Could a state, or the federal government, set up a system of universal primary care as a first step toward comprehensive, publicly funded health care for all?
Mr Baldwin- this is a proposal to phase in a comprehensive health care system over time that is publicly funded and includes EVERYONE. t is worth noting that most systems around the world started with one sector of care- Canada- started with universal hospital care in Saskatchewan back in the 1960s and expanded over time to other sectors of care.Starting with primary care makes sense because it is relatively inexpensive and has a huge return on investment. It is the only sector that has been shown to improve the health of the population. The key points of any legislation must include everyone, be publicly funded, publicly accountable, public stewardship but can have private delivery of care. This is not a half measure ,everyone is included.
Universal primary care seems right. Everyone accesses care and public health improves. It would be affordable in broad terms.
However, as an incremental step toward universal single-payer health insurance, it would not work. Single-payer provides for huge administrative savings by eliminating the insurance middleman. It can also reduce drug prices through negotiations. Such savings will be needed to pay for expected increased usage, expansion of the primary care workforce, improving physician reimbursement over inadequate Medicaid and Medicare levels, and handling, at some point, specialty. And, of course, it means that insurance companies will still be around to mess with the process.
Without the savings made possible by a complete single-payer program, federal or state, that ends private insurance, the "incremental" approach will reach a quick dead end.
It appears primary care now is little more than a wellness check, not even a physical, and a panel of blood tests. Every medical need gets referred out to hospitals, specialists, screening test facilities, pharmacies, and urgent cares. The bureacracy has become as dazzling as the federal government's. And there's round-robin referrals in play to avoid having to do any patient-needed paperwork to obtain disability aid, short-term and/or long term.
Dick Gottfried first introduced the NY Health Act in 1992. Dems have held all three branches in NYS for YEARS and they still won't bring it to a vote. Dems are bad on healthcare in a different way, but bad just the same.
I appreciate this thoughtful essay but nothing is going to change while political campaigns continue to be funded by insurance companies, the pharmaceutical industry and corporate healthcare profiteers. Politicians on both sides of the isle accept this money. So it should come as no surprise that the financial interests of these companies is safeguarded in any proposed legislation.
We also can’t talk about universal primary care without addressing the cost and financing of medical education. As a primary care pediatrician (the lowest paid of primary care specialties), my medical education carries the same price tag and interest rates as that of orthopedic surgeons and anesthesiologists. I will die before I pay off my student loans.
I'm sorry. I just now had a chance to glance at your biography and your homepage. Or through here. Your for a terribly invasive risky procedure a diet/exercise complete lifestyle review and change is the prime example of why our healthcare is the worst on the planet. On you for being a morally bankrupt shill.
Did I make a comprehension mistake in thinking you're only proposing primary care under the plan? Am I wrong in thinking that does not include items such as specialist and major procedures? Everything associated with your body and mind? Optical, demtal, mental?
There must be legislative mandates concerning the entire sector. Such as has the complete eradication of private insurance options. The installation of a true free market, an avenue for providers and facilities to list recent diagnosis and outcomes, at what cost. The sector must be all encompassing for the policy to work as intended. Both pertaining to quality of care and capital outlay for it.
I do apologize. This could've easily been included or insinuated as I am a bit distracted yesterday and today. I am posting replying from the seat of a John Deere combine .
There was a hospital CEO I heard give a speech where he was asked about the future of hospitals and he said something like, "In the future, hospitals or health systems won't provide primary care." The point being some of the same made in the comments and article, that someone else (government, Walmart, etc.) would handle primary care and they would just do all the specialty work.
Hospitals and health systems don't provide primary care --or shouldn't. Primary care should be provided by small groups of docs and their teammates within 10 minutes of patient homes.
Where I live, about 80% of PCP practices are owned by Private Equity Corporations. And we have a shortage of PCPs. I spent two years applying to multiple groups, often many multiple times, before I was accepted as a new client. For more than a year, I drove over an hour each way for primary care despite the fact that I live in a metropolitan area. The vast majority of my care comes from specialists rather than my PCP because, per Contract, she is required to refer me. Of course, Specialists contribute to the fact that we have the World’s Most Expensive Health Care. (I love to complain ad nauseum about the dermatologist who billed $hundreds for the 60 seconds needed to freeze a scaly spot of skin from my chest. Out of pocket was about $400 to me. In the old days, my family doc did those for free.)
You can't have government controlled anything in the United States. Look at the VA trying to control costs. They can even tell what a practitioner is doing day to day, it who s/he has seen. You CAN have a single payer, and I can show you how. Go read my blogs.
Thanks for the great article. Just to clear up a few misunderstandings, this article proposes universal primary care as a first step in creating a universal publicly financed system. It would immediately create a system of "everybody in/nobody out," with no means testing and it would all be publicly financed. Once the single payer was created, then of course we would go on to add other sectors of care, such as hospital care. This is how they got single payer in Saskatchewan, the first province to enact single payer in Canada. They started with universal hospital care in Saskatchewan, and then added primary care, etc. So, this has been done before.
Even this first step would immediately help primary care providers since they would be paid out of a universal publicly financed pool. They would not longer need to haggle with insurance companies, or sell out to some private equity firm or hospital since they would have secure and sustainable source of funding.
Thank you Dr Deb Richter! I have followed your work since I first met you at an IHI (IDCOP) meeting years ago. I agree completely with your plan to start with primary care. I am always impressed that it is primary care doctors who are most supportive of universal healthcare. I would have loved to work in a system free of administrative interference and profiteering and my patients would have benefitted immensely. Keep on ! I retired 7 years ago.
Mr Baldwin- this is a proposal to phase in a comprehensive health care system over time that is publicly funded and includes EVERYONE. t is worth noting that most systems around the world started with one sector of care- Canada- started with universal hospital care in Saskatchewan back in the 1960s and expanded over time to other sectors of care.Starting with primary care makes sense because it is relatively inexpensive and has a huge return on investment. It is the only sector that has been shown to improve the health of the population. The key points of any legislation must include everyone, be publicly funded, publicly accountable, public stewardship but can have private delivery of care. This is not a half measure ,everyone is included.
Universal primary care seems right. Everyone accesses care and public health improves. It would be affordable in broad terms.
However, as an incremental step toward universal single-payer health insurance, it would not work. Single-payer provides for huge administrative savings by eliminating the insurance middleman. It can also reduce drug prices through negotiations. Such savings will be needed to pay for expected increased usage, expansion of the primary care workforce, improving physician reimbursement over inadequate Medicaid and Medicare levels, and handling, at some point, specialty. And, of course, it means that insurance companies will still be around to mess with the process.
Without the savings made possible by a complete single-payer program, federal or state, that ends private insurance, the "incremental" approach will reach a quick dead end.
It appears primary care now is little more than a wellness check, not even a physical, and a panel of blood tests. Every medical need gets referred out to hospitals, specialists, screening test facilities, pharmacies, and urgent cares. The bureacracy has become as dazzling as the federal government's. And there's round-robin referrals in play to avoid having to do any patient-needed paperwork to obtain disability aid, short-term and/or long term.
You need a different primary care doctor.
Dick Gottfried first introduced the NY Health Act in 1992. Dems have held all three branches in NYS for YEARS and they still won't bring it to a vote. Dems are bad on healthcare in a different way, but bad just the same.
Indeed
I appreciate this thoughtful essay but nothing is going to change while political campaigns continue to be funded by insurance companies, the pharmaceutical industry and corporate healthcare profiteers. Politicians on both sides of the isle accept this money. So it should come as no surprise that the financial interests of these companies is safeguarded in any proposed legislation.
We also can’t talk about universal primary care without addressing the cost and financing of medical education. As a primary care pediatrician (the lowest paid of primary care specialties), my medical education carries the same price tag and interest rates as that of orthopedic surgeons and anesthesiologists. I will die before I pay off my student loans.
Oregon has proven half measures don't work. Just another excuse for the industry and it's Beneficiaries to deny real world politic
What do you mean by "half measures"? What are you referring to?
I'm sorry. I just now had a chance to glance at your biography and your homepage. Or through here. Your for a terribly invasive risky procedure a diet/exercise complete lifestyle review and change is the prime example of why our healthcare is the worst on the planet. On you for being a morally bankrupt shill.
and you still didn't answer the original question of what is a "half-measure." It was a simple question and nothing to get incensed over. lol
Wow. This only tells me that you know nothing about Lipedema.
Did I make a comprehension mistake in thinking you're only proposing primary care under the plan? Am I wrong in thinking that does not include items such as specialist and major procedures? Everything associated with your body and mind? Optical, demtal, mental?
There must be legislative mandates concerning the entire sector. Such as has the complete eradication of private insurance options. The installation of a true free market, an avenue for providers and facilities to list recent diagnosis and outcomes, at what cost. The sector must be all encompassing for the policy to work as intended. Both pertaining to quality of care and capital outlay for it.
I do apologize. This could've easily been included or insinuated as I am a bit distracted yesterday and today. I am posting replying from the seat of a John Deere combine .
There was a hospital CEO I heard give a speech where he was asked about the future of hospitals and he said something like, "In the future, hospitals or health systems won't provide primary care." The point being some of the same made in the comments and article, that someone else (government, Walmart, etc.) would handle primary care and they would just do all the specialty work.
Hospitals and health systems don't provide primary care --or shouldn't. Primary care should be provided by small groups of docs and their teammates within 10 minutes of patient homes.
Where I live, about 80% of PCP practices are owned by Private Equity Corporations. And we have a shortage of PCPs. I spent two years applying to multiple groups, often many multiple times, before I was accepted as a new client. For more than a year, I drove over an hour each way for primary care despite the fact that I live in a metropolitan area. The vast majority of my care comes from specialists rather than my PCP because, per Contract, she is required to refer me. Of course, Specialists contribute to the fact that we have the World’s Most Expensive Health Care. (I love to complain ad nauseum about the dermatologist who billed $hundreds for the 60 seconds needed to freeze a scaly spot of skin from my chest. Out of pocket was about $400 to me. In the old days, my family doc did those for free.)
I’m going with expanded and improved Medicare For All. Stop the beyond billions in corporate welfare.
From the patient perspective this would be a gamechanger! How can we help advocate for this?
Can primary care for children (PEDS) exist without vaccines?
There does come a point where we do have to start triaging and saving as many as we can.
You can't have government controlled anything in the United States. Look at the VA trying to control costs. They can even tell what a practitioner is doing day to day, it who s/he has seen. You CAN have a single payer, and I can show you how. Go read my blogs.
Thanks for the great article. Just to clear up a few misunderstandings, this article proposes universal primary care as a first step in creating a universal publicly financed system. It would immediately create a system of "everybody in/nobody out," with no means testing and it would all be publicly financed. Once the single payer was created, then of course we would go on to add other sectors of care, such as hospital care. This is how they got single payer in Saskatchewan, the first province to enact single payer in Canada. They started with universal hospital care in Saskatchewan, and then added primary care, etc. So, this has been done before.
Even this first step would immediately help primary care providers since they would be paid out of a universal publicly financed pool. They would not longer need to haggle with insurance companies, or sell out to some private equity firm or hospital since they would have secure and sustainable source of funding.
How can I report malpractice under Medicare with supplemental?
Excellent article. Thanks.
Mark Brakke, MD
Family Physician, MN
Thank you Dr Deb Richter! I have followed your work since I first met you at an IHI (IDCOP) meeting years ago. I agree completely with your plan to start with primary care. I am always impressed that it is primary care doctors who are most supportive of universal healthcare. I would have loved to work in a system free of administrative interference and profiteering and my patients would have benefitted immensely. Keep on ! I retired 7 years ago.