Rand Paul is building his U.S. Senate campaign around his opposition to big government — and especially the deficit spending that has led to a $13 trillion national debt. Costly programs must be slashed, Paul says.
But as a Bowling Green eye surgeon, Paul built his medical practice on payments from Medicare and Medicaid, the massive government health care programs considered to be leading contributors to the national debt.
Paul, the Republican nominee, has been paid $130,461 in Medicaid funds since 2006, about one-third of the sum that he billed the program, according to the state Cabinet for Health and Family Services, which administers that program. Doctors' Medicaid billings often are disputed in part, leading to smaller payments than they requested.
Paul's campaign refused to say Friday how much he gets from Medicare. The U.S. Department of Health and Human Services said it does not release such information to protect the privacy of doctors who are paid with public funds.
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But Paul's campaign confirmed that he receives far more funding from Medicare than Medicaid, and roughly half of his medical income comes from the two programs.
On the campaign trail, Paul calls for the abolition of entire agencies, such as the U.S. Department of Education, while complaining that Medicare payments to doctors have been cut too deeply, making it one of the few government expenses he consistently defends.
"Physicians should be allowed to make a comfortable living," Paul told supporters in Louisville in May, according to the Wall Street Journal.
Paul's campaign chairman, David Adams, said the candidate's political and personal stances are not inconsistent. Paul is sincerely critical of government spending, but being an eye surgeon essentially requires him to accept Medicare and Medicaid patients, Adams said.
"If you look at it from a medical perspective, who gets their eyes operated on? Usually, it's older people," Adams said. "And in this country, you don't have much choice after you turn 65. You're usually on Medicare. So I don't know how you avoid Medicare."
By contrast, Paul's father, U.S. Rep. Ron Paul, R-Texas, also is a doctor who criticizes deficit spending. But Ron Paul refuses to take Medicare and Medicaid funds, calling it "stolen money." Under federal rules, doctors can opt out of the programs, which serve the elderly and the poor, respectively.
The Democratic campaign of Paul's opponent, Attorney General Jack Conway, said it's wrong for Paul to demand smaller government for others while defending the spending that benefits him.
"Medicare must be preserved and, as attorney general, Jack Conway has built a strong record protecting Medicaid by increasing fraud collections by 600 percent," Conway spokeswoman Allison Haley said.
"On the other hand," Haley said, "Rand Paul is once again displaying his hypocrisy by advocating cutting scholarships to our children, aid to farmers and nearly every other government program except the ones that line his own pocket."
Terry Brooks, executive director of Kentucky Youth Advocates, which promotes social-services spending, said politicians should explain to angry voters this year why programs such as Medicare and Medicaid are valuable.
"If he could speak candidly in his medical role, what Dr. Paul could say is that government support helps people receive medical care and, in his patients' case, enjoy good eye health," Brooks said. "But Dr. Paul doesn't seem willing to say this publicly. We're just hearing arguments about waste, fraud and abuse."
Long before he began his run for the Senate, Paul was a conservative political activist in Western Kentucky and founder of Kentucky Taxpayers United, which called for tax cuts and less government spending. In a 1999 letter to the Bowling Green newspaper, Paul argued against taxpayer-provided health care.
"Who are the taxpayers?" Paul asked. "They are your neighbors. If you maintain a right to health care or housing, you must argue that your belief, which you call a 'right,' is sufficient to send armed tax collectors to your neighbor's house to expropriate that 'right.' "
As a Senate candidate, Paul has pledged to write a balanced budget every year if elected and to use the filibuster to protest other senators' deficit spending.
But Paul has not committed to cutting Medicare or Medicaid if that's determined to be fiscally necessary, acknowledged Adams, his campaign chairman.
President Barack Obama's bipartisan Commission on Fiscal Responsibility and Reform, created in February, has announced that its chief priority is getting a grip on entitlement programs, including Social Security, Medicare and Medicaid.
"Continuing to cut medical reimbursements to physicians, especially in the absence of any other cost controls, is not the right answer," Adams said. "We should all be able to agree on that."