Taking a Stand

by Rand Paul

  With Dr. Bowers, I operated on a grandfather who would see his grandchildren and a red berry bush outside of his house for the first time in years. I operated on a middle-aged woman who couldn’t afford health insurance. After the surgery she wrote: “Thank You Sen. Paul” on the rear window of her car with white shoe polish as they do with “Just Married” and rode around like that for a week. Dr. Bowers told me that she then added “Thank You Dr. Bowers” on the window, after Barbara performed a second surgery, a week later.

  Of all the surgeries we performed, maybe the most poignant story belonged to a vet who Barbara Bowers told me was living in a homeless shelter. This was in May 2014, right when the VA scandal broke and Eric Shinseki resigned. An internal review had found misconduct in nearly two-thirds of VA facilities, and thousands of veterans across the country have been impacted by long wait-times that were covered up by Veterans’ Hospital Administration officials.

  The people who think that the government can efficiently distribute medicine need to explain why the VA, a much smaller system, has been struggling for decade after decade.

  In order for this veteran to get treatment for his cataracts, he would have had to wait for months, and then travel a few hundred miles to a VA hospital in St. Louis for the operation. He was homeless. How could he afford to get there? Even if he could find a way, he’d either have to live for weeks in a shelter in St. Louis or on the streets of a city he didn’t know in order to make the appointments and follow-up for both eyes. Instead, he was resigned to going blind.

  Which, for all intents and purposes, he was when he walked into Dr. Bowers’s office. The surgeries restored his vision to almost 20/20. The last I heard, he was no longer living in the shelter. Dr. Bowers tells me he now has a car, a job, and his own roof over his head. I believe we have a lifelong commitment to our vets. As president, it would be a top priority of mine to fix the wait lines at VA hospitals. I think, however, that can only be done when we overhaul the whole health-care system. It’s my belief that a free market health-care system would take care of our veterans and the indigent too.

  Doctors from the United States like Barbara Bowers have been performing charity work since Benjamin Franklin’s day. As soon as doctors are granted hospital privileges they have to agree to cover the emergency room for people who don’t have insurance. There are doctors who give much more than I have. As of this writing, some two thousand medical professionals in the States have signed on to volunteer in Liberia and other Ebola-stricken African countries.6

  But there is also plenty of medical help given right here in America, and it’s given in a quiet, unpretentious way. In 1925, Helen Keller addressed the Lions Club International convention, a moment that began nearly a century of the Lions Club helping the world’s blind. A quote from that speech hangs in my Senate office: “It is because my teacher learned about me and broke through the dark, silent imprisonment which held me that I am able to work for myself and for others,” she said. “It is the caring we want more than money. The gift without the sympathy and interest of the giver is empty. If you care, if we can make the people of this great country care, the blind will indeed triumph over blindness.”

  America has a big, generous heart, and that heart beats because of a free market. Let’s get government out of health care and allow what we do best to distribute health care to the greatest number of people. Government-controlled health care drives us toward bankruptcy. The freedom of the marketplace ensures solvency.

  A New Approach

  How would that look? Well, the first priority would be to get government out of the business of setting prices. The Sustainable Growth Rate, or SGR, is a policy created by Congress in 1997 that was supposed to tie Medicare payments to physicians to the country’s economic growth—sort of like cost-of-living increases. But Medicare payments far outpaced the economy, so every year, and sometimes more than once a year, Congress has to pass something called a “doc fix” to free up enough money to cover the shortfall. The policy was flawed from the start, and yet here we are seventeen years later still putting plugs in a bucket that has more leaks than the NSA. It’s time for a new bucket. End the SGR, the government system that sets fees.

  The disappointing truth is that wasteful spending in Washington has drained the Medicare trust funds. The combination of massive debt, fewer active workers, and more retirees is pushing Medicare into bankruptcy. Medicare is unfunded by nearly $40 trillion. Simply put, this is an unsustainable path, and Obamacare is not the answer. In fact, Obamacare has borrowed money from Medicare to cover its cost. Washington cannot continue to promise everything to everyone without a plan to pay for it.

  My plan is simple. We could still have a federal Medicare system to pay for our seniors’ health care. Every senior would be covered. No one could be turned down, and it would deliver top care without some of the frustrations people have with the current system. In the current system, there are two problems. Government is the only “insurance” you can get, and the system is estimated to be $35 trillion in the hole over the next few decades.

  It is simply not sustainable. Not just our children, but possibly those of us who are in our fifties may see a broken, unreliable, costly, and ineffective program if we don’t look for a new path.

  Doctors are already dropping off the Medicare payment rolls. More will follow. Seniors will be left with bigger bills and fewer options.

  Instead, I want to put some competition back into the system, and I want to make sure seniors can choose from the best health-care plans in the country.

  Before Obamacare, the best plans in the world were the ones your congressmen and senators got. These plans are still available to many federal employees, including the president and his staff.

  Why not let every senior have these plans? Federal employees choose from more than 250 different insurance plans.

  The federal health-care plan is less expensive than the current Medicare plan because it is not administered by government bureaucrats. My plan would save taxpayers $1 trillion over the next ten years and reduce Medicare’s unfunded liabilities by almost $16 trillion. Individual seniors will save thousands of dollars from their personal health-care budgets each year while receiving more generous benefits.

  The Federal Employees Health Benefits Program (FEHB) describes an array of insurance options available to 4 million federal employees and their dependents, roughly 10 million people. The government pays about three-quarters of the total costs of insurance plans chosen by beneficiaries based on their individual needs and preferences.

  Like Medicare, FEHB is a regulated marketplace where plans cannot deny coverage to anyone for any reason. Everyone within the plan will pay the same premium regardless of health status or preexisting conditions.

  This program also makes it easier for insurance plans to enter the market to compete for seniors’ business—including allowing employers to continue covering seniors through retirement.

  With my plan, all Medicare-eligible patients could enroll in FEHB as if they were federal employees, and willing employers can give eligible patients the option of staying on their current plans and still receive the government’s contribution.

  To make this fiscally possible, the initial eligibility age for seniors will be increased gradually from sixty-five to seventy over a period of twenty years, and the benefits will be means-tested. However, no current or near-term enrollees would have their eligibility delayed. If you are near retirement, this will not apply to you.

  Medicare as we know it is broken and in desperate need of reform. It simply cannot survive without a careful fix that helps both the patients and the taxpayers.

  My plan fixes the Medicare system and gives seniors access to the best health-care plans—those that used to be offered to members of Congress—and does so without breaking the bank. Seniors deserve to have a world-class health-care system, and U.S. taxpayers deserve to have their dollars put to better use in a system that will not eventually bankrupt the coun
try.

  Giving seniors the same plan that top-level federal employees have is fair, and it saves $1 trillion over ten years. This commonsense reform is the solution to putting Medicare on a sustainable path for our kids and grandkids.

  Next, for non-Medicare citizens, my plan would let consumers decide what kind of insurance they want and where they want to purchase it. The idea of choice should be given back to the American people. It is ridiculous to require everyone, from single twentysomethings to sixty-year-old empty-nesters, to purchase federally mandated insurance plans that cover care they do not need or want, such as pediatric dental coverage for children they don’t have. True freedom of choice would let patients buy any type of insurance they want, including inexpensive catastrophic care insurance.

  When we were young, this was the type of insurance my wife and I purchased for our family and ourselves. We did the math and paid for our routine care out of pocket, which for us, as it is for most young people, was minimal. Our health insurance was true “insurance” against an accident or major illness, not prepaid medical care. We saved tens of thousands of dollars over the years by doing this. Shouldn’t every American get to decide how much they want to spend on insurance? Why should the government determine that?

  We need to keep our eye on the ball. What we have isn’t working. It’s important for Republicans, myself included, to not just oppose Obamacare but to present compelling ideas for replacement.

  My health-care plan would bring a real marketplace to health-care delivery. Tax-free savings accounts are a big part of this. I have long supported making all medical expenses tax deductible, allowing insurance to be bought across state lines, state-level tort reform, and empowering all citizens to save for health expenses by removing the high-deductible insurance policy requirement for access to health savings accounts.

  Allow the marketplace to work in health care; allow the purchase of insurance with lifelong tax-free savings accounts. Health savings accounts, started at birth, could accumulate to such remarkable levels that health insurance costs would plummet. It could be similar to the cost of term life insurance policies.

  My plan wouldn’t forget the poor: I know there are people who can’t afford health insurance, and some who are in desperate need of care right now. It’s not my intention to ignore the needs of those individuals. Besides having taken the Hippocratic Oath, I’m a Christian, and I have a deeply held belief that we help those less fortunate than ourselves. If we don’t try to fix the problem in the system, then the less fortunate will always be less fortunate. If we properly reform the system, we will have more funds left over for those who truly need help.

  For the exceptions to the rule, for those who live in poverty or are afflicted with expensive chronic medical conditions, helping them would fall both on charities and the government.

  “The proper conservative reaction is not to imagine a government stripped of public obligations when it comes to the health of citizens,” Michael Gerson and Peter Wehner wrote in an article in National Affairs. “It is to propose an alternative health-care plan that doesn’t centralize all power in Washington and that keeps costs down, solves the problem of insuring those with pre-existing conditions, and reduces the number of uninsured.”

  My health-care plan would do just that. It would also bring something very special back to the American people, something that Obamacare stole from them—the freedom of choice. That’s the health-care platform on which I stand.

  4

  Getting to Work

  In Washington, they can’t conceive of reducing the annual deficit, much less attacking the debt, and at home the people are ready and eager to attack both deficit and debt.

  After I was elected to the Senate in November 2010, I lived part-time in my father’s Virginia condominium. Like most adult children, I hadn’t lived with my parents for a long time—more than twenty-five years. My dad was still a congressman and weighing the decision of running for president again, and I was the freshman senator-elect from Kentucky, trying to get the feel of how things worked in the Senate. In one of our joint interviews, my dad, invoking the long-held rivalry between the upper and lower chambers, joked, “Yeah, if he behaves himself and works hard maybe someday he could serve in the House, too.”

  My time living with Dad was fun for both of us, I think. I’m pretty sure it was the first time in history that a son served in the Senate and a father served simultaneously in the House. Of course, the press made all sorts of comparisons. I remember one political cartoon in particular that poked fun at Dad’s economic philosophy.

  The first frame showed my father and me in the kitchen. “Dad, let me write you a check for rent,” I said in the cartoon balloon. “Son, we only accept gold and silver around here,” Dad replied. The next frame had me telling my dad I was going to the store and asking if he had anything to add to my grocery list. “Son, we don’t believe in central planning around here,” Dad said.

  Perhaps the sharpest comparison was made on the baseball field. Every year, Congress plays a charity game that pits Democrats against Republicans. Dad is a great athlete. In high school, he was the Pennsylvania state track champ in the 220. I grew up playing most sports and was pretty good at several, but a standout at none.

  The Congressional Baseball Game is now held in Nationals Park but it used to be played on a Triple-A field in Virginia. It was there that my father hit a home run out of the stadium, the only member of Congress to ever do so. The feat landed him in the Congressional Baseball Hall of Fame. He was inducted in 2012 in a pregame ceremony. Dad threw out the first pitch and I caught it.

  In the annual game, players wear uniforms representing their home states. My dad was wearing his old 1970s Houston Astros uniform and I was wearing the uniform of Western Kentucky University, which is in my hometown. I must admit my colleagues were a little disappointed. “How come you’re not as good as your dad?” was a common razzing I heard that night.

  Not that I’m being defensive about it, mind you, but the Democrats have a ringer—Cedric Richmond, the congressman from New Orleans who pitched varsity for Morehouse College (okay, maybe I am being a little defensive about it). I struck out my first year against the Democrat ace but got a single the next year—not that anyone’s counting. The game benefits the Boys and Girls Club of D.C., and is one of the best bipartisan events in Washington. My dad always joked that if we played more baseball and did less legislating, the country would be in better shape. He might have a point.

  I lived with Dad for a just a couple of months. I just couldn’t take the traffic on the 14th Street Bridge. I imagined all of those lost hours commuting. I decided to rent a small apartment on Capitol Hill. I wanted to be within walking distance of my office. I was eager to get to work.

  I will never forget seeing the Senate Chamber for the first time and learning the history of the desks, including those of Daniel Webster and Jefferson Davis. The desk Davis sat at still shows a mark from a Union soldier’s bayonet after the senator from Mississippi left it to lead the Confederacy. In the desk drawers are hand-etched signatures of those who have occupied the Senate through the ages—though some are said to be forgeries.1

  I was given Henry Clay’s desk. Traditionally, the Clay desk was passed down through the years to the senior senator from Kentucky. Since Mitch McConnell was then, and is again, the Senate leader, the Clay desk came to me. When Joe Biden swore me in, he told me that Clay was only twenty-nine when he became a senator, which was under the minimum age of thirty set by the Constitution.

  The age minimum for the House is twenty-five, and you can read into that if you want. Perhaps the Framers thought the additional five years would afford the senators more worldly experience and knowledge. Whether that’s held true is anyone’s guess. Perhaps Edward Everett Hale, the chaplain of the Senate in the early 1900s, summed up the collective knowledge of the Upper Chamber best. He was once asked if he prayed for the senators. “I look at the senators,” he purportedly answered, �
�and pray for the country.”

  There is likely no legislator from Kentucky more famous than Henry Clay. He served as both the Speaker of the House and president of the Senate. He ran for president of the United States four times and, in 1844, nearly bested James Polk. He was Secretary of State for John Quincy Adams. After his death in 1852, he lay in state in the Capitol Rotunda, the first person on whom that honor was bestowed.

  Henry Clay was called the Great Compromiser. During my orientation, one of my Senate colleagues asked me with a touch of irony and a twinkle in his eye, “Will you be a great compromiser?”

  It was a question I would often wrestle with.

  To me, Henry Clay’s life story is, at best, a mixed message. His supporters argue that he rose above sectional strife to carve out compromise after compromise trying to ward off civil war. In their book, Henry Clay: The Essential American, David and Jeanne Heidler write that Abraham Lincoln admired Clay “more than he did any other man on the American political scene.”

  Clay’s detractors contend that his compromises were morally wrong and may have even encouraged war. They say that during fifty years of public life, he not only embraced slavery—he owned forty-eight slaves—but supported the Fugitive Slave Law until his death. Henry Clay also compromised on the extension of slavery into new states. He was the deciding vote in the House to extend slavery into Arkansas.

  In lionizing legislators like Henry Clay, writers sometimes attempt to mitigate their subject’s faults by arguing that they were simply men of their time. That doesn’t make it right.