The Illusion of Inaction: Lessons from Medicare Physician Payment Reform.

In July 2026, the Centers for Medicare & Medicaid Services released its 2027 Medicare Physician Fee Schedule proposed rule, once again placing physician payment at the center of a familiar policy debate. Despite broad recognition that the current Medicare physician payment system is unstable, meaningful reform has repeatedly failed to materialize. Drawing upon my experience as a Robert Wood Johnson Foundation Health Policy Fellow serving on the U.S. Senate Finance Committee, this perspective examines the disconnect between widespread agreement about the need for reform and the political, fiscal, and procedural realities that impede legislative action. Ultimately, lasting reform will require moving beyond temporary fixes and toward a more predictable and sustainable payment system.