The American medical system is notably unbalanced, favoring costly surgical procedures over basic public health services. The American Medical Association (AMA), representing physicians, has historically opposed single-payer health insurance since President Truman's proposal in 1945. Many doctors, however, wish for such a system today. The AMA also contributes to the disparity between primary care doctors, who are often overworked and underpaid, and specialists, who earn significantly more and enjoy better work-life balance. This imbalance is largely thanks to the AMA's Relative Value Scale Update Committee (RUC), which was designed to give the AMA control over Medicare's compensation structure.
Created in 1991, the RUC sets values for medical procedures based on recommendations that the Department of Health and Human Services usually accepts. Despite primary care doctors making up over a third of the physician workforce, specialists dominate the RUC, leading to compensation standards that prioritize specialized, interventionist care over preventive efforts valued by family and general practitioners. Consequently, primary care physicians earn around $200,000 or less, while specialists can earn upwards of $500,000.
Another conflict of interest involves the AMA's proprietary diagnostic codes, known as CPT codes, for which the organization collects significant royalties, totaling around $300 million annually. This income creates a financial interest for the AMA in maintaining the status quo, detracting from patient care. The American healthcare system is further strained, as nearly 100 million Americans lack insurance at some point in a year, and many more face underinsurance due to high deductibles and claims denials. This reliance on specialists and invasive treatments leads to a neglect of cost-effective public health strategies.
Robert Kuttner notes that the AMA’s influence extends to hospitals, which benefit financially from using CPT codes, further burdening primary care doctors with administrative work focused on profitability rather than patient care. This situation contributes to burnout among primary care providers, who are increasingly advocating for unionization, highlighting the strain of their roles.
Despite the AMA’s longstanding influence on healthcare policy, there exists an alternative known as the International Classification of Diseases, endorsed by the World Health Organization and publicly available. However, political resistance from the AMA has thwarted efforts to switch to this system, even when legislative attempts are made.
Research suggests that the AMA's control over Medicare payment systems escalates healthcare costs by promoting unnecessary reliance on specialists and inflating procedure compensation rates. The U. S. presents a contrasting approach to countries with national health insurance, where payments to healthcare providers are determined by government rather than interest groups. In the UK, the British Medical Association advocates for better conditions for general practitioners, while the AMA has not supported similar goals for its members.
Hospitals often seek profit maximization through specialist services, further perpetuating the imbalance between primary care and specialty care. For instance, a procedure that used to be performed by primary care doctors is now referred to specialists who charge higher fees.
The U. S. healthcare system has endured decades of attempts to control rising costs, with private interests complicating and expanding the system to maximize profits. As long as private interests dominate, solutions to contain costs through modified payment systems are unlikely to succeed.
https://prospect.org/health/2025-01-07-how-ama-undermines-primary-care/
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