Medicare for All: The Politburo Setting healthcare prices

 by Chad Savage, M.D.

When I hear politicians promise that Medicare for All will fix our broken healthcare system, I have a simple question: Have they looked at how Medicare determines what a doctor gets paid?

Our healthcare system is already heavily influenced by government price-setting. We don’t need more of the same. We need a fundamentally different approach.

Medicare uses something called the Resource-Based Relative Value Scale, or RBRVS, to determine payments for thousands of physician services. The system assigns values based on physician work, practice expenses, and malpractice costs. Physician work itself involves estimates of time, technical skill, mental effort, judgment, and stress. Those values are adjusted for geographic differences and multiplied by a conversion factor to calculate payment.

Sounds simple enough? Not even close.

Medical specialty societies submit recommendations, often based on surveys asking physicians to estimate how much time and effort their services require. The American Medical Association’s Relative Value Scale Update Committee, known as the RUC, evaluates these recommendations and advises the Centers for Medicare and Medicaid Services. CMS then reviews the recommendations, considers other information, and makes the final decisions.

Think about all the opportunities for distortion. Physicians estimate their own work. Specialty societies advocate for their members. Committees must reconcile competing interests. Bureaucrats decide which estimates to accept. Then government officials adjust the numbers to comply with budget-neutrality requirements and other rules. Change payments for one service, and payments for others may have to change, too.

All this requires an army of people, an enormous amount of administrative effort, and endless revisions. Yet the resulting formulas still cannot reliably tell us what a particular medical service is worth to an individual patient.

It sounds like something a Politburo would devise: a committee trying to calculate the correct value of thousands of goods and services for millions of people. The problem with central planning has always been that no group of officials can possess all the information needed to understand what people actually want and what they are willing to sacrifice to get it.

We see the consequences in medicine. A procedure can be reimbursed more generously than the time a physician spends listening to a patient, sorting through complicated symptoms, managing chronic disease, and preventing future problems. The system can reward resource-intensive interventions over more efficient care, not necessarily because patients benefit more, but because the payment formula assigns greater value to the intervention.

And who decides what constitutes quality?

Government payment programs increasingly attempt to reward quality according to centrally selected measures. But what a bureaucrat considers quality may not be what you or I consider quality. A payer might reward reduced utilization or compliance with certain metrics while a patient values timely access, a physician who listens, additional diagnostic evaluation, or the freedom to choose a treatment. Incentives designed around a payer’s priorities can even conflict with a physician’s judgment about what an individual patient needs.

Consider how you make decisions with your own money. When you buy a television, you compare price, reliability, features, and performance. When you choose a restaurant or plan a vacation, you weigh quality against cost and your own preferences. You even compare spending across categories: Is the new television worth more to you than a weekend getaway?

You do all of this intuitively, every day, without paying an army of bureaucrats to calculate the relative value of every possible purchase.

Why should healthcare be exempt from the basic principle that people value things differently?

One patient may gladly pay more for same-day access to a trusted physician. Another may prioritize a particular specialist or a longer consultation. Patients should be able to weigh those differences and decide whether the perceived benefit justifies the price. Providers, in turn, should have an incentive to compete on the things patients value.

Our system is broken partly because administrative payment formulas already distort how resources are allocated. Medicare for All’s government takeover of healthcare would take the current system’s dysfunction and make it absolute.

We don’t need a better Politburo to determine what healthcare is worth. We need to give patients greater control over their healthcare dollars, make prices transparent, and allow competition to reward efficiency, access, and quality as patients themselves define it.

As a professional government bureaucrat himself, MI Senate candidate Abdul El-Sayed’s “solution” of Medicare for All reminds me of the old saying “If you’re a hammer, everything looks like a nail.”

In Michigan’s Senate race, that’s why I support Mike Rogers’ approach: put patients in control. Give people transparent prices and the power to make their own healthcare decisions. Rather than having bureaucrats dictate what care is worth, let patients decide what matters to them and how their money is spent. That’s how we move toward a healthcare system that rewards value, efficiency, and quality.

https://www.americanthinker.com/blog/2026/10/medicare-for-all-the-politburo-setting-healthcare-prices/