The big debate over American healthcare is stuck in a trap. Government officials treat Medicare like a simple math problem on a budget spreadsheet, believing they can balance the books by constantly cutting pay for physicians. This ignores how our bodies work because human life is not just another line item on a ledger, and the medical care needed to keep people healthy should not change every time the government wants to rewrite its budget.
Right now, independent medical practices across the country are quietly going under. For 25 years, the cost of running a medical practice has gone up, yet main street physicians do not receive the regular inflation raises that hospitals and nursing homes do. When you look at real inflation, Medicare physician pay has dropped by 33% over the past 25 years. Big Healthcare, including hospitals and the insurance industry, benefits the most. This creates an impossible trap for older physicians and new medical graduates alike, as they simply cannot afford to keep local medical practices open.
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This financial squeeze does more than close practices; it ruins the mental health of physicians and causes massive burnout. When the government cuts pay, corporate healthcare bosses trap physicians on a grueling relative value unit, or RVU, hamster wheel. This wheel forces physicians to speed through visits and rush from room to room to meet strict patient-volume quotas. At the same time, this metric has been twisted into the RVU leash. While the hamster wheel forces endless speed, the corporate leash controls a physician’s medical decisions, stripping away their independence to maximize company profits. Physicians are trapped between running faster on the wheel and being held back by the leash, knowing that if they slow down to give deep, meaningful care, the system punishes them financially.
This broken system started in the 1980s, when Congress gave hospitals automatic raises for inflation but tied physicians to strict “budget neutrality” laws. Under these old rules, if a family physician gets a raise, a surgeon must take a pay cut. Later laws never fixed this; they just froze physician pay and ignored the real costs of running a medical practice.
Even recent fixes from Washington work like a magic trick. For this budget cycle, the government offered physicians a small pay bump, but officials simultaneously added an “efficiency” pay cut that wiped out the raise before it ever reached local practices. Reps. Ron Estes (R-KS) and Tom Suozzi (D-NY) are trying to stop this by introducing the Efficiency Adjustment Delay Act. Furthermore, physician leaders on the House Appropriations Committee, such as Dr. Andy Harris, a Republican congressman representing Maryland, have stepped up to battle this administrative overreach, leading the charge to block funding for burdensome regulatory models that bury independent practices under paperwork. Still, when the government keeps cutting pay, local physicians must close their doors, and many sell out to giant hospital chains. This hurts taxpayers because big hospitals charge extra “facility fees” for the exact same visit.
Fortunately, some leaders in Congress see this crisis, and bipartisan groups are stepping up with good ideas. We should give them credit for trying to fix things. For example, Reps. John Joyce (R-PA), Greg Murphy (R-NC), and Kim Schrier (D-WA) recently introduced the Patients First Act to give physicians automatic updates for inflation and fix old budget rules.
In the Senate, a team led by John Boozman (R-AR), Peter Welch (D-VT), and Roger Marshall (R-KS) introduced the Provider Reimbursement Stability Act, which stops wild pay swings by updating old budget limits. Also, the Strengthening Medicare for Patients and Providers Act, led by Reps. Raul Ruiz (D-CA) and Gus Bilirakis (R-FL), would tie physician pay directly to the Medicare Economic Index, which tracks the real cost of running a practice. In tandem, Sen. Bill Cassidy (R-LA), chairman of the Senate health committee, has introduced targeted solutions such as the Skin Substitute Access and Payment Reform Act to directly root out predatory markups, while pushing a site-neutral payment framework to halt anticompetitive hospital corporate buyouts. These bills are a great start, and Congress deserves praise, but good intentions will not save a dying medical practice, and leaders must actually pass them.
The government often claims it does not have the money to pay physicians fairly, but that funding gap is a choice, not a rule. We can easily fund these new bills without adding a single dollar to the national debt because the healthcare system is full of waste and corporate greed.
The best place to find the money is in private insurance overpayments. The Medicare Payment Advisory Commission found that private Medicare Advantage plans cost taxpayers $76 billion more than traditional Medicare for the exact same patients. Insurance companies make patients look sicker on paper just to get bigger government checks. Taking back even a small part of that $76 billion in corporate padding would fully fund a fair inflation raise for front-line physicians.
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Washington can also protect patients by taking money away from criminals and putting it back into care. The Health Care Fraud and Abuse Control Program brings back $2.80 for every dollar spent stopping fraud, meaning we can catch $16.6 billion in fake billings and kickbacks and send that money right to real physicians.
By passing these new bipartisan bills, raising old budget caps, and matching pay to inflation, Congress can save our medical system. We must stop asking how little we can afford to pay our physicians, and instead ask how much we value our own survival. A system that cares more about a balanced spreadsheet than a working medical practice is broken. It is time for Congress to stop automatically adjusting financial updates for corporate interests, including insurance companies and health networks, and not for physicians, and finally start supporting the front-line healers who save our lives.
Dr. Eric Wargotz is a practicing physician, clinical professor emeritus of pathology at the George Washington University School of Medicine and Health Sciences, and senior staff pathologist and immediate past chief of pathology and medical laboratory director at Luminis Health Doctors Community Medical Center. The views expressed in this article are solely his own and may not represent the official positions of any of his affiliates.
