I'd like to commend Kent Moore and the other authors of “What Every Physician Should Know About the RUC” [February 2008] for an illuminating and insightful article on the fundamental assumptions, biases and mechanics that underlie the financing of Medicare.

All too frequently we collectively moan about the decline of applicants in our noble and altruistic specialty and the economic headwinds facing medical school graduates. It is not by accident that graduates of American medical schools are fleeing primary care. The RUC ensures this. As the article points out, there are only five votes out of 29 on the RUC advocating for primary care, and it requires a two-thirds majority to alter relative values. Is it any wonder that primary health care is undercompensated? Indeed, when insurance payment mechanisms were initially constructed a century ago in Minnesota, surgical interests made certain their reimbursements were at the top of the scale. Their assumptions and policies remain largely unchallenged.

We will never have meaningful realignment of our health care priorities in this country unless we dismantle this arcane paradigm of “one vote per specialty or subspecialty” and confer on primary care its full economic benefit. The AAFP would do well to promulgate this.