The AMA's Monopoly Over Medical Coding Undermines Root-Cause Care—Americans Should Petition CMS to Change It
Source: Merlot Fogarty. "Here’s How You Can Make Your Insurance Cover Root-Cause Care." September 14, 2026. thefederalist.com
The Gist
The author argues that a private doctors' organization (the AMA) has too much unchecked power over which medical treatments can be billed to insurance and how much they cost—and this system rewards quick, specialized treatments over long-term care that addresses the root causes of illness. She urges readers to submit public comments to a federal agency (CMS) by a specific deadline to help change this system, arguing that patient stories about denied care or unexplained costs are exactly the evidence regulators are looking for.
Conclusion
Americans should submit public comments to CMS urging reform of the AMA's monopoly control over medical billing codes (CPT) and pricing, because this system incentivizes quick-fix specialty care over root-cause, preventive treatment.
Premises
- The AMA has near-total, unchecked power to create or block official medical billing codes (CPT codes), without which doctors cannot bill insurers for services.
- The same AMA body that controls coding also sets the prices Medicare pays for those codes, and CMS adopts these recommendations almost wholesale.
- Private insurers base their contracts on a percentage of Medicare's price list, meaning the AMA's decisions effectively govern nearly all U.S. health billing.
- The specialists who serve on the AMA committees setting codes and prices have a financial interest in valuing their own specialties and procedures highly, creating a conflict of interest.
- This system has led to certain root-cause treatments (e.g., some infertility care) being unable to be billed at all because specialty societies have opposed their coding.
- CMS itself has acknowledged concerns about this 'monopoly' and its role in fostering a 'sick care' system focused on treatment over prevention.
- CMS is currently soliciting public comments (via a specific docket, closing Sept. 14) and is legally required to respond to significant comments, meaning citizen input can have real regulatory impact.
Assumptions
- That CMS's regulatory reconsideration process is genuinely responsive to public comment and not merely a formality.
- That the AMA's conflict of interest in coding/pricing is a primary (rather than minor or coincidental) cause of the U.S. health system's emphasis on specialty/quick-fix care over root-cause treatment.
- That alternative coding/pricing bodies or processes would produce better outcomes (more root-cause and preventive care) than the current AMA-led system.
- That patient anecdotes about denied claims or diverted care are representative of systemic failure rather than isolated incidents.
- That the current administration's stated priority on 'root-cause' medicine will translate into meaningful regulatory change if enough comments are submitted.