Bravo for daring to talk about this topic.

I am pasting below relevant comments that I also posted to the Covert Rationing Blog.

See these posts on Health Care Renewal and the articles to which they link:
http://hcrenewal.blogspot.com/2007/05/more-on-disparities-between.html
http://hcrenewal.blogspot.com/2007/03/on-disparities-between-reimbursement-of.html

Also see this post on Retired Doc’s Thoughts blog and the articles to which it links:
http://mdredux.blogspot.com/2007/11/pathophysiology-of-primary-care.html

It looks like how the RUC has operated is mainly responsible for the poor and declining reimbursement for primary care and cognitive services.

As I said in a comment on the latter post above:
It seems very clear that 1) Medicare controls physician reimbursement for Medicare patients, and indirectly strongly influences all physician reimbursement, since managed care organizations and insurers tend to just go along. 2) The Medicare reimbursement rates in turn are heavily influenced by the RUC. CMS does not seem to get any other input on updating the RBRVS system. 3) The RUC is dominated by sub-specialist proceduralists. 4) The RUC seems to make no effort to get input from physicians in the trenches. As best as I can tell, the actual membership of the RUC is not published, although it is possible to figure who most of the members are.

This appears to be a terrible, unfair system, and the RUC appears to be one of the missing links that explain why US health care is such a mess.

Goodson has described very clearly the negaive effect of the RUC and its specialist dominated work -force on the health of primary care and this nation.
Two excellent Power-point presentations can be accessed at

http://www.businessgrouphealth.org/opportunities/webinar080107ucsf.ppt

http://healthcaredisclosure.org/docs/files/BodenheimerPaymentMay2006.pdf

that further cast light on the murky operation of the RUC.

While Goodson’s commentary detailed the RUC reccomendations to CMS (ususally accepted) the presentations above will further detail the ripple effect on other payers.
The AMA must have been concerned about the legality of this committee. It did request an opinion from the FTC.

That opinion did state in 1996 “it does not appear that the proposed dissemination of information is likely to violate anti-trust law…..We have not conducted an independent investigation, and our opinion could change if the facts change significantly”
http://www.ftc.gov/bc/adops/ama.shtm

The facts speak for themselves and the decisions of the committee have proved that grounds for reevaluation including another complaint to the FTC may be necessary.

Recent opinions of William Plested the President of the AMA decrying pay-for -performance and other health care reforms is but another example of the mood of the AMA.

The CPT is a proprietary document of this organization. Aside from being a considerable revenue stream for the AMA it is also a mechanism that furthers its strangle -hold over Primary Care.

It is unlikely that with the considerable lobbying power that the AMA posseeses that correstive legislation is likely. the only solution may be litigation.
Failing that statements of mine published in The Annals of Internal Medicine may be prophetic and appropriate

“Medical subspecialties that are nurtured in the ivory towers of academia have further reduced the stature of the internist. Effective lobbying by their affiliated societies and by commercial manufacturers of the medical devices they use assured them disproportionately higher reimbursement than that of their generalist colleagues. Absent an identity, the internist’s only remaining role is thought to be that of provider of ambulatory care to the chronically ill whose medical problems are beyond procedural intervention and lucrative compensation.
A continuing decline in professional stature and income, when coupled with deteriorating working conditions, makes the continued existence of internal medicine untenable. I am pessimistic that current political and professional interests will allow significant change to resuscitate internal medicine. Would it then not be opportune to draft an obituary for internal medicine and commission a requiem to its memory? ” (http://www.annals.org/cgi/content/full/144/9/702-a)

[...] adopted RBRVS.  But then they made a huge mistake.  They let the AMA develop the RUC – The primary care reimbursement mess.  The members of that secret society include very few primary care physicians and many [...]

[...] with my other blog at MedPage Today) Over at DB’s Medical Rants, rcentor comments on the machination of the RUC, also known as the “RBRVS Update [...]