Medicare Fight Takes Center Stage At KY-SEN Debate (VIDEO)

The debate over what to do with Medicare — which has become a centerpiece of the Kentucky Senate race of late — took a prominent role in a televised debate between Republican nominee Rand Paul and Democratic nominee Jack Conway last night. As he has for weeks now, Conway hammered Paul for his past statement supporting a massive increase in the Medicare deductible to help, Paul has said, move the system to a “market-based approach.” Paul accused Conway of twisting his words on the issue.

The fight has come to define the Senate race, and served to put a new spring in Democratic steps after a summer campaign that was all about Paul’s momentum. Now the fight over Medicare (as well as another battle over drug enforcement) has put Paul on the run, with some polls showing Conway gaining steam in the final weeks of the election.

At the debate last night, Conway tried to capitalize on that momentum, jabbing Paul over Medicare at every possible moment.[TPM SLIDESHOW: TPM’s Day At ‘Fancy Farm’: Kentucky Pols Spar At Annual Political Kickoff Picnic]

As Huffington Post‘s Amanda Terkel flagged, the raucous back and forth on Medicare reached its highest point in the debate surrounding a question about earmarks.

Conway called out Paul for his past statements suggesting that the amount of money paid to doctors by Medicare should go up, while at the same time saying the amount of money Medicare patients should spend out of pocket should go up, too.

“There’s the issue,” Conway said. “You pay more, he gets more.”

Paul, an ophthalmologist, took a stab at Conway’s wealth by referring to the racehorse his family owns. “Ultimately, maybe people who own a racehorse or maybe people who have millions of dollars might have to pay more of the cost,” Paul said, referring to the Medicare debate.

Conway was ready for that one, it seems.

“Rand Paul, I am sick and tired of you putting forward something so callous and acting like it’s courageous,” he said. “I don’t know what he just proposed there. He talked about a racehorse, but he either said he’s for means-testing Medicare or he’s proposing one heck of an increase in the Medicare tax.”

Watch the exchange, as clipped by the HuffPo, and reported by Terkel:

Beyond the Medicare focus, the debate covered other well-trodden ground in the Kentucky race. Politico‘s Jonathan Martin reports that Conway spend much of the time “doing his best to make the contest a referendum on Paul and local issues while distancing himself from his own party,” a theme seen throughout the campaign. Conway “talked as though he had his sights set on the governor’s mansion in Frankfort more than Washington,” Martin reports, ticking off the list of hyper-local issues Conway mentioned throughout the debate.

For his part, Paul stuck to his reform-minded guns. He continued to try “feverishly to nationalize the contest,” Martin writes, preferring to talk about the White House’s failures while Conway talked about “who’s going to put Kentucky first.”

All in all, the debate was a nasty one as the Louisville Courier-Journal reports.

“Step up and be a man,” Paul said to Conway during the discussion of Medicare and Social Security. “Take a chance, say you’re for something.”

The TPM Poll Average shows Paul leading the race 46.9-41.7.