Rand Paul is an ophthalmologist, so he's not in the business of dispensing terminal diagnoses. "It's a happier practice," he tells me, "than being an oncologist." Reviewing the nation's X-rays, however, he comes to a downright bleak conclusion: a financial cancer. "It takes a long time for a country to consume its wealth," he says. "An individual can go bankrupt in a matter of months, but a country can take a generation or more—and I think it's been going on for a generation or more. There's a day of reckoning coming and it's close. It's much nearer than it's ever been. Nobody can predict things like this exactly, but there's a sense in our country, and a sense in the Tea Party movement, that the day of reckoning is much closer."

The causes of this cancer, according to Paul, are familiar: out-of-control government spending, pork-barrel projects, bloated entitlements. The standard campaign litany, dusted off for every election cycle.

Less familiar, however, is the treatment Dr. Paul is prescribing. The federal government he envisions is a parched, skeletal—even dismembered—one: "A government that works under the enumerated powers of the Constitution," he explains. "A government that balances its budget every year, whose primary function is national defense and the judiciary and the legislative branches, and regulating interstate commerce only so much to keep open borders between the states." That means abolishing departments like Education and gutting ones like Commerce and Energy, disbanding the Federal Reserve, and getting rid of regulatory bodies like the Environmental Protection Agency. (Indeed, the federal code as revised by Rand Paul might yield fewer rules than the game of Yahtzee: "Things that are nonviolent," he said in 2008, "shouldn't be against the law.") That means scrapping agricultural subsidies, bailouts, and other corporate welfare. That means raising the eligibility age on Social Security—if, indeed, we must have Social Security. That means repealing President Obama's health-care plan and establishing high-deductible insurance plans that would force medical providers to compete on price, since patients would be paying much of the bill out-of-pocket. ("It sounds funny, but you need to be paying more for your health care," he says.) And finally, that means yanking troops back from most of the 750-plus military bases the United States maintains around the globe and staying the hell out of places like Iraq.

Rand Paul is a surgeon, but for this hard-case patient, he sees zero use for a scalpel. The proper tool is a chain saw.

• • •

The primary wasn't a problem for Rand Paul. What tripped him up was the victory. Paul beat Grayson—who had the backing of Kentucky's senior senator (minority leader Mitch McConnell) and of the GOP establishment Paul once derided as "Rudy McRomney and the Republican gang"—by more than 23 percentage points. For roughly 22 hours thereafter, he was a media darling. At his victory rally, held at a country club in his adopted hometown of Bowling Green, Paul said he bore "a message from the Tea Party, a message that is loud and clear and does not mince words. We have come to take our government back." It was a good sound bite, duly transmitted worldwide: a revolutionary salvo, fired not just at President Obama but at all of Washington. And then, buoyed by his triumph, Rand Paul went on the air—and off on one of his tangents.

The subject was the 1964 Civil Rights Act, arguably the holiest piece of legislation of the modern era. First on NPR, and then on The Rachel Maddow Show, Paul expanded on a critique of the act that he'd outlined months before for the Louisville Courier-Journal. While deploring racism, he took umbrage at the provision that forced private businesses, like the infamous Woolworth's lunch counter, to desegregate. He illustrated his argument this way: "If you decide that restaurants are publicly owned and not privately owned, then do you say that you should have the right to bring your gun into a restaurant, even though the owner of the restaurant says, 'Well, no, we don't want to have guns in here...because people might drink and start fighting and shoot each other'? Does the owner of the restaurant own his restaurant? Or does the government own his restaurant?" Replace guns with black people and his point becomes clear.