Yesterday, President Obama's top economists released a report on how health care reform will improve the economic health of the country.
The President's Council of Economic Advisers estimate that "expanding health insurance coverage to the uninsured would increase net economic well-being by roughly $100 billion a year, which is roughly two-thirds of a percent of GDP" and that "[With health care reform] the real income of the typical family of four could be $2,600 higher in 2020 than it otherwise would have been and $10,000 higher in 2030." The report makes the case that, "slowing the growth rate of health care costs will prevent disastrous increases in the Federal budget deficit" because, absent reform, "Medicare and Medicaid expenditures are projected to rise from the current 6 percent of GDP to 15 percent in 2040..."
The report identifies seven "drivers" of inefficiency that need to be addressed in health care reform:
1. Provider incentives that reward providers for volume of services rather than quality, cost and efficiency.
2. Limited financial incentives for consumer to consider price, quality and choice of health care setting.
3. Pricing of medical treatments that are slow to adjust for productivity improvements and decreasing marginal costs of production.
4. Fragmentation caused by patients receiving care from independent and competing organizations instead of vertically integrated groups like Geisinger and the Mayo health systems.
5. Lack of information for providers on the clinical risks and potential health benefits of alternative treatments.
6. Lack of comprehensive performance measurement and feedback to providers on how well or poorly they are doing on providing recommended care.
7. Lack of information to consumers on the effectiveness of different treatments.
What's missing? That the growing lack of internists and other primary care physicians in the U.S. is a principal driver of higher costs and a major reason why we lag behind other countries.
Oh, to be fair, they did mention primary care in passing:
"Though we describe them separately, it is important to note that there may be interactions between expanding access to coverage and slowing cost growth. For example, wider access to primary care, with an emphasis on prevention, is likely to help restrain cost growth."
That's it. No other mention of physician workforce issues. No mention of medical home. No mention of internal medicine, family medicine, or pediatrics. No mention of "patient-centered" care except for once in the introduction. No statement about the urgency of reversing the imminent collapse of primary care medicine.
This, despite the evidence that primary care is consistently associated with better outcomes and lower costs of care.
That such bright people overlooked the importance of having an adequate primary care physician workforce suggests several possibilities. One is that they are unpersuaded by the evidence. Another is that they simply overlooked it. A third is that they are aware of the evidence, but have decided for political reasons not to make it a priority. Or maybe they just forgot.
No matter the explanation, the Obama administration needs to make physician workforce issues, and especially the need to avert a collapse of primary care medicine, a higher priority. The urgency of the issue deserves a lot more attention than 17 words out of a 51 page report that was supposed to make the definitive economic case for health care reform.
Today's question: What else do you think should be done to get White House policymakers to make primary care a priority that matches the urgency?