Paul talks health care in roundtable setting

Commonwealth Journal (Somerset, KY)

Aug. 08--There's one topic that's on everyone's lips these days, and Kentucky's own opthalmologist-turned-U.S. Senator was in town Monday to talk about it. Republican Sen. Rand Paul of Bowling Green flew into Lake Cumberland Regional Airport for a little under an hour to speak about the ongoing struggle to find a health care bill that Congress can agree upon. Paul spoke to a roundtable of about 20 notable local figures from various sectors -- business, government, education, the Chamber of Commerce, and more -- on his ideas about how to fix a health care system that Republicans have decried as broken since the advent of "Obamacare" but have thus been unable to repair through legislation in the early days of the Donald Trump administration.

The Somerset stop was one of five on the day, along with Pikeville, Hazard, Middlesboro and Campbellsville, the latter where Paul was headed after the meeting.

Paul, in his typical style as a liberty-minded policy wonk, advocating market-based ideas over big government, had a lot to say, both on his own and in reply to those at the table. Following are a selection of his statements from Monday's event:

--On Kentuckians without insurance under Affordable Care Act's individual mandate:

"If you do a survey and say, 'Why don't they have it?', 50 percent of them say they don't have it because it's too expensive. We have 50,000 people in Kentucky who don't have insurance and ... get punished for it. They pay the individual mandate fine, and still don't have insurance; 50,000 people pay $16 million in fines. Half of them make less than $25,000 a year. There are still poor people paying a tax and not having insurance."

--"The main problem is this: (President Barack Obama) said, 'I want everybody to have good insurance. I don't want them to have inadequate insurance, so I'm going to put down these mandates on insurance, and these mandates are going to say what insurance must include.' ... I don't think he thought through that it costs money to add that."

--"They call it 'adverse selection.' The people buying insurance are really sick and they really need it, and the young, healthy people are like, 'This is too expensive. I'm going to wait and get it after I get sick.' So everybody in the pool becomes very sick, and that's the 'death spiral' they've been talking about over Obamacare. Premiums have doubled."

--On his party's-backed health care plans that haven't been successful:

"One of the Republican plans that I didn't vote for had a $280 billion fund for the insurance companies. I'm not really inclined to have the government give any private business money, much less industry that makes $15 billion a year already. Before Obamacare, they made $6 billion; after Obamacare, we mandated insurance ... now the profits are $15 billion, but they still whine and say, 'Oh, we can't make any money in the individual market.' So they doubled the rates for people who were in the individual market -- 100 percent increase in the last six years -- and now in America, 50 percent of the individual market has only one insurance company, 50 percent of the counties have only one insurance company, so they're getting monopoly prices, basically."

--"They put forth a plan, they call this 'insurance stabilization fund.' They're acknowledging that they're not going to get rid of the fundamental flaw of Obamacare, the adverse selection. They're just going to subsidize it by dumping this money in ... Look, you could do this for anything then. New cars are expensive; why don't we do a new car stabilization fund, in which we'll put $200 billion from the taxpayer? It will lower the (price for) everybody who wants to get a new car. ... We could do it for iPhones, college tuition, there would be no end in sight if we think the government's role now is to collect all the money to put it in something to get something at a cheaper price. Really, what we need is (to figure out) how come TV's are so cheap? Figure out how the market works in electronics and most things and get health care to work that way."

--Paul's idea on individuals joining an association, initially speaking to Terry Tuttle, owner of Baxter's Coffee:

"Instead of you buying insurance with your family, what if you join the National Restaurant Association, and there's 15 million people in the association. ... You'd be bigger than Wal-Mart. You'd be bigger than Toyota or General Motors. You'd be probably 10 times bigger than the largest corporation in America. All it takes is legalizing it; it doesn't cost any money. It just means legalizing the ability of associations across state lines to sell insurance."

--On the opportunity to push forward a plan with free markets:

"Last week, I spoke to the president on Monday, then went to the White House on Tuesday and spoke to the Department of Labor. I think that they can do this on their own. ... They've actually overly narrowly interpreted the law. We think they can have a more expansive definition of what an association is. The president is very interested in this, so we may get this done by executive action in the next week or two."

--"There are three things we don't have insurance on at all: LASIK surgery, contact lenses, and plastic surgery. Price goes down or stays stable every year. LASIK surgery went from $2,500 an eye to $250 an eye over about a 15 year period, because people pay cash and competition works."

--In response to a question by Mike Noftsger of Forcht Bank about getting able-bodied people off of Medicaid care in Kentucky:

"If we as a state decide we want to give these people health insurance at no cost, we should say, 'The only way to do this is to double the state income tax.' But then you see the downside of it ... We go to a 12 percent state income tax, we get Medicaid for 400,000 new people who are able-bodied, and then what happens to business here in the state? I'm guessing some of them might go to Tennessee where there's 0 percent income tax. The best way to make policy is to make sure you know what the penalty is for your policy."

--"We're all alarmed at opioid use. ... You know what the no. 1 corollary to where the drug problem is? Medicaid expansion. If you look at a map of Kentucky and say, 'Where is the opioid problem the worst?', it's where Medicaid has expanded the greatest. ... Now they can get their Oxycontin and stuff for free."

--"The battle's not over with the insurance. I think it's going to go on. I do think that it's going to get worse over the next six months, the Obamacare, because of the death spiral in the individual market, where insurers are leaving and quitting selling insurance ... I think the price is going to continue to go up through the roof and something is going to happen. ... I think they're going to do just the bailout of the insurance companies, and I don't think it fixes any of the problems. ... I think there's going to be enough Republicans and Democrats who sometime this fall or maybe in the spring will bail out the insurance companies. They're going to complain that they're not going to sell to people anymore in the individual market unless we give them money, and that's already what they're asking for. That, to me, is sort of the epitome of 'crony capitalism.'"

--In response to a question from Lake Cumberland Regional Hospital CEO about deregulation harming his hospital's reimbursements and financial health, and how Medicaid expansion has been beneficial to the hospital:

"The answer really isn't ultimately having everybody on Medicaid -- if you were 100 percent Medicaid, you would lose money, and wouldn't be able to survive. We end up having a skewed perception. Everybody wants to help people ... so we'll give everybody Medicaid, but really what we want to have is everyone on private insurance. We want them to have a job and private insurance. So we need to figure out what our goal is, which direction we're going."

--After talking with Judge-Executive Steve Kelley about what the unemployment rate in Pulaski County is (about 5.2 percent):

"That's 95 percent of people working, but it's really not quite that good, because you don't count the people who have fallen out of the work force. They talk about the overall job participation rate, it's like 62 percent for the country. We've got a problem in Kentucky in the sense that we're at least that low or lower. We've got a lot of people who just permanently don't work. I think we need to mix a little bit of tough love in with trying to help people. ... Gov. (Matt) Bevin's talked about a work requirement for the able-bodied portion of Medicaid, and I think absolutely. I'd do it for everything. ... Not as punishment, more as reward, because (work) is where we get our self-esteem. It doesn't matter what your job is, that's how you become who you are, is through your work."

--"I think we can take care of our poor, but traditionally the poor have been 5-10 percent, at the most, of the public. The poor aren't supposed to be 30, 40, 50 percent. You're not defining what 'poor' is accurately if half of your community is poor."

--"You've got a fork in the road. We can go toward what made America great, or we can go toward what made Europe lousy. What made Europe lousy was big government socialism. They control everything. What made our country great was basically freedom. Where do we get the idea that someone should tell you that you should get insurance and what should it be? Once upon a time, the buyer and the consumer decided things, and we were driven by the freedom of choice. Because of that, we became the richest, freest nation ever in recorded history."

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