David Frum hits Rand Paul for opposing cuts to Medicare physician payments, based on a short item in the Wall Street Journal. Paul is an ophthalmologist who treats Medicare patients. Therefore, says Frum, "Rand Paul's libertarianism stops where his pocketbook starts." He calls this "Rand Paul's personal special interest" and elsewhere describes it as a "small government for everybody except me personally" philosophy. Frum concludes, "I guess this is what the original Rand meant by the morality of selfishness."
Clever. And it will indeed be an attractive line of attack for Paul's Democratic opponent, assuming (as seems likely) that he wins the Republican primary tomorrow. Frum fails to mention something rather important, however: the Sustainable Growth Rate (SGR) formula Paul is quoted as criticizing is widely viewed as a disaster.
SGR has failed to control Medicare costs. Congress has had to tinker with and postpone the targets on an annual basis. Its basic requirement to keep doctor payment below the rate of economic growth has resulted in significant cost-shifting -- a perspective that informed much of the conservative opposition to the public option and other Democratic health reform measures. To be sure, getting rid of SGR would be costly. So would a 40 percent cumulative cut in physician payments in 2016, reducing payments to below their 1980 value.
Underpayment for services isn't necessarily the best way to get Medicare spending -- or federal spending more generally -- under control. By the way, "Rand" is short for "Randall." Rand Paul was not named after Ayn Rand.
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