“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
“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
“Congress, Be Careful What You Wish For”: For Far Too Many Lawmakers, It’s So Much Easier To Criticize Than Govern
The funny thing about a dog that chases a car? Sometimes it catches the car and has no idea what to do next.
Over the last several days, members of Congress have spoken out with a variety of opinions about U.S. policy towards Syria, but lawmakers were in broad agreement about one thing: they wanted President Obama to engage Congress on the use of military force. Few expected the White House to take the requests too seriously.
Why not? Because over the last several decades, presidents in both parties have increasingly consolidated authority over national security matters, tilting practically all power over the use of force towards the Oval Office and away from the legislative branch. Whereas the Constitution and the War Powers Act intended to serve as checks on presidential authority on military intervention abroad, there’s been a gradual (ahem) drift away from these institutional norms.
That is, until this afternoon, when President Obama stunned everyone, announcing his decision to seek “authorization” from a co-equal branch of government.
It’s one of those terrific examples of good politics and good policy. On the former, the American public clearly endorses the idea of Congress giving its approval before military strikes begin. On the latter, at the risk of putting too fine a point on this, Obama’s move away from unilateralism reflects how our constitutional, democratic system of government is supposed to work.
Arguably the most amazing response to the news came from Rep. Peter King (R-N.Y.), the chair of the House Homeland Security Subcommittee on Counterintelligence & Terrorism, and a member of the House Intelligence Committee:
“President Obama is abdicating his responsibility as commander-in-chief and undermining the authority of future presidents. The President does not need Congress to authorize a strike on Syria.”
This is one of those remarkable moments when a prominent member of Congress urges the White House to circumvent Congress, even after many of his colleagues spent the week making the exact opposite argument.
The next question, of course, is simple: now that Obama is putting Congress on the spot, what’s likely to happen next? Now that the dog has caught the car it was chasing, what exactly does it intend to do?
Lawmakers, in theory, could cut short their month-long break, return to work, and consider their constitutional obligations immediately. That almost certainly won’t happen, at least not the lower chamber — as my colleague Will Femia reported earlier, House Republican leaders have said they’re prepared to “consider a measure the week of September 9th.” There are reports Senate Democratic leaders may act sooner, but no formal announcement has been made.
The dirty little secret is that much of Congress was content to have no say in this matter. When a letter circulated demanding the president seek lawmakers’ authorization, most of the House and Senate didn’t sign it — some were willing to let Obama do whatever he chose to do, some didn’t want the burden of responsibility. Members spent the week complaining about the president not taking Congress’ role seriously enough, confident that their rhetoric was just talk.
It spoke to a larger problem: for far too many lawmakers, it’s so much easier to criticize than govern. In recent years, members of Congress have too often decided they’re little more than powerful pundits, shouting from the sidelines rather than getting in the game.
It’s one of the angles to today’s news that’s so fascinating — Obama isn’t just challenging Congress to play a constructive role in a national security matter, the president is also telling lawmakers to act like adults for a change. They’re federal lawmakers in the planet’s most powerful government, and maybe now would be a good time to act like grown-ups who are mindful of their duties.
In his first inaugural address, Obama said, “[I]n the words of Scripture, the time has come to set aside childish things.” For the last four-and-a-half years, much of Congress ignored this call. Today, members received a striking reminder.
Yes, Congress is a hapless embarrassment. It can’t pass a budget; it can’t pass a farm bill; and it can barely manage to keep the government’s lights on. But institutional responsibilities don’t fade away just because radicalized GOP lawmakers are struggling through a post-policy phase.
There is a real possibility that Congress will simply decline to give the president the authorization he seeks. I suspect Obama will get the votes he needs, but note that Sens. John McCain (R-Ariz.) and Lindsey Graham (R-S.C.), two senators who never saw a country they weren’t tempted to bomb, issued a statement this afternoon that read:
“We believe President Obama is correct that the Assad regime’s use of chemical weapons requires a military response by the United States and our friends and allies. Since the President is now seeking Congressional support for this action, the Congress must act as soon as possible.
“However, we cannot in good conscience support isolated military strikes in Syria that are not part of an overall strategy that can change the momentum on the battlefield, achieve the President’s stated goal of Assad’s removal from power, and bring an end to this conflict, which is a growing threat to our national security interests. Anything short of this would be an inadequate response to the crimes against humanity that Assad and his forces are committing. And it would send the wrong signal to America’s friends and allies, the Syrian opposition, the Assad regime, Iran, and the world — all of whom are watching closely what actions America will take.”
In other words, McCain and Graham realize Obama is eyeing narrow, limited military intervention, and they’re outraged — they want a broader conflict with a massive U.S. role. They may well vote against a measure on Syria because it doesn’t go far enough in their eyes.
And that’s certainly their right. Others will oppose strikes for progressive reasons. Others still endorse the White House strategy.
The point is, the people’s elected representatives will have a debate, which is exactly what it should do. It won’t be pretty, but it’s how the United States is supposed to operate. Congress has clear responsibilities — whether lawmakers want them or not — and it’s time they exercise them.
By: Steve Benen, The Maddow Blog, August 31, 2013
“Humiliating Desperate People”: The Myth Of Welfare And Drug Use
Now, if you’re the kind of person who forwards apocryphal stories about voter impersonation and drug-addled welfare queens, this makes sense to you—obviously, if you’re on public assistance, you’re probably using drugs. But, if you’re the kind of person who takes facts seriously, this is a ridiculous idea.
While drug use is more common among women receiving welfare, the overall incidence rate is small; in one study, only 3.6 percent of recipients satisfied screening criteria for drug abuse or dependence. Among food-stamp recipients—another group targeted for testing—the rate is similarly low.
The myth of welfare recipients spending their benefits on drugs is just that—a myth. And indeed, in Utah, only 12 people out of 466—or 2.5 percent—showed evidence of drug use after a mandatory screening. The total cost to the state was $25,000, or far more than the cost of providing benefits to a dozen people. The only thing “gained” from mandatory drug testing is the humiliation of desperate people.
Which, judging from the GOP’s continued enthusiasm for the idea, is enough. In Ohio, for instance, state senator Tim Schaffer has introduced legislation that would establish a drug-testing program for the state’s welfare program. “It is time that we recognize that many families are trying to survive in drug-induced poverty, and we have an obligation to make sure taxpayer money is not being used to support drug dealers,” Schaffer said. “We can no longer turn a blind eye to this problem.”
If Ohio is anything like Florida, which also has a drug-testing program, Schaffer will find that the large majority of welfare recipients are neither drug users nor drug dealers. From 2011 to 2012, just 108 of the 4,086 people who took a drug test failed—a rate of 2.6 percent, compared to a national drug use rate of over 8 percent. The total cost to Florida taxpayers? $45,780.
The most colossal failure of this policy was in Arizona, which passed a drug-testing law in 2009. In 2012, an evaluation of the program had startling results: After three years and 87,000 screenings, only one person had failed the drug test, with huge costs for the state, which saved a few hundred dollars by denying benefits, compared to the hundreds of thousands spent to conduct the tests.
Of course, none of this has dampened enthusiasm for these laws, which is why Republicans in Michigan’s House of Representatives have passed a bill that requires tests if there’s “reasonable suspicion” a welfare applicant is using drugs or other illegal substances. Likewise, a Tennessee Republican in Congress wants to do the same. North Carolina lawmakers passed a similar law, but—in something of a surprise—it was vetoed by Governor Pat McCrory, who in a statement, said “This is not a smart way to combat drug abuse.”
It isn’t. It should be said, however, that the focus on cost and effectiveness obscures a broader point: Mandatory drug testing for welfare benefits is unfair and immoral. Drug use isn’t a problem of poverty; it’s found among all groups and classes. Indeed, if we’re going to test welfare applicants—who receive trifling sums of money from the government—it makes as much sense to test bailout-receiving bankers, loan-backed students, defense contractors, tax-supported homeowners, married couples with children (who receive tax credits), and politicians, who aren’t strangers to drug use.
In other words, if stopping waste is your goal, then drug screening should be mandatory for anyone receiving cash from the government, which—in one way or another—is most people. But Republicans haven’t proposed testing for church clergy or oil executives. Instead, they’re focused on the vulnerable, with schemes that would embarrass a Bond villain.
Trapped in its right-wing, anti-government mania, the GOP has become a party defined by its disdain for the poor, and esteem for the wealthy. It’s the reason Mitt Romney railed against the “47 percent,” built a convention around praise for “job creators,” and endorsed an agenda that reduces the debt by decimating social services. Indeed, when Republican politicians aren’t attacking the disadvantaged for their alleged lack of virtue, they’re calling for us to shred the “hammock of dependency,” as if low-income Americans spend their lives in comfort, resting on the government dole. To the Republican Party, a comprehensive health-care law—inspired by conservative ideas—is more offensive than a country where millions go without insurance and care.
In this GOP, at this time, it’s only natural that Republican lawmakers would go after welfare recipients. Since, to many in the party, they deserve it.
By: Jamelle Bouie, The Daily Beast, August 30, 3013
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