In 2007, readers of the Annals of Internal Medicine could read part of the solution to a great medical mystery.(1) For years, health care costs in the US had been levitating faster than inflation, without producing any noticeable positive effect on patients. Many possible reasons were proposed, but as the problem continued to worsen, none were proven.Prices are High Because They are Fixed That Way
The article in the Annals, however, proposed one conceptually simple answer.
The prices of most physicians’ services, at least most of those that involved procedures or operations for Medicare patients, were high because the US government set them that way. Although the notion that prices were high because they were fixed to be so high was simple, how the fixing was done, and how the fixing affected the rest of the health system was complex, mind numbingly complex.
Perhaps because of the complexity of its implementation, the simplicity of the concept has not seemingly reached the consciousness of most American health care professionals or policy makers, despite the publication of several scholarly articles on the subject,.efforts by humble bloggers such as yours truly, a major journalistic expose, and recent congressional hearings. The lack of discussion of this issue seemed to be a prime example of what we have called the anechoic effect, that important causes of health care dysfunction whose discussion would discomfit those who are currently personally profiting from the current system rarely produce many public echoes. (For a review of what is known to date about how the offputtingly named Resource Based Relative Value Scale Update Committee (RUC) works, and previous attempts to makes it central role in fixing what US physicians are paid public, see the Appendix.) Continue reading Another Attempt to Show the RUC Behind the Curtain