Reason Writers Around Town: Shikha Dalmia on the Tea Party and the Prospects for Entitlement Reform


In her latest Forbes column, Reason Foundation Senior Analyst Shikha Dalmia digs into the campaigns of prominent Tea Party candidates and finds that they are more serious about entitlements than entitlement reform. These candidates came out guns blazing against out-of-control federal spending. But when it comes to doing something about the biggest culprit in this spending—Medicare, Medicaid, and Social Security—they have turned from macho to mush. The most distressing switcheroo, she notes, has been pulled by the apostle of limited government and free markets himself, Kentucky's Rand Paul. As Dalmia writes:

A doctor himself, he denounced Medicare as socialized medicine. Yet he has balked at the idea of cutting physician salaries, even though American physicians make twice as much as doctors in OECD countries. Why? Because their cartel, the American Medical Association, both restricts the supply of physicians through insanely restrictive licensure requirements and controls the Medicare board that determines physician compensation, as the Wall Street Journal reported this week. Yet, Paul now maintains: "Physicians should be allowed to make a comfortable living." (But he is just being fair—not pleading for his special interest of course!)…

Read all about it here.

NEXT: Boehner on Medicare Cuts: No Thanks!

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  1. So Rand Paul is a hyopcrite. Big deal. His old man is a fucking racist scumbag. At least Rand Paul would have voted for the Civil Rights Act.

    1. Please, for the love of God, don’t feed it.

      1. Feed what?

        Also, I didn’t hear/read/see anything. It’s like the first post on this thread is void of all substance.


  2. Hooking up with Christine O’Donnell:


    1. When her underwear came off, I immediately noticed that the waxing trend had completely passed her by. Obviously, that was a big turnoff,

      So, what is this metrosexual complaining about here? That she had more hair than him?

      1. It’s just more liberal whining about Bush.

        1. It’s a good day when someone can make you actually laugh out loud.

        2. Can anything come close to topping this for 2010 comment of the year? No chance.

    2. The guy who wrote that article is a creep and a fucking coward. I hope someone else who was there plasters his image and name all over the motherfuckin’ intertubez.

      1. You forgot to add liar. 0% chance that’s how things went down (or not in the bedroom). Oh, this girl was so aggressive, and came over, and threw herself at me, and asked me to bed. I didn’t take a single action until I saw her nasty bush, and then I went to sleep. Anyone who believes this story is an idiot.

        Want to know what really happened? This guy hooked up with a pudgy cougar. Sex was not consummated. Pudgy cougar runs for Senate, and this turd thinks he can make a few bucks selling some pics to Gawker.

        Seriously, there are like 20 pictures on that site. I haven’t taken 20 pictures all year. This guy was all over O’Donnell that night, he’s just too embarassed to admit it.

        1. The dickhead in the boy scout uniform edited himself out of the photos. So who took the photos? And how did this guy get them?

    3. “The costume that I wore for the Halloween a year before?a boy scout’s uniform that belonged to a friend?was still sitting in my closet.”

      Epic Fail. The guy is clearly gay.

    4. I’d hit that.

  3. Politicians say things to get elected. I blame us as much as them for this expediency. Let’s see what he does after he takes his seat.

    1. Oh yeah, politicians usually become more corageous after they take office, LOL!!

      1. No, they almost never do. But an ace of clubs can dream, can’t he?

  4. I’ll get slammed for this, but I would like to point out that the states set the licensing requirements for medical professionals. Different states allow non-physicians to prescribe medications. Osteopathic physicians operate outside of the AMA. No physician is required to be a member of the AMA to practice.

    A cartel? Please.

    1. It’s not that physicians have to be members of the AMA, it’s that the AMA basically calls the shots on who gets licensed, whether that power is exercised by the state or not.

  5. Sadly, this is not exactly surprising. The complete disconnect between supposedly limited government and getting your goodies is annoying, but not news. In fact, it’s one of the prime reasons we’re in this mess. Politicians have nothing but incentives to offer more handouts.

    Oddly, this reminds me of Harry Browne’s big question from his 1996 campaign: “Would you give up your favorite federal program if it meant you’d never have to pay taxes again?” No one wants to give up their stuff without getting something in return.

  6. The premise that the people’s desires are “nothing” if not embodied in politicians is, like, super-libertarian.

  7. Rand Paul is not a libertarian, or a particularly free market guy. That should be pointed out a million times if necessary.

    1. Perhaps, but his opponent is twice as bad.
      Should we point that out two-million times?

    2. dennis, that would seem to largely be the point of this post. Except extended to Tea Parties in general.

  8. I’m married to a physician, and needless to say, the conversation gets … strained … when I point out the libertarian view of the AMA’s licensing cartel.

    Yeah, physicians would make less money if the cartel was revoked and everything else was kept the same, but if all the other laws fucking them over were also repealed, they’d be wealthier or at least happier.

  9. No physician is required to be a member of the AMA to practice.

    Strawman. The issue is that you have to get a government license to practice medicine. Get rid of the licensing, and the cost of medicine would go down and the quality and outcomes would go up.

  10. Since when does the government set physicians’ salaries? Screw Shikha’s fauxtarian attitudes. Being a libertarian is to be AGAINST wage controls. Sheesh.

    1. It’s an inevitable result of setting up a third party payment system.

      The government agrees to pay for medical treatment via medicare.

      So the doctors and patient don’t have to consider costs.

      So spending spirals out of control.

      So the government is forced to control costs.

      Just like in Canada, where single-payer led directly to wage controls and shortages.

      People need to realize that healthcare is a limited resource. You can’t just guarentee people you’ll pay for something there is a finite amount of. One way or another, someone is not going to get it.

      1. But Medicare isn’t some cushy deal for doctors. It’s not like they get paid above market rate for their services, or even market rate. It’s not like it is with teachers, where the gov’t schools have long paid more than the private ones. I don’t see what the problem is with Rand Paul’s statement.

        1. Government schools pay less than private ones, IIRC.

          I’m not saying that medicare rates aren’t low. I’m saying they are low as an inevitable product of third-party payment. The government has no other means to control costs, since they can’t refuse to pay for treatment or shop around and tell the patient which doctor to see or which treatments to accept.

          And I’m not saying they should be able to do that either. I’m just pointing out that IF you are going to have the government pay for people’s medical care, then all of this is inevitable.

  11. It just illustrates the problem with third-party payment is compounded what the payor is the government.

    Not only is cost-control removed by assigning a third party to pay, but the fact taht it’s the government means the doctors can influence how MUCH they get paid, via the political system. The doctors can’t set their own rates through a private insurance company. But they CAN control a government board appointed to determine rates, and they CAN lobby congress to keep their rates from getting cut.

  12. Hopefully the establishment will make it so uncomfortable for them that they decide they don’t want second terms and go back to their principles instead of pandering for votes.

  13. Doctors should allowed to make a comfortable living just like everyone else in the country is allowed to. It should be permitted, not mandated by their labor union (the AMA).

  14. Shikha Dalmia has made careless claims about the AMA that are just plain wrong. Contrary to this article’s statements, the AMA does not restrict the supply of physicians or control Medicare payments. The reality is that the AMA is working to increase the supply of physicians and is urging Congress to lift the cap on government-funded medical residency training slots so that all future medical students can finish their training and become full-fledged physicians. Medicare sets physician payment rates, and the RUC committee makes recommendations within Medicare’s budget neutral constraints, where increases for one service result in across the board decreases for all services. The hard work of volunteer physicians saves taxpayers millions of dollars, and information is publicly available on the RUC at http://www.ama-assn.org/go/rbrvs.

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