COMMENTARY

Organized Medicine: The Problem or the Solution?

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Introduction: The Origin of the RUC

Hello and welcome. I'm Dr. George Lundberg, at large for Medscape.

The RUC (rhymes with YUCK) is a poster child for everything that is right and everything that is wrong about American organized medicine. The acronym stands for American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee.

Born of the necessity for fiscal fairness as the RBRVS (Resource-Based Relative Value Scale), of mathematical creativity in the highest levels of academic economics at Harvard; vetted through the time-honored and -tested cauldron of rigorous anonymous peer review; published in 1988 and widely disseminated by the most respected vehicles of their sort and time (New England Journal of Medicine and JAMA); and endorsed and adopted as policy and for use by the largest, reasonably representative organized body of physicians in the world (the AMA) in 1991, as well as the US Congress for Medicare use, the RBRVS stood as a beacon of sound economic science informing that most conflicting of human values: How much is a professional person's work worth?

Well, that was then, and this is now -- 2013.

The RUC (still rhymes with YUCK) has become the whipping boy for how the greed of some individuals -- organized by extraordinarily astute and effective medical politicians, blessed after a political process of the still largest (but long since not reasonably representative) body of organized physicians in the world, the US government, and most private payers -- has skewed the whole emphasis and practice of American medicine into becoming a vastly overexpensive megalith of inefficient waste.

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