Here's a righteous rant . . .

on the Health Affairs blog. As I have said here many times, real health care reform -- the kind that can make Medicare and all health care more affordable, while actually improving patient outcomes -- requires putting more resources into primary care and less into high-priced specialty care. One institution that stands in the way is the Relative Value Scale Update Committee (RUC), which advises Medicare on the reimbursement rates for various procedures. The RUC is dominated by high-priced specialists, and you can guess what the result is.

The American Academy of Family Physicians is standing up for its members, yes, but also for you. They are supporting legislation introduced by Rep. Jim McDermott that would require CMS to hire independent contractors to review the values placed on medical procedures. As McDermott note:

"Most people don't know this, but there is this small panel that decides behind closed doors what the reimbursement rates will be for certain medical procedures," McDermott said in the news release. "For two decades now, this panel has been dominated by (sub)specialists who undervalue the essential and complex work of primary care providers and cognitive specialists, while often favoring unnecessarily complex, costly and excessive specialty medical services. The result of this is clear -- there is a shortage of family doctors, patients don't necessarily get the services they need and medical costs are increasingly driven higher."

McDermott also pointed out that "since the creation of the RUC in 1991, the income disparity between primary care versus procedure-heavy (sub)specialists has grown from 61 to 89 percent."

I don't want to see a civil war in the medical profession but maybe that's what it's going to take to fix this.