Speak Your Piece: Killing Primary Care

Primary care was supposed to be the centerpiece of President Obama's health care reform bill — the way the country was to reduce the amount it spends on medicine. So why is his administration cutting primary health care allotments by 27 percent?

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The U.S. Department of Health and Human Services announced Wednesday a 27.4% cut in Medicare physician fees.  Primary care was not spared.

Primary care was already barely scraping by. There have been double-digit increases in the cost of delivering primary care and only single digit (if that) increases in annual revenue — and those increases have been generally due to increased work effort. 

Primary care leaders, the few who remain, are still in shock over the cuts.

I now consider both parties and all administrations and Congresses for the past 30 years as responsible for this debacle and the consequences to come.

Cuts Will Be People

Anyone with any understanding at all regarding primary care understands that it is about people. 

Primary care consists of people delivering basic health care services to people. Primary care involves the most fundamental health services, those needed by nearly all Americans nearly all the years of their lives in nearly all locations. 

Primary care fees go 50 – 60 percent to support the services of primary care personnel attempting to deliver more primary care with less money and support. When you cut primary care, as the federal government announced this week, you kill off primary care personnel, primary care services, primary care delivery capacity, and one of the few remaining sources of economic impact from health care for much of rural, exurban and micropolitan America.

If you tried to impair health or health care for most Americans or if you tried to eliminate health care spending as a vehicle for economic recovery for most Americans, it would be hard to think of a way to do more damage than what the federal government announced this week. 

Primary care is 40 – 100% of the workforce in 30,000 zip codes with 65% of the population. Kill off primary care and you kill off jobs, services, and economic impact – especially where all three are most needed. 

Those over 65 consume 2 to 3 times more primary care than those not on Medicare. Primary care demand increases the most as Americans age. Why would anyone who understood primary care or the needs of those over 65 allow primary care to be chopped in pieces? Areas already shortest in primary care are also the most dependent on both primary care and Medicare and Medicaid – and both are failing to support primary care.

Primary Care Can’t Offload Costs

Primary care fees do not go to the pocketbooks of primary care physicians. Primary care fees do not go to stockholders or investors. Frankly there are no profits or to attract investors. 

Academic centers that did invest in primary care in the 1990s lost small fortunes even when primary care costs were much lower. Large systems and academic centers long ago decided to stop propping up failing primary care years ago. 

Primary care has been failing for one simple reason. The annual costs for delivering primary care have exceeded the funds required to deliver it. The cost increases are double digit like all other health care. But unlike other health care, primary care has not been able to create new services, corner specific health markets, drive off competitors, or address even basic financial needs.

From the start, the Obama administration has claimed the benefits of primary care. These are now seen as empty arguments. 

To claim the benefits of primary care such as savings of other health care costs, you actually have to understand primary care. Primary to understanding primary care is to understand that the failure of primary care is due to too little support. 

Lesser support should be understood as destroying primary care and the ability of primary care to save health care costs. It is also failure to address the frustrations of more and more Americans who are losing basic services in a wide variety of areas.

Reform Requires More Primary Care

Primary care was to be a cornerstone of Obamacare just as in RomneyCare or Managed Care. Cracks in the Obama argument appeared with failures in Romneycare as there was simply insufficient primary care resulting in far more costs than planned. Now the Obama Administration is acting in ways that will insure even less primary care. 

This failure in primary care, regardless of what finally happens on Jan 1 2012, represents a betrayal of 240,000 primary care physicians, 50,000 primary care nurse practitioners, 270,000 primary care nurses, 30,000 primary care physician assistants, and about 1 million other dedicated primary care personnel. It is a betrayal of those who have hung on to deliver primary care despite year after year of steady failure-by-design. 

It is a betrayal of those who helped design Obamacare. It is a failure of those who worked to support Obama.

It’s already too late to do much to prepare for this disaster, one that could be substantially worse with anything less than the best possible influenza year in recent history. It is too late for responsible health care providers and systems to notify their patients or their employees. It is too late to anticipate the major changes to attempt to adjust care needs due to primary care losses.

Most of all what Health and Human Services did this week represents a total failure to understand the basic health needs of the American people. 

Dr. Robert C. Bowman, M.D., founder of the Rural Medical Educators Group of the National Rural Health Association, is a physician and long time health education policy advocate. He is professor in Family Medicine at A.T. Still University School of Osteopathic Medicine in Arizona. You can read more from Bob at his Basic Health Access Blog.

 

Topics: Health
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