“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
“Guess Why”: Republicans Supported Attacking Syria, Now They Don’t
For decades, Republicans have been more supportive than Democrats of an interventionist foreign policy. Surveys conducted earlier this year showed that Republicans were consistently more likely than Democrats to support striking Syria if Assad used chemical weapons. But partisanship is powerful in the age of President Obama, powerful enough to overcome longstanding partisan preferences on international affairs. A new poll shows that the president can’t count on the traditional coalition for the use of force abroad.
This morning, NBC News released a survey showing that only 42 percent supported striking Syria, with 50 percent opposed. Those numbers flip when the question specified that the US would rely on airstrikes and stand-off range weapons, like cruise missiles. Then, 50 percent were on board. That probably means the president doesn’t have to worry too much about public support in determining whether and how to strike Syria.
But even narrow support for strikes is underwhelming compared to earlier surveys from Quinnipiac, CNN, Pew, and The Washington Post, which asked voters hypotheticals about how they would react to a Syrian chemical weapons attack. Those polls suggested that a majority or plurality of voters would support strikes.
So what’s the difference between those earlier survey’s and today’s NBC poll? Republicans. In every previous survey, Republicans were most likely to support attacking Syria. Each poll showed more than 50 percent of Republicans willing to strike Assad if he used chemical weapons. Today’s NBC News poll shows far less Republican support, with just 41 percent in support and 49 percent opposed. That’s 15 points less than April’s Pew Research survey, which found that 56 percent of Republicans would support strikes. In comparison, Democratic support hasn’t declined—46 percent support strikes, just like in April. And so for the first time, more Democrats support intervention than Republicans.
The easiest explanation is partisanship. The president has clearly signaled his intention to strike Syria, Republican leaders have sent mixed signals, and the party rank-and-file has taken the cue. That’s not overly surprising and largely consistent with research by political scientists, although perhaps the extent of the drop should be a bit surprising, given the party’s relatively recent willingness to bomb every country between the Mediterranean and the Karakoram, at one point or another.
The most important question is whether this represents or presages a lasting Republican shift on foreign policy. I’m doubtful, but who knows. It does seem, however, that if the president’s foreign policy gets more ambitious, Republicans might reflexively, if temporarily, embrace a more restrained approach. That would make it easier for a candidate like Rand Paul to run on a reserved foreign policy in the 2016 Republican primaries.
By: Nate Cohn, The New Republic, August 30, 2013
“Now Is The Time, Still”: The Invisible Issues Of 1963 Are Just As Invisible To Some Today
“So even though we face the difficulties of today and tomorrow, I still have a dream.” — Dr. Martin Luther King Jr., August 28, 1963
This is “tomorrow.”
Meaning that unknowable future whose unknowable difficulties Martin Luther King invoked half a century ago when he told America about his dream. If you could somehow magically bring him here, that tomorrow would likely seem miraculous to him, faced as he was with a time when segregation, police brutality, employment discrimination and voter suppression were widely and openly practiced.
Here in tomorrow, after all, the president is black. The business mogul is black. The movie star is black. The sports icon is black. The reporter, the scholar, the lawyer, the teacher, the doctor… all of them are black. And King might think for a moment that he was wrong about tomorrow and its troubles.
It would not take long for him to see the grimy truth beneath the shiny surface, to learn that the perpetual suspect is also black. As are the indigent woman, the dropout, the fatherless child, the suppressed voter and the boy lying dead in the grass with candy and iced tea in his pocket.
King would see that for all the progress we have made, we live in a time of proud ignorance and moral cowardice wherein some white people — not all — smugly but incorrectly pronounce all racial problems solved. More galling, it is an era of such cognitive incoherence that conservatives — acolytes of the ideology against which King struggled all his life — now routinely claim ownership of his movement and kinship with his cause.
When he was under fire for questioning the constitutionality of the Civil Rights Act of 1964, for instance, Senator Rand Paul wanted it known that he’d have marched with King had he been of age. And he probably believes that.
But what people like Paul fail to grasp is that the issues against which African-Americans railed in 1963 were just as invisible to some of us back then as the issues of 2013 are to some of us right now. They did not see the evil of police brutality in ’63 any more than some of us can see the evil of mass incarceration now. They did not see how poll taxes rigged democracy against black people then any more than some of us can see how Voter ID laws do the same thing now.
So there’s fake courage in saying, “I would have been with Martin then.” Especially while ignoring issues that would press Martin now.
No, being there took — and still takes — real courage, beginning with the courage to do what some of us are too cowardly, hateful, stubborn or stupid to do: see what is right in front of your face.
Because when Martin Luther King said, “I have a dream,” he was not, contrary to what some of us seem to believe, calling people to co-sign some vague, airy vision of eventual utopia. No, he was calling people to work, work until “justice rolls down like waters and righteousness like a mighty stream.” This was not a sermon about the someday and the eventual. “Now is the time,” said King repeatedly. So it was. And so it is.
We live in King’s “tomorrow” and what he preached in that great rolling baritone at the temple of Lincoln 50 summers ago ought to inspire us anew in this post-Trayvon, post-Jena 6, post-Voting Rights Act, post-birther nonsense era. It ought to make us organize, agitate, educate and work with fresh determination. It ought to challenge you to ask yourself: What have you chosen not to see? And now, having seen it, what will you do to make it right?
Because, we face tomorrows of our own.
Thankfully, we move into them with the same elusive hope — and towering dream — of which King spoke, the one that has always driven African-American people even in the valley of deepest despair.
Free at last!
Free. At last.
By: Leonard Pitts Jr., The National Memo, August 26, 2013
“It’s All Academic Governor”: Chris Christie’s Debate Phobia Won’t Win Him GOP Support
“We are not a debating society. We are a political operation that needs to win.”
Thus did Chris Christie offer one of the most pregnant statements yet in the ongoing Republican argument over the party’s future. At the risk of sounding like one of those “professors” the New Jersey governor regularly condemns, I’d argue that these 15 words, spoken at a Republican National Committee meeting in Boston last week, raise more questions than they answer. Here are a few.
How do you decide on a winning strategy without debating it first? What is wrong with debating differences on policy and philosophy that people in political parties inevitably have? Don’t the voters expect to have some idea of what a party and a candidate believe before they cast their ballots — and doesn’t that imply debate? Doesn’t the phrase “political operation” risk implying that you are seeking power for power’s sake and not for any larger purpose?
There is also this: Isn’t Christie himself engaged in an important debate with Sen. Rand Paul over national security issues? There’s nothing academic about that.
One of two things is going on here: Either Christie knows he’ll need to have the debate he claims he wishes to avoid but doesn’t want to look like he is questioning fundamental conservative beliefs, or he really believes that the “I can win and the other guys can’t” argument is enough to carry him to the 2016 Republican presidential nomination he shows every sign of seeking. The latest signal came Friday when, under pressure from pro-gun activists, he vetoed a weapon ban he once advocated.
His target audience, after all, is an increasingly right-wing group of Republican primary voters who are unforgiving of ideological deviations. The last thing Christie needs is the sort of debate that casts him as a “moderate.”
Let’s stipulate that Christie is far less “moderate” than either his fans among Democrats and independents or the hardest-core conservatives seem to believe. Simply because Christie was nice to President Obama after Hurricane Sandy — at a moment when New Jersey needed all the federal help it could get — lots of people forget how conservative the pre-Sandy Christie was.
In 2011, he went to the summer seminar sponsored by the Koch brothers in Colorado, heaped praise on them and said, among other things: “We know the answers. They’re painful answers. We’re going to have to reduce Medicare benefits. We’re going to have to reduce Medicaid benefits. We’re going to have to raise the Social Security age. We’re going to have to do these things. We’re going to have to cut all type of other government programs that some people in this room might like. But we’re gonna have to do it.”
If I were on the right, I’d be taken with Christie’s skills at making conservative positions seem “pragmatic” and “practical.” Candidates who are perceived as dogmatic or highly ideological rarely win elections.
But here’s the problem: You can’t run as a pragmatic candidate if your party won’t let you. For Christie to win, he will have to convince the grass-roots Republicans who decide nominations that the party’s steady march rightward is a mistake.
Surely Paul, Ted Cruz and others among Christie’s potential opponents won’t let him slide by without challenging him hard — yes, “debating” him — about what he really stands for. Christie needs something more substantial than “You guys are losers,” even though he would relish saying it.
Mitt Romney’s experience in 2012 is instructive. He was a relatively pragmatic governor, especially on health care, and could have been a more attractive candidate than he turned out to be. Yet the dynamics of a Republican primary electorate that is short on middle-of-the-roaders pushed Romney away from his old self and toward positions that made him less electable. Faced with opponents to his right, he was reactive and drifted their way. In the end, it wasn’t clear who Romney was, other than the candidate who spoke derisively about the “47 percent.”
Those who understand how a “political operation” works know that genuine pragmatism requires a defeated party to engage in rethinking, not just repositioning. Bill Clinton laid out a detailed program and a set of arguments as a “New Democrat.” George W. Bush spoke of “compassionate conservatism” and challenged at least some of the most reactionary positions held by congressional Republicans.
Winning reelection this November by the biggest possible margin will buy Christie time. But eventually the debating society will beckon. He’ll have to be very clear, if not professorial, about the argument he wants to make.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, August 18, 2013
“Marginalized By Louder Fringe Voices”: Barely A Blip On The National Radar, The Tea Party Is Losing August
August 2009 was the month of the Tea Party town hall.
We were just eight months into the Obama presidency, and Democratic congressmen headed home for recess only to get ambushed by mobs chanting their opposition to ObamaCare. As The New York Times reported at the time, “members of Congress have been shouted down, hanged in effigy, and taunted by crowds.” The August 2009 town halls certainly created obstacles on the road to health care reform, and in many ways, gave birth to the national Tea Party movement.
Now here we are in August 2013, when some observers thought that Tea Party groups would actually derail the tenuous legislative push for immigration reform. The anti-immigration group NumbersUSA is certainly trying, posting “Town Hall Talking Points” along with lists of congressional events at which to reel them off.
But midway through August, the Tea Party is barely a blip on the national radar. What happened?
1. The anti-immigration Tea Party crowd is being out-crazied
Despite the heroic efforts of Rep. Steve “Cantaloupe Calves” King, the anti-immigration faction of the Tea Party is being crowded out by voices even farther out on the fringe.
The news out of the town halls has featured Oklahoma’s “Birther Princess” and a Republican congressman casually musing about impeachment. Outside of the town halls, Republicans are publicly feuding with each other over whether to agitate for a government shutdown and conservative talk radio hosts are expending their energies defending the wisdom of turning a Missouri rodeo into a minstrel show.
The right wing’s summer cacophony is muffling the noise of the anti-immigration forces, as well as deepening the Republican image problem among moderates and people of color.
2. The Republican leadership wants no part of Tea Party agitation
For all we know, the Tea Party fizzle may be exactly what the Republican leadership wants. According to Politico, “House Republican leaders have spoken about immigration only when asked during the August recess.” That suggests Speaker John Boehner and his allies are looking to lower the temperature, creating a climate that eventually will allow compromise to win the day.
But it’s not just the formal Republican leadership that is refusing to join the anti-immigration crusade. Tea Party favorites like Sens. Rand Paul and Ted Cruz haven’t been leading the anti-immigration parade either, despite their opposition to the bipartisan Senate bill. The Daily Caller‘s Mickey Kaus lashed out, saying, “If Amnesty Wins, Blame Cruz,” as Cruz is siphoning off conservative grassroots energy for his fight against ObamaCare.
The best NumbersUSA could book for its Stop Amnesty tour is Rep. King. A recent rally led by King, held in the congressional district of the second-highest ranking House Republican, attracted a mere 60 people. Meanwhile 1,500 pro-immigration-reform activists held a Wednesday rally in the heavily Latino congressional district of the third-highest ranking House Republican.
3. Republican money is on the other side
The 2009 town hall outbursts were nationally organized in part by conservative groups FreedomWorks and Americans for Prosperity, which were funded by the billionaire Koch brothers.
But the Kochs support immigration reform, as do Karl Rove and 100 other major Republican donors. As of June, pro-immigration groups had outspent opponents more than 3-to-1.
These three factors are connected. Because the anti-immigration squad is so poorly funded and lacking in leadership, it is vulnerable to being marginalized by louder fringe voices and better organized mainstream voices.
The louder the fringe voices become, the stronger the case mainstream Republicans can make to their leaders to accept immigration reform, on the grounds that the party can’t survive if it remains associated with birthers and bigots. At the same time, since the Tea Party can’t get the conservative grassroots riled up now, they won’t have much of a case to make to incumbent congressmen that they will face fierce primary challenges next year if they agree to a compromise with Democrats.
Score August as a big win for immigration reform.
By: Bill Scher, The Week, August 16, 2013
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