Rand Paul has another problem

• By Jennifer Rubin

Sen. Rand Paul (R-Ky.) 

(James Crisp/Associated Press)

In the spring of 2010 stories first swirled around Sen. Rand Paul’s certification as an ophthalmologist by an outfit called the “National Ophthalmology Board,” an entity he founded. This week I discovered that while he continues to present himself as “board certified” the NOB has been out of business since 2011, and in any event, does not under Kentucky law permit him to advertise as “board certified.”
In 2010 Rand Paul explained that he formed the board in 1997 along with 200 young ophthalmologists to protest a decision by the American Board of Ophthalmologists to grandfather those who were certified by 1992, but to limit certification for a ten year period for those first certified after that date. Rand Paul fell within the latter group. He found that decision “discriminatory” and unfair so he set up the NOB along with his wife and father-in-law to certify himself. Despite calling itself “national,” it appears to have operated purely in Kentucky. The board remained in operation until 2000, when it was dissolved. It was reinstated in 2005. Since the certification story broke, the NOB again dissolved in 2011.
However, it is not clear how that entity would have comported within Kentucky law. Michael S. Rodman, executive director of the Kentucky Board of Medical Licensure tells Right Turn, “The Kentucky Board of Medical Licensure does not  license physicians based on their specialty board certification nor is it a requirement for licensure. ” However, he explained that “Board does address specialty board certification  through our regulation on physician advertising.” Rodman confirmed that if a board is not on the list, then a Kentucky specialist is prohibited from advertising himself as board certified.  That list does not include the National Ophthalmology Board.
A physician in Kentucky and elsewhere can still practice without certification, but since the 1990′s the certification has become increasingly important in the medical field. Beth Ann Comber of the American Board of Ophthalmology tells me, “Board certification, and especially MOC [Maintenance of Certification] participation, by an ABMS-recognized board helps patients make more informed choices regarding their medical care. Today, the internet connects patients with a wealth of physician information, but it’s often difficult for patients to determine where the information on those sites comes from, how the ratings are determined, and where paid advertising stops and unbiased information begins. . . .Certification is voluntary, so physicians who make the choice to participate in continuous learning and quality improvement activities are doing so out of a personal commitment to high standards for their patients and their practice.” Moreover, “there are many hospitals, private practice groups, insurers, etc. that require board certification for staff privileges or leadership positions. Some medical specialty societies also require board certification for membership or offer a special class of membership for board certified physicians.”
Rand Paul continues to perform eye “surgery in his home state, often getting favorable media attention for performing free eye procedures. His profile on the website of the Tri-Star Greenview Regional Hospital, where Paul has privileges, includes the notation “Specialty Board Certifications: Ophathalmology.” Likewise on the Healthgrades  Web site where patients can locate physicians his entry reads: “Ophthalmology, Board Certified.”
Since 2005 Rand Paul has not been certified by any board recognized by the state of Kentucky, and since 2011 has had no certification since the NOB was dissolved. I asked Rand Paul’s staff a series of questions, trying to determine why he still held himself out as a “certified” ophthalmologist:

Did the National Board of Ophthalmology have examinations and/or continuing education requirements? If so, what were they?
How many doctors claimed certification through the NBO? Did they continue to do so or did they obtain American Board of Ophthalmology certification?
When it dissolved, did Dr. Rand stop presenting himself as “board certified”?
The Kentucky Board of Licensure’s list of approved accreditation boards does not appear to include the NBO so why did Dr. Rand believe he had the right under Kentucky law to advertise as board certified? Did he receive an exemption or opinion of some sort from the state licensure board?
Is he continuing to hold himself out as “board certified”?
Has he taken any continuing education since he was originally certified? Since 1997?

I got back a nonresponsive answer that recited his medical school and residency record. As to the certification issue, a Rand Paul spokeswoman would only say:

In 1997, Dr. Paul led a nationwide protest against the American Board of Ophthalmology’s decision to require recertification for younger ophthalmologists, but not for older ophthalmologists. Over 200 young ophthalmologists co-signed a letter with Dr. Paul to protest the policy. When ABO refused to extend their recertification policy to all ophthalmologists, the group formed a competing board certification group called the National Board of Ophthalmology.  The group administered its own certification exam for about a decade, but is no longer active.
NBO is a nonprofit corporation and all who took part were volunteers without salary. Dr. Paul has not profited in any way from this group.
The decade-long battle against a policy that the ABO did not make binding on all members is just another example of Dr. Paul’s willingness to fight against any law or rule that doesn’t include equal protection for everyone.

In refusing to answer the direct questions Rand Paul will prompt further inquiry as to whether he skated around Kentucky law, received appropriate continuing education and represented himself forthrightly to his patients, paid or otherwise. It is noteworthy that he says 200 people signed the letter; he does not confirm that any of them relied on the NBO certification.
Rand Paul is already under fire for plagiarism charges, and has reacted angrily to that story. (“It annoys the hell out of me. I feel like if I could just go to detention after school for a couple days, then everything would be okay. But do I have to be in detention for the rest of my career?”)  His reaction doesn’t bode well for presidential campaign-level scrutiny. At one point he told the New York Times, “To tell you the truth, people can think what they want, I can go back to being a doctor anytime, if they’re tired of me. I’ll go back to being a doctor, and I’ll be perfectly content.” If he does, he would be smart to get certified by the American Board of Ophthalmologists to be fully compliant with state law and give patients the reassurance he’s current on the latest developments in his field.
So long as he is a U.S. senator with presidential aspirations, however, he will need to respond calmly and honestly with controversies about his own actions and record. By providing so little information he guarantees continued scrutiny.

Study suggests politics of Obamacare could shift against GOP

Morning Plum: Study suggests politics of Obamacare could shift against GOP

By Greg Sargent 

November 5 at 8:55 am

 

 

Barack Obama (Reuters/Yuri Gripas)

Obamacare’s rollout problems have hit the White House with a political double whammy. The problems themselves feed a narrative, justifiably, about administration incompetence in managing Obama’s most important domestic initiative. Meanwhile, media coverage gives more weight to the “rate shock” and “losing coverage” storylines, because fewer have accessed exchanges — and fewer are aware of benefits such as subsidies to keep replacement coverage cheap.
But a new study released by the Kaiser Family Foundation suggests that if the website does get fixed, the politics of Obamacare could shift against its foes.
The study finds that roughly 17 million Americans will be eligible for tax credits to buy coverage in the exchanges, out of 29 million who might seek insurance from them. This includes those who are currently uninsured or are insured in the individual market. Estimating this is complex, because of multiple varying factors, but Kaiser employs a state-by-state analysis using 2012 and 2013 federal data.
Many experts believe the law will ultimately benefit significantly more people than it will hurt, because it will expand coverage to the uninsured and many who lose coverage will find the replacement cheaper thanks to subsidies and standards designed to minimize financial and medical risk from crappy coverage.
But now,  Obamacare’s foes have the advantage in the political argument. They can marshal knowable facts against the law: 300,000 Blue Cross and Blue Shield customers in Florida bumped!  Proponents must respond with predictions, or where possible, by pointing to people who may be finding a better deal, thanks to the law. This dynamic is heightened, as Jonathan Cohn notes, by coverage that downplays or ignores subsidies altogether.
But the Kaiser study suggests this could change. “Much of the discussion is now driven by anecdote,” Larry Levitt, a senior vice president at Kaiser, tells me. “There has been a lot of focus on sticker prices. But the fact is that most of the people buying in this market will be eligible for subsidies, and won’t be paying those sticker prices. We’ve lost sight of the people who will benefit from the law. As the website starts to work better, we’ll likely see more anecdotes on the other side.”
To foes, of course, this is largely beside the point. There is a legitimate policy argument at the crux of this battle: Many Republicans don’t believe the federal government should regulate the individual market, or spend money redistributively, in the fashion Obamacare aspires to, whatever the result. As Cohn says:

You can set higher standards for insurance, even though it means forcing some people to get better coverage. Or you can leave the standards as they are, even though those standards expose people to financial and medical calamity. Obama and his allies chose the former. Those who disagree should explain why they prefer the latter.

The latter could prove a tougher case to make over time. The de facto GOP position is to return to the old system, and polls suggest low public support for it. If those millions begin gaining subsidies, and Republicans begin to lose their advantage in the battle of anecdotes, the politics of Obamacare could shift once again.
Of course, the administration has to fix the damn website first.
*******************************************************************
 * A BAD OMEN FOR OBAMACARE? The Wall Street Journal is getting attention today with this:

Insurers say the early buyers of health coverage on the nation’s troubled new websites are older than expected so far, raising early concerns about the economics of the insurance marketplaces. If the trend continues, an older, more expensive set of customers could drive up prices for everyone, the insurers say, by forcing them to spread their costs around.

As it happens, the Kaiser study addresses this, too, concluding that it’s likely that those with a preexisting condition who have been excluded from the individual market will be among the earliest sign-ups, so this is expected. But if more “young and healthies” don’t sign up over time, that’s obviously a problem.
 * OBAMACARE WORKING IN KENTUCKY: Abby Goodnough has a good piece on how Obamacare enrollment is working just as it’s supposed to in Kentucky, including this anecdote:

The woman, a thin 61-year-old who refused to give her name, citing privacy concerns, had come to the public library here to sign up for health insurance through Kentucky’s new online exchange. She had a painful lump on the back of her hand and other health problems that worried her deeply, she said, but had been unable to afford insurance as a home health care worker who earns $9 an hour.       

Within a minute, the system checked her information and flashed its conclusion on Ms. Cauley’s laptop: eligible for Medicaid. The woman began to weep with relief. Without insurance, she said as she left, “it’s cheaper to die.”

As Goodnough notes, this demonstrates “how enrollment could work once the technical problems of HealthCare.gov are resolved.” That is, if they are resolved.
 * WATCH THE TEA PARTY/BUSINESS SPLIT IN TODAY’S ELECTIONS: Today in the Virginia gubernatorial election, Dem Terry McAuliffe is backed by some GOP-aligned business interests who shunned Tea Partyer Ken Cuccinelli. And in Alabama, there’s a House special election primary pitting a Tea Partyer against an establishment candidate backed by business figures who think the insurgent would harm the business climate, which both sides view as a “battle for the heart and soul of the national Republican Party.”
If McAuliffe wins, it will be seen as another clear case where the nomination of a Tea Partyer led the GOP to blow what should have been a winnable race.
* WHAT TO WATCH FOR IN VIRGINIA: As the Fix crew notes, keep an eye on McAuliffe’s margin among women, after aggressively attacking Cuccinelli over abortion, contraception and other issues important to them:

In 2009, Republican candidate Bob McDonnell was more trusted by women on such issues. Cuccinelli is unlikely to beat McAuliffe among women voters, but a losing margin larger than Mitt Romney’s nine-point deficit to President Obama in 2012 could prove insurmountable.

Also watch turnout among other constituencies increasingly important to the Democratic coalition of the future, particularly (as Ron Brownstein notes) given that McAuliffe ran a campaign emphasizing liberal social issue positions designed to appeal to them, even in a purple state.
* WHAT THE TEA PARTY HATH WROUGHT: Michael Gerson has a good one here:

Liberal Republicanism has essentially ceased to exist. This means that tea party conservatives are revolting against a more uniformly conservative party. The RINOs they hunt are actually an endangered species. So they have transformed tactical disagreements — over, say, a hopeless attempt to defund Obamacare — into defining ideological struggles.

And, of course, the Obamacare rollout problems — which have only deepened the Tea Party conviction that its epic collapse is underway — will only increase demand for more such intra-party defining ideological struggles later.
* FACT OF THE DAY, ENDA EDITION: The Employment Non-Discrimination Act cleared its first Senate hurdle late yesterday, and Jeremy Peters adds this:

Nondiscrimination legislation including sexual orientation and gender identity has languished in Congress for nearly 40 years.

And it will likely continue doing so, because John Boehner and the House GOP leadership is unlikely to even allow a vote on ENDA this time.
 * OPPOSITION TO ENDA IS SOFTENING: With ENDA unlikely to get a vote in the House, Paul Kane makes a smart point:

Most opponents, including Boehner, have focused their concerns on allegations that the legislation would benefit trial lawyers and have shied away from the morality and family-values questions that once dominated the issue.

And yet, social conservatives still appear to wield enough sway over GOP leaders to block a vote from happening at all, at least for now.
* AND GOP CAN ONLY STAND ATHWART HISTORY FOR SO LONG: Roll Call’s David Hawkings has a terrific look at the Congressional politics of ENDA, with proponents so confident of long term victory that they will not drop the current proposal’s transgender protections:

Advocates of the bill — which would outlaw workplace discrimination against gay, lesbian, bisexual and transgender people — are working to create something of a self-fulfilling prophecy: The metaphoric arc of history is bending so quickly toward this measure of justice that, by the time midterm Election Day arrives in one year, Republicans in close races will appear dangerously out of touch unless they have become part of turning ENDA into law….the gay rights community now looks united behind a strategy of waiting for the comprehensive victory it is confident will come before too long.

What else?

Americans not ready to give up on Obamacare

The Morning Plum: Americans not ready to give up on Obamacare

By Greg Sargent November 1 at 9:14 am

The Plum Line

 

President Obama (Reuters /Brian Snyder)

With Democrats continuing to grow more skittish about Obamacare’s awful rollout problems, the Kaiser Family Foundation is out with some important new polling that deserves a careful look from Dem Congressional officials — and political commentators.
The most important finding in the Kaiser poll — which is in some ways the gold standard of health care polling — is that significantly more Americans want the Affordable Care Act kept or expanded than want it repealed and replaced with a GOP alternative or with nothing at all. Here’s the key finding:

What would you like to see Congress do when it comes to the health care law?
Expand the law: 22
Keep the law as is: 25
Repeal the law and replace it with a Republican-sponsored alternative 13
Repeal the law and not replace it: 24

A total of 47 percent wants to keep or expand the law, versus 37 percent who want to replace it with a GOP health reform plan or scrap it completely. This poll was taken October 17-23, more than two weeks after the problem-plagued rollout began (though in fairness, before the “you can keep your plan” furor blew up).
How is it possible that more Americans want to stick with the law, when it’s obviously (as Republicans and some commentators say) such an epic disaster, both in policy and political terms alike?
The answer lies in the way the question was asked, and this has important larger implications. Kaiser’s line of questioning may be the best out there at shining light on what people really mean when they say they either support or oppose the law (a plurality of 44 percent view it unfavorably), and what they really mean when they say they want to get rid of it. If anything, the question is generous to Republicans, because it offers respondents the choice of an unspecified generic Republican alternative. Ultimately, what this finding suggests is that, whatever their dissatisfaction with Obamacare, people do not want to return to the previous system, and perhaps more crucially, do not believe Republicans are offering a serious alternative. Indeed, only 13 percent favor repeal and replace, GOP style.
This is a useful depiction of the current political and policy situation. It’s true Republicans have offered alternatives to Obamacare. But there is no Republican consensus position on health care reform. Republicans probably can’t pass their ideas through the House and certainly can’t pass anything that would ever become law. Among GOP voters, the Kaiser poll shows a split: Only 29 percent of Republicans want repeal and replace, versus 42 percent of Republicans who want to scrap the law and replace it with nothing.
In other words, the de facto GOP position is to go back to the old system. Rather than do that, more Americans want to stick with Obamacare. (Yes, this is one poll. But this pattern — more prefer “keep and change” or “keep and fix” versus doing away with it entirely — goes back years in fine-grained polling.)
Could this change, if the “sticker shock” and “you can keep your plan” controversies take hold, as Republicans hope? Sure. And if the law’s problems continue into the new year, this could imperil the law’s long term prospects and turn into a full blown political debacle for Dems. But right now, the basic nature of the big choice voters face on health care reform remains clear. For the time being, it continues — improbably, perhaps, given the current political furor — to favor Obamacare.
* THE BIG CHOICE ON OBAMACARE: Jonathan Chait goes deep into the basic tradeoff that the law’s overhaul of the health care market requires, explaining why “letting people keep their insurance” would undermine that tradeoff. This:

People accept this transfer from the healthy to the sick because it is the only way to make medical care affordable to the sick…If you believe the healthy are entitled to keep the financial benefits of their good health, then you must also believe the sick must be denied medical care. Should that principle be the foundation of our health-care system?

As Chait suggests, this is the moral choice the law asks folks to make. The above polling suggests it’s possible people are prepared to make this trade. Republicans will argue that once more people clearly understand the true nature of this choice, they’ll want to get rid of it. Related to this is the question of how many people will pay more, and how many will benefit. We’ll just have to wait and see.
* DEMOCRATS NERVOUS ABOUT OBAMACARE PROBLEMS: The New York Times leads with a big story reporting on anxiety among Democrats, particularly those up for reelection in 2014, about the problems plaguing the Obamacare website. Their worry:

The politics of the rollout are coming into clearer focus by the day. Democrats emerged from the government shutdown Oct. 16 sure that they would be the political beneficiaries of a Republican brand that took a beating from voters tired of the brinkmanship. But the problems with the website are sending Democratic reputations plunging along with those of their adversaries.

The fact that Dems are proposing various delays is a political problem for the White House, but all that really matters in the long run is whether the website get working again. This maneuvering among Dems is unlikely to force a delay in the law. Failure to fix the website will.
* EMERGING BELTWAY NARRATIVE ON OBAMA’S COMPETENCE: Charlie Cook says the Obamacare rollout problems and NSA spying revelations are putting Obama at real risk:

What makes these problems more troublesome than some other controversies is that they go to the question of Obama’s competence, rather than to differences of policy or ideology. On policy disputes, one side may like a decision and the other may dislike it, often resulting in a political wash. However, competence issues cut across the partisan and ideological spectrum, and they can have a real impact on independents and moderates…While it is certainly understandable that no president is clued in on all of the sources and methods of various intelligence agencies, the fervor surrounding the surveillance issue has risen to the point of comedic fodder.

It’s still possible the law could fail long term and turn into an extended political debacle for Dems. But as noted here yesterday, this could cut both ways: If the law works, those independents and moderates could continue to see the GOP as an intransigent obstacle to constructive governing.
 * THE MASSACHUSETTS HEALTH CARE PRECEDENT TO OBAMACARE: Glenn Kessler has a deep, deep dive into the question of whether slow early enrollment in Romneycare is relevant to the current situation, where enrollment is also likely to be slugginsh at the outset. If you want all the facts, this is a good place to start.
Clearly there is some real relevance to the current situation, and clearly, it’s very possible most enrollment in Obamacare will occur very late in the process. But unfortunately, any such historical context is likely to be overlooked if early enrollment figures are low, and the coverage will continue to be brutal.
* MORE ON THE TEA PARTY/BUSINESS RIFT:  Keep an eye on this special primary runoff election in Alabama, where business is sinking big money into a battle between the business establishment’s candidate and a Tea Party opponent. A similar rift is already on display in the Georgia Republican Senate primary. I’m skeptical that the business community’s alliance with the GOP will be seriously compromised, even if the party remains in the grip of Tea Party elements. But many on both sides of this battle seem to see it an indicator of the future direction of the GOP, so it bears watching.
* ANOTHER ‘NUCLEAR’ STANDOFF LOOMS IN SENATE: With Republicans blocking two more nominees — Mel Watt to the Federal Housing Finance Agency and Patricia Millett to the D.C. Circuit Court of Appeals — Senate liberals are again pressing the Democratic leadership to revisit rules reform. Remember, in the resolution of the last nuclear crisis, Dems reserved the right to revisit the rules if GOP obstructionism continued.
Also, it bears repeating: Senate liberals are not calling for a complete elimination of the filibuster on everything, including legislation. They are calling for doing away with it on executive nominations, i.e, the President’s picks to run the government.
* THE GOP ‘WAR ON THE POOR’: Paul Krugman’s column today argues that a primary motivator of GOP policy positions today, particularly on Obamacare, is the base’s panic about a nation of takers allying with the Democratic Party to transform the country. Key nugget:

All of this hostility to the poor has culminated in the truly astonishing refusal of many states to participate in the Medicaid expansion. Bear in mind that the federal government would pay for this expansion, and that the money thus spent would benefit hospitals and the local economy as well as the direct recipients. But a majority of Republican-controlled state governments are, it turns out, willing to pay a large economic and fiscal price in order to ensure that aid doesn’t reach the poor.

In this telling, opting out of the Medicaid expansion isn’t about fiscal responsibility or any other serious policy rationale; it’s about who would benefit from the expansion.
* THE NEXT GOP ATTACK ON OBAMACARE: Related to the above: Sarah Kliff reports that thus far the vast majority of enrollees to Obamacare are those who are taking advantage of the Medicaid expansion. Note this:

The yawning gap between public and private enrollment is handing Republicans yet another line of criticism against President Obama’s health overhaul — that the law is primarily becoming an expansion of a costly entitlement program.

Expect a lot more of this. The GOP base just laps up this kind of stuff, but does the middle of the country see it in these terms?
* AND HAS THE LEAKER OF ROMNEY’S TAX INFO BEEN OUTED? The new book on Campaign 2012 by John Heilemann and Mark Halperin is out, and it reports that Jon Huntsman Sr. was the secret source for Harry Reid’s claim that Mitt Romney didn’t pay income taxes for 10 years. At the time, Huntsman insisted to me that he was not the leaker. I asked him repeatedly, and he repeatedly denied it.
What else?