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Please begin with an informative title:

I have an elderly friend who recently had a wonderful expensive new type of eye surgery performed called DSEK which has cleared her vision so she can read again and at 94 it is wonderful.  Her surgery was paid by Medicare.

In looking at Dr. Rand Paul's official Senate 2010 website and links, I see that he performs this DSEK procedure, so I thought I would see what he says about government involvement, review of new procedures, payment arrangements, etc. and it is set out, below:


You must enter an Intro for your Diary Entry between 300 and 1150 characters long (that's approximately 50-175 words without any html or formatting markup).

First, here is a brief description of his Medical career from Wiki:

Paul currently owns a private ophthalmology practice in Bowling Green, Kentucky. He first worked at the Graves-Gilbert Clinic in Kentucky, but eventually established his own clinic in December 2007.[8][9] Paul specializes in corneal transplants, glaucoma surgery, and LASIK,[9] and began offering sutureless DSEK corneal transplantation in 2007.[10]

Dr. Paul  is the third of five children born to Carol and Ron Paul.  He grew up in Lake Jackson, Texas and attended Baylor University.  He graduated from Duke Medical School in 1988.  Dr. Paul completed a general surgery internship at Georgia Baptist Medical Center in Atlanta and completed his residency in ophthalmology at Duke University Medical Center.   Upon completion of his training in 1993, Rand and Kelley moved to Bowling Green to start their family and begin his ophthalmology practice.

How much tax money went into the Baylor University and Duke University programs that trained him is a separate, but equally interesting question as to how that fits with the Tea Party and Libertarian arguments.

Here are some excerpts from his Rand Paul Senate, 2010 website:

As a doctor I have had first-hand experience with the vast problems facing health care in America. Like other areas of the economy where the federal government wields its heavy hand, health care is over-regulated and in need of serious market reforms. As Senator, I would ensure that real free market principles are applied to fix this problem.
. . . .
But many see bigger government as the solution to this problem. As if more regulation and more bureaucracy is going to solve it. Socialist medicine does not work because socialism does not work. When people blame the current crisis on the free market they are making a grave intellectual error. Simply because these large companies are benefiting does not mean we currently have a free market. When the government passes legislation, regulations, and mandates, this can hardly be called a “free” market.

And then, below, is some material from his ophthalmology office website and a link to his own article about his doing the procedure and other sites about the procedure and government "regulation", "bureaucracy" and "Socialist medicine" that approved the procedure and its payment so eye doctors like Rand Paul can do it an get paid. Here is his own description of his practice



T h e M e d i c a l C e n t e r
Physician Newsletter A
Rand Paul, MD
 New Corneal May, 2007  
Transplant available at Medical
New Technique Requires No Sutures —
For Faster Recovery and Better Results
The biggest advance in more than two decades is making
corneal transplant surgery much more beneficial and effective
for patients. This new technique removes and replaces only the
very back layer of the cornea, entering the eye through a tiny
incision. The small incision makes it possible to complete the
procedure without the sutures that are the mainstay of traditional
corneal transplants. Without sutures, the risk of infection,
inflammation, and rejection is reduced, and the eye heals
much faster.
“Using the new technique,” said Dr. Rand Paul, an ophthalmologist
with Graves-Gilbert Clinic, “I am able to remove and
replace just two percent of the cornea, versus 100% in a traditional transplant, resulting
in quicker healing, fewer complications, and faster vision recovery. By one month, the
eye generally heals to a point comparable to two years after traditional surgery.”
The new procedure, called DSEK, is appropriate for people who need a corneal transplant
due to corneal swelling or damage at the back of the cornea. Patients with inherited Fuchs’
dystrophy, a previous cornea injury, or a failed transplant can also benefit from the surgery.
DSEK is not for people with damage or disease in the front part of the cornea, such
as keratoconus.
“Traditional corneal transplant surgery, which has remained largely the same for several
decades, required 16 sutures. Now, I can selectively remove the thin back layer of the
cornea and replace it with healthy tissue. Because there is no large incision, vision recovers
more rapidly, and a future injury is less likely to damage the transplant. DSEK is a
tremendous step forward,” said Dr. Paul.
Dr. Paul's website is here and you will see his description of his performing this procedure


For information on DSEK see:
And http://www.medpagetoday.com/... and http://www.dukehealth.org/...

A National Institute for Health and Clinical Excellence (NICE) guidance on corneal endothelial transplantation was issued in 2009. The guidance states that the current evidence on the safety and efficacy of corneal endothelial transplantation (also known as endothelial keratoplasty [EK]) is adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance and consent (NICE, 2009).
A number of nonrandomized comparative studies (Hjortdal and Ehlers, 2009; Bahar, et al., 2008a; Allan, et al., 2007; Price and Price, 2006b), large case series (Price and Price, 2008; Terry, et al., 2008; Suh, et al., 2008;
Page 4 of 11 Coverage Policy Number: 0390
Mearza, et al., 2007), and one RCT (Price, et al., 2008) have examined the safety and effectiveness of DSEK and DSAEK. There is sufficient evidence in the published peer-reviewed literature to support the use of DSEK and DSAEK for the treatment of corneal endothelial disorders.
Then if you want to see how the procedure is approved by "regulation" of the government "bureaucracy" and "Socialized medicine so insurance companies will pay Dr. Paul to do it, see, for example:


If Dr. Paul truly believes the "Tea Party" and Libertarian ideas and is against government regulation and bureaucracy, presumably he can demonstrate it by not making money from doing expensive new procedures that he can only do and only get paid for if the procedure is approved by that "bureaucracy" and the "regulation" of "Socialized medicine" that allows him to bill and collect from insurance companies and Medicare for the patients he operates on.

Maybe the next interviewer will do a "Maddow" on him and let him have all the time he wants to try to explain why he is against "Socialized medicine" and "regulation" and "bureaucracy" and yet proudly advertises his medical practice that does this new government bureaucracy approved expensive procedure?

I wonder how many of his patients pay him through Medicare?  

Does he think he could perform this procedure without it being approved by a government bureaucracy?

I think he will do about as well in addressing these questions as he did trying to explain his favoring the right of private businesses to discriminate and yet claiming not to support discrimination!

Extended (Optional)

Originally posted to theworksanddays on Sat May 22, 2010 at 01:44 PM PDT.

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