Well, with respect to the RVU system, I will mention this: as an emergency physician, our group gets paid about eight RVUs for reducing a dislocated shoulder. I think we get four RVUs for managing an acute MI on the way to the cath lab. Granted, a dislocated shoulder is painful and the patient is quite appreciative when I put it back where it's supposed to be, but this takes me about thirty seconds with modern anesthetics. Getting an acute STEMI to the cath lab, though, is much more difficult; I have to manage their meds, watch their rhythm and vital signs, call the interventional cardiologist and the cath lab crew in, etc. And, at night, watch the rest of the ED as well. There's no question in my mind that managing an acute MI is far more risky and requires much more work. And yet the RVUs have been set at half that of a shoulder dislocation. Or something like that.
The only conclusion to draw from that is that orthopedics specialists had quite a lot of influence on the assigning of the relative values to the various procedures, and saw an opportunity to enrich themselves. If anyone has another explanation, I'd be glad to hear it. I'm not complaining about this situation, by the way; as an ER physician, I just see whoever comes in and eat what lands on my plate. But I do find it amusing and no more sensible than anything else I see these days.
Now that I've gotten to the age (61) where I am most likely to need medical care, I find our entire system of medical care, and how we deliver it and pay for it, completely ridiculous. I admit it has made me a comfortable living and been a rewarding way to spend my professional life, but given that God started us all out at least theoretically equal in our infancy, I find the inequities in our system, just in this country, absolutely breathtaking. An accurate way to describe our medical care system in this country might be this: a financial arrangement devised to channel money to those who complain the most and advertise the most, while meantime occasionally providing medical services in an arbitrary and uneven fashion, frequently to those who require it the least.