Primary Care Succeeds While Americans Get No Healthier
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- MedPAC's March report to Congress found that by every tracked metric, primary care in America is succeeding: nearly all Medicare beneficiaries have a PCP, over three-quarters can see their PCP within two weeks, rural patients face shorter wait times, and PCP compensation is rising faster than other specialties
- U.S. clinical outcomes outperform peer nations on most measures — vaccine rates, cancer screenings, diabetes and hypertension management — yet excess mortality is driven by external causes such as drugs, alcohol, suicide, homicide, and traffic accidents, not poor primary care access
- The Medicare physician fee schedule is budget-neutral by design, so any increase to primary care reimbursement comes arithmetically at the expense of specialty care — a structural feature, not a bug, that advocacy groups have treated specialists as obstacles to overcome rather than providers patients also need
- CAHPS patient-experience scores and MedPAC's own focus groups show declining access to specialists, a trend the authors say risks delayed diagnoses, higher acuity at presentation, and greater resource utilization for patients with complex, multisystem disease
- Christopher P. Childers (surgical oncologist, University of Washington) and Thomas C. Tsai (Harvard Medical School surgeon) write that countries outperforming the U.S. on health don't have more primary care visits per capita — they have less poverty, less violence, better housing, and broader access across the full medical spectrum
- The authors argue the U.S. has accepted a "false premise" that better population health runs solely through the primary care office and built a payment architecture that actively undermines the specialty access patients with complex conditions actually need
Why it matters: The MedPAC data Childers and Tsai cite undercuts the conventional "invest more in primary care" playbook by showing that primary care access metrics are already rising while specialist access — critical for cancer, kidney disease, and other complex conditions — is simultaneously falling under Medicare's budget-neutral fee schedule. The tens of millions of uninsured and underinsured face the same access barriers that no clinic-based reform can fix, according to the authors, because the real drivers of U.S. mortality are upstream social conditions.
