Sen. Rand Paul just gave one of the most important speeches on foreign policy since George W. Bush declared war on Iraq. But instead of declaring war on another country, Paul declared war on his own party. Or, at least, its entire approach to foreign policy.

In his address last night at the Center for the National Interest — a think tank founded by Richard Nixon — Paul gave, for the first time, a comprehensive picture of how he thinks about foreign policy. His moderate non-interventionism is a far cry from his father's absolutist desire for America to exit the world stage. But Paul's stance is light years away from the hyper-hawk neoconservatism that's dominated Republican foreign policy thinking for decades.

Paul is signaling that, when he runs for president in 2016, he isn't going to move toward the Republican foreign policy consensus; he's going to run at it, with a battering ram. If he wins, he could remake the Republican Party as we know it. But if he loses, this speech may well be the reason.
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In the abstract, this doesn't tell you a whole lot about what Paul believes. But when he gives specific examples of where he agrees and disagrees with Obama's policy, the core idea becomes clearer: Paul wants to scale down American commitments to foreign wars.

Paul endorses the original decision to invade Afghanistan, but criticizes Obama's decision to escalate it. He savaged the Libya intervention, calling Libya today "a jihadist wonderland." He supports bombing ISIS, but blasted Obama's decision to arm the Syrian rebels: "the weapons are either indiscriminately given to 'less than moderate rebels' or simply taken from moderates by ISIS."

But Paul also, much more quietly, agrees with major parts of the Obama agenda. In a move that's bound to infuriate Republican hardliners, he's calling for negotiations with Iran over its nuclear program. He tacitly endorsed Obama's sanction-and-negotiate approach to the Ukraine crisis. And he called for a peaceful, cooperative relationship with China.

In Paul's ideal world, America only very rarely engages in war. Most of its relations with foreign powers are conducted via diplomacy and trade with other states. This is hardly a detailed theory of how to conduct American foreign policy, but it is absolutely a conservative vision for ramping down America's role in the world.

The Obama-bashing reveals Paul's real target: the GOP

Paul's agenda has a lot more in common with Barack Obama's view of the world than it does with, say, John McCain's. But his speech very cleverly played up the criticisms of Obama, and minimized the points of agreement. That's because the basic goal of the speech was to teach conservatives that they can oppose foreign wars and Democrats at the same time.

The real target of Paul's speech were the neoconservatives: the wing of the GOP that believes that American foreign policy should be about the aggressive use of American force and influence, be it against terrorist groups or Russia. Paul's unsubtle argument is that this view, dominant in the GOP, is a departure from what a conservative foreign policy ought to be.

His tactic for selling this argument is innovative. He's reframed arguments with neoconservatives as arguments with Obama, banking on the idea that he can get everyday Republicans to abandon hawkishness altogether if they see Obama as a hawk. "After the tragedies of Iraq and Libya, Americans are right to expect more from their country when we go to war," Paul said, clearly linking his critique of Obama to an attack on the Bush legacy.

Until this speech, Paul's 2016 foreign policy positions hadn't been clear. Now it is. Rand "clearly wants a more restrained US foreign policy," says Dan McCarthy, the editor of The American Conservative magazine. According to McCarthy, who's talked about these issues with Paul's staff, Paul has been engaged in a "trial and error" experiment. The idea is to figure out how to make a less aggressive foreign policy politically viable in the Republican Party.

After this speech, the testing phase appears to be over. According to his advisors, this speech represents the final, overarching framework for Paul's worldview. Rand has developed a strategy for wrenching conservatives away from the Bush legacy, and it's now a question of implementing it.

The stakes in the Paul-GOP fight are tectonic

Paul is setting the terms of the 2016 election. So far, every plausible Republican nominee who's spoken about foreign policy has taken a more hawkish tack. Paul has picked a fight on foreign policy, and now he's going to get one.

The Republican primary, then, will be at least partly a referendum on the future of Republican foreign policy. If Paul wins the primary — let alone the presidency — then the GOP and its elected officials will have to line up behind him. That will mean defending his foreign policy against Democrats, who will likely blast Paul from an interventionist point of view.

"Paul's been clear about his goal," DNC Press Secretary Michael Czin told reporters before the speech. "He wants to see America retreat from our responsibilities around the world." A Paul primary win would force Republicans around the country to line up behind Paul's non-interventionism against these attacks. It might also lead the Democratic Party to become more hawkish as it unites against Paul's philosophies — and that's particularly true if Hillary Clinton, who is already on the more hawkish side of the Democratic spectrum, is the nominee.

"Rand is the first guy," McCarthy says, "to have a chance to come in and do something different than what our foreign policy has been doing in 70 or more years." He's not wrong.

LOS ANGELES — Amazon had warned that it would lose bundles of cash in the third quarter, and it didn't disappoint.

But the size of the loss and a forecast that warned of more red ink by year's end chilled investors, who had already sent shares sharply lower for the year.

The Seattle-based online retailer (TICKER: AMZN) said it had a net loss of $437 million for the quarter, or 95 cents a share, compared with $41 million, or 9 cents a share, in the year-ago quarter. Analysts had forecast a loss of 74 cents a share.

Revenue rose 20% to $20.6 billion, short of the $20.84 billion projected by analysts. Amazon shares tumbled 11%, to $278.89, in after-hours trading. Ahead of the report, shares had lost 23% year to date, singed by prior big losses.

(Reuters) - The Ebola crisis is forcing the American healthcare system to consider the previously unthinkable: withholding some medical interventions because they are too dangerous to doctors and nurses and unlikely to help a patient.

U.S. hospitals have over the years come under criticism for undertaking measures that prolong dying rather than improve patients' quality of life.

But the care of the first Ebola patient diagnosed in the United States, who received dialysis and intubation and infected two nurses caring for him, is spurring hospitals and medical associations to develop the first guidelines for what can reasonably be done and what should be withheld.

Officials from at least three hospital systems interviewed by Reuters said they were considering whether to withhold individual procedures or leave it up to individual doctors to determine whether an intervention would be performed.

Ethics experts say they are also fielding more calls from doctors asking what their professional obligations are to patients if healthcare workers could be at risk.

Rand Paul, whose foreign policy views have become a frequent target of his GOP critics, will use a high-profile speech in New York on Thursday to urge the United States to exercise restraint when engaging in wars overseas.

At a dinner hosted by the Center for the National Interest, the libertarian-minded Kentucky senator, a potential White House contender in 2016, will argue for “limits” on U.S. engagement in military conflicts. It’s a view that runs counter to the hawks among his fellow Republicans who have called for a more aggressive American presence in hot spots in the Middle East.

“America shouldn’t fight wars where the best outcome is stalemate,” Paul plans to say, according to excerpts provided by his office. “America shouldn’t fight wars when there is no plan for victory. America shouldn’t fight wars that aren’t authorized by the American people, by Congress. America should and will fight wars when the consequences — intended and unintended — are worth the sacrifice.”

Paul plans to add: “After the tragedies of Iraq and Libya, Americans are right to expect more from their country when we go to war.”

Paul aides say the speech will be the first time the freshman senator fully spells out his “conservative realist” foreign policy, outlining how he views international trade, diplomacy and the national debt as it relates to national security.

Sen. Rand Paul is summoning his top strategists and political advisers to Washington one week after the November election for a strategy session over his widely expected 2016 presidential bid.

The gathering of Paul's top lieutenants in the nation's capital has been quietly organized by Doug Stafford, his chief political strategist, who began reaching out to key figures in Paul's political world earlier this month, multiple sources told National Journal.

Stafford has told invitees to reserve Nov. 12 on their calendar both during the day and into the night. Paul himself is expected to attend some of the meetings.

"This is the come to Jesus before the planned launch," said one Paul insider, who has been invited to the gathering.

The meeting of the Kentucky Republican's kitchen cabinet has been kept under wraps, with most of the invitees not even told who else will be there. Stafford has yet to circulate a formal official agenda, though few on "Team Rand," as Stafford sometimes calls the group, need to be told the talk will focus on a presidential run.

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Dog bites man, that's not news. Man bites dog, now that's news. Or so goes the old newspaper adage, and we see it manifested all the time. Take this latest video clip for example. While it wouldn't usually be news to see a cop pulling over a motorist, seeing a motorist pulling over a cop and asking to see ID is another matter entirely.

The video comes courtesy of one Gavin Seim, a self-styled liberty activist and former congressional candidate from Washington State's 4th district. In this instance, Seim is advocating (and civically enforcing) a law on the books in Washington that precludes law enforcement officers from patrolling in unmarked vehicles, a measure designed so that motorists know they're being lawfully pulled over by police and not by an impersonator.

Seim sees a sheriff's deputy patrolling in an unmarked, plain-white Dodge Charger, so he flags him down and – in as clear a reversal of roles as we've ever seen – proceeds to ask the deputy for ID while alerting him to the state law which he's apparently violating. Fortunately, both parties act respectfully, as you can see from the video which Seim captured and posted online in both edited and full versions.

President Obama may have been busy golfing this weekend, and his brand new Ebola Czar may have had more pressing matters to attend than the White House's Saturday evening meeting on the US "response to domestic Ebola cases" (because clearly the Ebola Czar is superfluous at such Ebola-related events), but that doesn't mean that the administration will once again be caught with its pants down the next time an Ebola index patient is unveiled on US soil. Nope.

In taking a page right out of America's response to the Ebola pandemic in... West Africa, where the US has dispatched several thousands troops to do, something, unclear what, earlier today, it was revealed that the U.S. military is forming a 30-person "quick-strike team", which according to CNN is "equipped to provide direct treatment to Ebola patients inside the United States, a Defense Department official told CNN's Barbara Starr on Sunday."
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To summarize: the Pentagon, as in the US army, will provide direct treatment to Ebola patients.

So just how exactly is the US army's crack 30-person "SWAT" team which has a whopping 5 doctors, more competent to deal to deal with what is, at last check, a medical situation than, say, America's medical professionals? Or is, in the parlance of our times, where an "Iraq military advisor" really means crack commando fighting Syrian troops on the ground on behalf of Qatar and Saudi Arabia, "direct treatment" merely a euphemism for something far less enjoyable?

For the partial answer to some of these questions, please read "Public Health Emergency Declared In Connecticut Over Ebola: Civil Rights Suspended Indefinitely, and also "Obama Mobilizes National Guard, Army Reserves To Fight Ebola" - they serve as a good starting point for where all of this is ultimately headed.

It was very cool! We had about 260 participants, which is a bit lower than our initial expectations but still very nice. We received overwhelmingly positive feedback about the agenda and organization.

What exactly do you mean regarding the transcripts?

Dr. Paul has championed ophthalmology priorities such as repeal of the sustainable growth rate, preserving office-use access to compounded drugs, and derailing problematic quality measures for ambulatory surgical centers. Dr. Paul also serves on the Senate Health, Education, Labor and Pensions Committee.

The transcript of his remarks as prepared for delivery can be found below.

TRANSCRIPT:

Good morning. It really is a pleasure to be here with you all today. It's great to be with normal people for a change. I work in a city where logic is the exception and dysfunction the norm. DC is so dysfunctional we can't even pass things we agree on. I have a bill that I co-sponsor with Harry Reid and I can't even get a vote on that.

When I think of how screwed up DC is, I think of what Groucho Marx said about politics: "The art of politics is looking for problems everywhere, finding them, misdiagnosing them, and applying the wrong remedies."

Being here in Chicago with fellow physicians is a big improvement over DC any day of the week.

I would like to thank the American Academy of Ophthalmology for inviting me here today. It is an honor to address you.

People often ask if being a physician affects my view of our nation's problems. Absolutely. I think physicians tend to be problem solvers. Physicians typically analyze a problem and apply the remedy based on the facts, not preconceptions.

Today I want to examine our healthcare system and look at ideas for making healthcare less expensive and more accessible.

Many years ago when my father first entered politics, he wrote an essay on Kwashiorkor. As you may remember Kwashiorkor is a stage in chronic starvation when protein deficiency becomes so severe that there is not enough intravascular colloid to maintain osmotic balance and fluid leaks into the abdomen creating ascites, the swollen bellies of starvation.

As a medical student, my father dreamed of a cure for Kwashiorkor, but the more he read, the more he discovered that the answer was economic, not medical.

I traveled to Guatemala this summer with the John Moran Eye Center and had a wonderful experience. Likely, nothing in my career has been more satisfying than seeing the smiles spread as the patches were removed the day after surgery. I'll never forget the Guatemalan man, who'd been blind before his cataract surgery, who fell to his knees to thank God. He told of how his life had been ruined by his blindness: His wife left him, he lost 40 pounds, he lost his job. In his jubilation the day after cataract surgery, he hoped to get his life back.

The team was lead by Alan Crandall from the John Moran Eye Center at the University of Utah. While we were in Guatemala, Alan gave me a copy of ‘Second Suns’ --- the story of two remarkable ophthalmologists and their ambitious goal of eliminating preventable blindness worldwide.

I read with fascination of the exploits of two great surgeons, Sanduk Ruit and Geoffrey Tabin, and their quest to basically create a process whereby cataracts could be removed and vision restored throughout the developing world.

Dr. Ruit introduced the small incision sutureless extracap cataract surgery performed with an IOL in under five minutes. A phenomenal medical accomplishment…but a large part of their success was also an economic breakthrough --- discovering how to manufacture intraocular lenses cheaply and locally in Nepal.

I was fascinated to read of Dr. Ruit and the accomplished phaco surgeon, Dr. David Chang, going head to head and Ruit's technique not only competing successfully for speed, but also for outcome.

Ruit had discovered how to perform cataract surgery as quickly as we do in America, but at one-tenth of the cost. His surgery gave just as good a result but didn't require phacoemulsification.

The medical advance of bringing sight to tens of thousands of the blind people in the developing world was as much an economic miracle as it was a medical breakthrough.

In our country we have had a debate over what system best delivers the highest quality of healthcare to the most amount of people, at the least cost, and the least time spent waiting for it.

Though the debate over Obamacare may appear, at times, to be a debate over healthcare, it is really a debate over what type of economic system distributes goods the most efficiently.

Which really, when you think about it, is extraordinary that the debate is necessary at all. Since the collapse of the Soviet Union, most economists have acknowledged that only when the marketplace determines the price of goods and services can the goods and services be distributed efficiently.

What does that mean?

It means that the Soviet Union failed because when prices are set by a central planner, mistakes inevitably occur.

The Soviet Union failed because they couldn't determine the price of bread. If they set the price too low, bread would fly from the shelves and there would be shortages and scarcity.

If they set the prices too high, the bread would rot on the shelves and bread would again be in shortage.

Only democratic capitalism, where millions of consumers vote daily, can determine the price of any good. The correct price of good is the price at which the most stuff is distributed to the most people.

There is no moral price. There is no correct price that any one individual can discover.

The Nobel Prize winning economist, Frederick Hayek, called this the fatal conceit, that any one individual would be so presumptuous as to believe they had sufficient knowledge to discover a "correct" price.

Every time a Washington bureaucrat sets a price, the consumer suffers.

You might respond that food or healthcare is too precious to let consumers decide its price.

If you believe that, realize you cannot escape economic truths. If you insist that healthcare is somehow different from all other goods and services, you will still suffer the consequences of economic fallacy.

If you set the price of cataract surgery too low, let's say free, the demand will be infinite and there will be shortages of cataract surgeries and cataract surgeons….and the only way to sort this out is by having the patients wait in line until supply can catch up with demand.

Adjusting supply to meet demand is not just a theoretical concept. It is the new normal in societies that reduce the apparent price of medical services to zero. In Canada, over a million people, at any point in time, wait in line for elective surgery.

When LASIK first arrived on the scene, I remember hearing of a prominent Canadian eye surgeon who would run through his government allotted number of surgeries by September and then come to the U.S. for the rest of the year and perform refractive surgeries.

But proponents of government intervention will argue, "Vision is too important a goal to be treated as a mere commodity. We could never leave something so precious as vision up to the vagaries of the cold, immutable marketplace.”

Yet, look at what happens in the LASIK marketplace and the contact lens marketplace. Prices fall and both LASIK surgery and contact lens are available in abundance.

But emotions run high when we talk of healthcare or basic needs such as food. Some argue that healthcare and food and water are too vital to be left up to capitalism. Only the government can distribute them fairly.

If you believe that, realize that the laws of economics, like the laws of thermodynamics, are inescapable… there will be consequences.

Rationing, either by mandate or by waiting in line, is an inevitable side effect of government distribution of goods.

But how would we take care of the poor? Isn't the civilized way to have government be in charge of healthcare and foodcare and the necessities of life?

I think there is another option: free up prices. Allow a marketplace of freely fluctuating prices for everyone. The consequences would startle you. The beauty of capitalism is that it distributes the greatest amount of goods at the cheapest price.

The economist, Joseph Schumpeter, once remarked, "The capitalist achievement does not typically consist in providing more silk stockings for queens, but in bringing them within the reach of factory girls in return for steadily decreasing amounts of effort…”

The wonder of Capitalism is not in producing a silk stocking that the Queen can purchase, but in producing silk stockings that even a shop girl can buy.

But wouldn't capitalism leave some people behind? Wouldn't some people be left without healthcare? Yes, but instead of destroying a system that works efficiently for the vast majority, why not address the needs of those left behind?

Instead of taking capitalism and pricing out of healthcare, why not let capitalism distribute most of healthcare and then devise ways of taking care of the indigent.

When poverty is the exception not the rule, the government and charities could get involved to fix the exception, but not screw up the system for the vast majority. Competition, when allowed to thrive, drives prices down.

How would we do this practically? Get government out of the business of setting prices. End the SGR, the government system that sets fees. It was wrongheaded policy from the beginning. It's been temporarily suspended over dozen times. Let's not temporarily fix SGR, let's abolish it once and for all!

Once prices are free to be set by millions of consumers, bidding instantaneously, will we free up choice.

For Medicare, we could still allow taxes to pay for the healthcare of senior citizens, but allow seniors the same choices that federal employees get. Federal employees get over 250 different insurance plans to choose from.

If you did that, there would be no need for government to fix either physician fees or patient prices.

Let consumers decide what kind of insurance they want and where they want to purchase it. It is a crime against nature to give unmarried young adults, insurance that covers pregnancy for the wife they don't have, in vitro fertilization for the kids they are not ready for, and pediatric dental coverage for the kids they don't have.

True freedom of choice would let patients buy any type of insurance they want, including inexpensive insurance. Shouldn't every American get to decide whether they'd rather buy expensive insurance or save that money for something they prefer?

To allow the marketplace to work in healthcare, we should allow the purchase of insurance with lifelong tax-free savings accounts. Health Savings Accounts started at birth would accumulate such remarkable amounts that health insurance costs would plummet to approach the costs that we associate with term life insurance.

For the exceptions to the rule, for those who live in poverty or are afflicted with expensive chronic medical conditions, government and charity can find a cure.

As physicians, we think of healthcare as medical problem. Only when we begin to understand that the most vexing medical problems are really economic problems will we be closer to a cure.

I think it would be an improvement if politicians acted more like doctors----

and if doctors became more involved in politics. We've been put through the meat grinder in the last few years, and no one in government seems to ask physicians how to improve healthcare.

America leads the world in so many medical innovations. I hope we don't lose that edge I hope the medical devices tax doesn't drive American medical companies overseas.

Our system wasn't perfect before Obamacare but I fear it's much worse now. There was nothing inherently wrong with medicine in our country.

The old system before Obamacare was not perfect, but I fear the new system with more government intervention will be worse. We are already reading of newly empowered patients who have subsidized health insurance and a $6,000 deductible.

We are in for a rude awakening when we discover that free or subsidized health insurance provides an incentive to seek care but with a $6,000 deductible, many of these new patients will still be non-payers.

As we discover the number of non-payers, we will also discover that premiums must rise to cover that cost. Unfortunately, the premiums will be paid by fewer and fewer non-subsidized purchasers of insurance.

We can search around for blame, and there is plenty. But the fact is, everyone in this room can help.

The voices in this room belong to experts in ophthalmology and leaders in communities across the United States. You should stand up and be heard.

Don't let the powers that be ruin medicine. Become part of the solution. Help fix the process. Support candidates who understand the problem and offer proper solutions.

Support policies that enable doctors and treat patients like consumers, while minimizing government.

If you don’t like what you see, be part of the next round of diagnosis and treatment.

I plan to be, and I would love to see you all with me. Maybe it’s time for a doctor to fix the problem.

I hope you'll join me and be part of the solution.

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