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?