress, and then they picked a means they couldn’t sustain politically by pursuing a long government shutdown and threatening to blow through the debt limit.”
Senator John McCain said this week, “Republicans have to understand we have lost this battle, as I predicted weeks ago, that we would not be able to win because we were demanding something that was not achievable.”
Senator Lindsey Graham put it more bluntly: “We really did go too far. We screwed up.”
But, far-right elements of the House cannot be reasoned with. They prefer to go down in a blaze of glory — or at least take the country down in one.
And arguably no one is more the face of this disaster than Senator Ted Cruz of Texas, labeled by one New York Republican representative, Peter King, as a “fraud” and “false prophet,” who helped orchestrate it.
The Houston Chronicle editorial board on Tuesday took the extraordinary step of trying to withdraw its endorsement of Cruz, an endorsement that no doubt helped get him elected. An editorial posted to the paper’s Web site began, “Does anyone else miss Sen. Kay Bailey Hutchison?”, the senator Cruz replaced. It went on:
“When we endorsed Ted Cruz in last November’s general election, we did so with many reservations and at least one specific recommendation — that he follow Hutchison’s example in his conduct as a senator. Obviously, he has not done so. Cruz has been part of the problem in specific situations where Hutchison would have been part of the solution.”
It seems everyone is waking up to what a disaster this current Republican contingent of extremists has become and how poisonous they are to the functioning of our democracy. Better late than never, I suppose.
Cruz’s favorable ratings are underwater in Pew’s, Gallup’s, Fox News’ and Quinnipiac’s polling.
But then, Cruz doesn’t put much stake in polls, with their pesky numbers.
According to an NBC News/Wall Street Journal poll taken last week, views of the Republican Party sank to record lows and 70 percent of respondents thought Republicans in Congress were putting their own political agenda ahead of what was good for the country.
The poll also found that negative feelings about the Tea Party had risen, with 47 percent saying they had negative feelings about the group, including 34 percent who described their feelings as “very negative.” Just 21 percent of Americans now say they feel positive about the group.
But when Cruz was asked Friday about the poll, he dismissed it as having a problematic methodology. He said: “If you seek out liberal Obama supporters and ask them their views, they’re going to tell you they’re liberal Obama supporters. That’s not reflective of where this country is.” In fact, it is Cruz’s methodology that is flawed. His grandiloquence may well be the undoing of the Grand Old Party.
According to a Pew Research report released Tuesday:
“A record-high 74% of registered voters now say that most members of Congress should not be reelected in 2014 (just 18% say they should). By comparison, at similar points in both the 2010 and 2006 midterm cycles only about half of registered voters wanted to see most representatives replaced.”
The report also found:
“An early read of voter preferences for the 2014 midterm shows that the Democrats have a six-point edge: 49% of registered voters say they would vote for or lean toward voting for the Democratic candidate in their district, while 43% support or lean toward the Republican candidate.”
Republicans terribly misplayed a weak hand on the government shutdown and the debt ceiling. There was never any chance of success other than scaring the president and the Democrats into caving. President Obama and Harry Reid called their bluff and they were left with no real options.
This is an embarrassment for the country, yes, but it’s also an embarrassment for the Republican Party that lays bare their motives, tactics and intention. It may not be so easy for voters to forget this come next November.
As the conservative Matt Drudge tweeted on Wednesday: “Speaker Pelosi Part 2: Opening Jan 5, 2015.” If only.
By: Charles M. Blow, Op-Ed Columnist, The New York Times, October 16, 2013
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