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.
Last night, CNN’s Eliot Spitzer took Paul to task on this apparent contradiction, asking the newly-elected senator why he was excluding doctors 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 asked 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?”
The Wonk Room has more on Paul’s contradictory SGR position and his desperate effort to name list specific savings.