Your assertion that the Medicare sustainable growth rate, or SGR, represents only "paper savings" is not supported by the actual history of the SGR and "doc fixes" enacted by Congress.
Though it is true that most SGR cuts have not gone into effect as scheduled, the SGR has actually done a great deal to control healthcare costs by keeping physician payment updates modest and pushing policymakers to offset the cost of avoiding cuts.
Congress has almost always identified alternative savings to replace the savings required by the SGR. The annual "doc fix" bills have resulted in substantial savings, including many significant Medicare reforms that likely would have been ignored but for the need to offset doc fixes. The proposed replacement system would actually cost far more than continuing the annual doc fixes.
Passing a permanent doc fix without offsets would be the exception, not the rule, and it would be a costly one that adds to our debt.
The writer is a senior policy adviser at the Committee for a Responsible Federal Budget.