Back in May, Senator-elect Rand Paul (R-KY) raised more than a few eyebrows when he backed Democratic efforts to prevent cuts to physician payments under a program called the sustained growth rate, or SGR. At one campaign event Paul, an ophthalmologist who generated 50 percent of his practice from government reimbursements, said, “Physicians should be allowed to make a comfortable living,” conveniently disregarding his pledge to institute “across the board cuts” on government spending.
Well, last night, CNN’s Eliot Spitzer took Paul to task on this apparent contradiction, asking the newly minted lawmaker about why he was excluding his former colleagues from the gruesome cuts — particularly since Medicare spending was primarily responsible for the growing deficit. Remarkably, Paul immediately backed away from his broad-brush indictment of government spending and argued that cutting reimbursements would reduce access to physicians:
SPITZER: You’ve said that the one place you don’t want to cut is doctor reimbursement rates?
PAUL: You’ve been reading too many liberal bloggers. Let me set you straight…What I have said is that look, if we want to cut physician fees automatically without a vote, let’s lump all federal employees in there, senators, congressmen and all two million federal employees and let’s all automatically cut their pay every year without a vote and I’m all for it. But right now, let’s not single out one set of people and say that somehow we’re going to balance the health care budget on one set of people. The problem is that ultimately if you keep reducing. For example, if physician fees go down in Medicare by 30 percent as they’re designated to do in December, you won’t find a doctor. I think we need to think about do we want to have doctors available to see patients and I think that’s a major problem.
SPITZER: But Senator, I’m correct in saying you’ve opposed cutting Medicare reimbursement rates even though the Medicare system is the single largest deficit hole we’re facing as we look at our budget and reimbursing doctors is the largest piece of that.
PAUL: You do have to figure out how to balance the Medicare budget and it’s going to take a lot of different things to do it, but you can’t balance it simply on one facet.
From there, the interview deteriorated into a painfully uncomfortable and at times personal exchange. Spitzer pressed Paul on his “peak income over the past decade,” to which the Senator dryly shot back, “do I want to go back to your personal past and talk about your past on this program? I don’t think so.”
Spitzer proceeded to ask Paul to name specific programs he would cut from health care, Social Security or defense. But Paul, demurred, explaining that he would offer a balanced budget in the next Congress — over 1, 2, 3, 4 and 5 year increments, but was still unsure of what to cut to get there. At one point, Paul even suggested that rather than pressing him for specifics, Spitzer should invite liberals and ask “how do you continue to have these programs?”
Paul went on to chastise lawmakers for breaking certain budget and spending rules. “The main thing you have to have is you have to have rules [to balance the budget],” and make “difficult decisions” he said, unaware that by reversing the physician cuts under SGR he would be, in fact, breaking a spending rule. “Nothing is off limits,” he said. “We will look at each individual program and we will do a stepwise process to this. We will say, can it be downsized, can it be privatized, can it be eliminated or can we not look at this program at all because it’s too important and it can’t be cut.” He offered no specifics last night, however.
Pushed to the edge by Spitzer, Paul did rattle off ideas like repealing the health care law and sending back TARP dollars, before telling Spitzer that his “personal agenda is getting in the way of making you a very good broadcaster” and claiming he had to leave for another interview. Spitzer responded curtly. “Sir, the tenor of the campaign in which you say you’re going to balance the budget and cannot name a single cut suggests to me that that debases politics,” he said and ended the segment.
Incidentally, Paul is in complete agreement with the administration and the doctor’s lobby on the reimbursement issue. In a speech to the Association of American Medical Colleges, HHS Secretary Kathleen Sebelius “pushed for an extension to the so-called doc fix to stop an expected 23% cut to Medicare payments for physicians,” saying “I hope that Congress will act quickly to pass it, so that our doctors and seniors can have some peace of mind while we work on a long-term fix.”