The ACP Advocate Blog
by Bob Doherty
Monday, January 26, 2009
Where, oh where, will we find $ for primary care?
As I've reported in several blog postings, it seems like everyone agrees, or at least they say they agree, that the U.S. needs more primary care physicians.
But when it comes to figuring out where the money for primary care should come from, well, the consensus just isn't there.
Dr. Benjamin Brewer, a primary care doctor, suggests in his Wall Street Journal column that the government could fund primary care by taking money from Medicare Advantage plans, cutting payments to hospitals for "high margin" surgeries and radiology services, revoking tax exemptions for hospitals that don't fulfill a mission of community service, or lowering Medicare pay for specialty care and procedures.
Noting Dr. Brewer's ideas, Jacob Goldstein asked readers of his Wall Street Journal blog what they thought of five different options for reducing spending to free up money for primary care.
These are the results from the 500+ plus respondents:
21%: cut Medicare Advantage.
20%: cut hospital pay for high margin services
26%: cut pat to specialists
11%: money shouldn't come out of existing health care spending
22%: primary care doesn't need more money
Granted, this was not a scientific poll. And Goldstein left out options that could have more support, such as prospectively applying some of the anticipated savings from reductions in preventable hospital admissions associated with primary care and using them to boost primary care fees.
Still, the fact that none of the options received more than one out of four votes (except for cutting specialists - barely - and one can imagine how that will play out in the political world) suggests trouble. And with 22% saying "primary care doesn't need the money," the consensus for primary care may be weaker than it appears.
The Wall Street Journal polls support two basic truths in politics. It easy to get people to agree to spend more money, but it is a heckuva lot harder to get agreement on where to cut. And those who have an interest in protecting themselves from cuts always start out with a political advantage over those seeking money at their expense.
Today's questions: Do you agree that the only way to fund primary is to take money from someone else in health care?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
- Should sunshine on my pharma make me happy?
- Would you like some sticks to go along with your c...
- Day One
- Stimulate this: Part 2
- Extra! Extra! Read all about it! Health care to ge...
- Have you been RUCed?
- Will primary care's "coalition of the willing" sta...
- Will the "Blue Dogs" have doctors singing the blue...
- Who is to blame for health care spending?
- Oh, Canada!
The Wall Street Journal's blog on health and the business of health.
Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.
The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.
Vignettes and commentaries on the medical profession.
The New Health Dialogue Blog
From the New America Foundation.
DB's Medical Rants
Contemplating medicine and the health care system
Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.
A blog dedicated to medical education, news, and policy as well as career advising.
Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.
Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.