Opinion: The primary care crisis paradox
Get the Health newsletter
Daily health & science — research, biotech, public health, the studies worth knowing. Free.
- MedPAC's March annual report to Congress found that primary care metrics are robust: nearly all Medicare beneficiaries have a PCP, over three-quarters can see their PCP within two weeks, and rural patients have even shorter wait times.
- The United States outperforms peer nations on vaccine rates, cancer screenings, and management of diabetes and hypertension, despite lagging in life expectancy.
- The U.S. life expectancy gap with peer countries is largely driven by external causes — drugs, alcohol, suicide, homicide, and traffic accidents — rather than inadequate primary care access, the authors write.
- Medicare's budget-neutral physician fee schedule means any increase to primary care reimbursement comes arithmetically at the expense of specialty care, a design feature the authors describe as the engine of a zero-sum reimbursement battle.
- CAHPS scores show declining patient access to specialists, a finding the authors say is corroborated by other surveys and MedPAC's own focus groups.
- Higher-performing countries do not have more primary care visits per capita than the U.S., but they have less poverty, less violence, better housing, and more equitable access across the full spectrum of medical care.
- Childers and Tsai urge investment in social and economic conditions that determine whether people get sick and a payment system that stops treating specialist access as a luxury.
Why it matters: The authors argue Medicare's budget-neutral fee schedule treats specialist access as a luxury rather than essential infrastructure — patients needing nephrology or oncology face delays even as primary care metrics improve. They contend that reshuffling physician payments between primary and specialty care leaves the actual mortality gap untouched, because the drivers of premature death live upstream of any clinic visit.
