Ever wonder why it takes weeks or even months to see your primary care doctor? Or why you leave appointments with more questions than answers, feeling rushed the entire time? This is a common experience, and it’s not necessarily your doctor’s fault. The health care system is in a state of crisis.
To make matters worse, Congress and the current administration are threatening devastating cuts to Medicaid, the Affordable Care Act, and Medicare. These programs aren’t just budget line items – they’re lifelines connecting the most vulnerable patients to the care they need. As frustrations build across the country, most people are coming to the same conclusion: our health care system is fundamentally broken. The cost is too high, access is too limited, and preventive care is undervalued.
This is partly due to a lesser-known entity quietly shaping and distorting our health care system from the inside. It’s called the RUC.
What Is the RUC and Why Should You Care?
The Relative Value Scale Update Committee (RUC), convened by the American Medical Association, has an outsized role in deciding how Medicare and, indirectly, most insurance plans determine physician pay. This panel of 32 mostly specialist physicians recommends how much every medical service is worth based on relative value units (RVUs). While they are technically just an advisory body, the Centers for Medicare & Medicaid Services (CMS) follows their advice more than 90 percent of the time.
Here’s the problem: the RUC is dominated by procedural specialists rather than primary care providers. Specialists’ work, like surgeries or high-cost diagnostics, is valued much higher than the time-intensive, relationship-based care that defines primary care. This has resulted in a system that rewards procedures over prevention, volume over value, and fragmented care over coordination.
Patients Pay the Price for Undervalued Primary Care
The consequences are serious. Because primary care is so severely underpaid:
- Doctors do not get enough time with patients. Primary care practices must see more patients in less time to remain financially sustainable. That means less opportunity for patients to ask questions and little time to build trust or manage complex needs.
- Team-based care is underfunded. Behavioral health specialists, care coordinators, pharmacists, and others are essential to comprehensive care, but current payment models often do not provide enough funding to support team-based care.
- Fewer clinicians choose primary care. New doctors, burdened with debt, often choose to further their career in higher-paying specialties. This trend is worsening provider shortages and extending wait times.
- Patients get sicker and spend more. When people cannot access timely primary care, they delay or skip necessary services, leading to worse outcomes and higher costs for everyone.
A Flawed System
The RUC’s process in determining the values of services is fundamentally broken. It relies on unverified surveys sent to small groups of physicians, often overestimating the time and effort required for specialty procedures. Its recommendations reflect the priorities of those with the most to gain. Its meetings are open to the public, but information on these meetings are hard to find. There is little accountability, minimal patient input, and no criteria to evaluate the value of services that patients care about most.
What Can be Done?
Fortunately, momentum is building for change. Secretary of Health and Human Services, Robert F. Kennedy Jr., has signaled interest in overhauling Medicare’s physician payment system to better support primary care and preventive services. This follows a year of preliminary action from Congress to change how Medicare pays primary care providers. As policymakers consider how to build a stronger foundation for primary care, reforming the RUC is essential.
Advocates and health policy experts are pushing for these reforms, including:
- Making the process more inclusive. Congress should require input from primary care providers, behavioral health clinicians, public health experts, and patients.
- Using real data. Payment for services should reflect the actual time, complexity, and impact they have on patients, instead of outdated estimates from biased surveys.
- Rebalancing payment priorities. Medicare must stop overpaying for low-value procedures and start fairly compensating services that help people stay healthy and manage their health better.
- More investments in the care infrastructure. Clinics need adequate resources and funding to deliver high-quality, team-based care, from electronic medical records to support for social needs.
Designing the System for the People
Health care does not have to be like this. People want a provider they trust, who knows their history, listens, and helps manage their health over time. We cannot get there without fixing how we pay for care in the first place.
The RUC may not be widely known, but it touches every corner of our health system. Its influence has shaped how doctors are paid, how care is delivered, how accessible primary care is, and how patients experience their care. Now is the time to push for a change to make the system work best for all patients.
