View Full Version : The shadowy cartel of doctors that controls Medicare

Tracy Riddle
07-16-2013, 01:04 AM

In a free market society, there’s a name for this kind of thing—for when a roomful of professionals from the same trade meet behind closed doors to agree on how much their services should be worth. It’s called price-fixing. And in any other industry, it’s illegal—grounds for a federal investigation into antitrust abuse, at the least.

But this, dear readers, is not any other industry. This is the health care industry, and here, this kind of “price-fixing” is not only perfectly legal, it’s sanctioned by the U.S. government. At the end of each of these meetings, RUC members vote anonymously on a list of “recommended values,” which are then sent to the Centers for Medicare and Medicaid Services (CMS), the federal agency that runs those programs. For the last twenty-two years, the CMS has accepted about 90 percent of the RUC’s recommended values—essentially transferring the committee’s decisions directly into law.

The RUC, in other words, enjoys basically de facto control over how roughly $85 billion in U.S. taxpayer money is divvied up every year. And that’s just the start of it. Because of the way the system is set up, the values the RUC comes up with wind up shaping the very structure of the U.S. health care sector, creating the perverse financial incentives that dictate how our doctors behave, and affecting the annual expenditure of nearly one-fifth of our GDP.

Jan Klimkowski
07-16-2013, 05:46 PM
I've done lots of medical journalism.

For instance, I helped make five series of a BBC2 prime time series called Trust Me, I'm a Doctor, most of it based on original, investigative, research. The title was of course in part ironic.

We made films about turf wars between plastic surgeons and (in lay terms) bone surgeons bickering over who should perform cleft lip and palette surgery on infants.

And we made films about courageous and innovative surgery in war zones where modern medicine wasn't available.

Yes, it's true that if you need to clean a wound of infection and have no drugs, a dressing of honey or sugar may do the job. I filmed a surgeon doing just that.

The most fundamental scandal is that most surgeons can and will say to their family: "don't go to that hospital" or "don't go to that doctor". They know where the highest risks lie, but this information is shared with friends and family only. The general public are left to suffer pain and trauma.