Wednesday, May 18, 2011

When did support for primary care become a partisan issue?

You’d think that ensuring that there will be enough primary care doctors would not become a partisan issue. If you are a Republican congressman from Texas, or a Democratic Senator from California, you’d want your constituents to have access to a primary care doctor, right?
Apparently not: in the hyper-polarized and ideological world in which we now live, even modest steps to support primary care have been caught up in the worst kind of partisanship. The Washington Post reported on Sunday that funding for a new expert commission authorized by the Affordable Care Act (ACA), which was to examine barriers to careers in primary care, has been blocked by Republicans:

“When the government set out to help 32 million more Americans gain health insurance, Congress and the Obama administration acknowledged that steering more people into coverage had a dark underside: If it works, it will aggravate a shortage of family doctors, internists and other kinds of primary care. So Page 519 of the sprawling 2010 law to overhaul the health-care system creates an influential commission to guide the country in matching the supply of health-care workers with the need. But in the eight months since its members were named, the commission has been unable to start any work.

The group cannot convene, converse or hire staff because $3 million that it needs for its initial year has been blocked by two partisan wars on Capitol Hill — strife over the federal budget and Republicans’ disdain for the health-care changes that Democrats muscled into law 14 months ago. . . Having voted four months ago to repeal the entire Patient Protection and Affordable Care Act, as the law is called, the House GOP has proposed a budget that ‘makes the case ... no new taxpayer dollars will be directed to fund the law,’said Conor Sweeney, spokesman for House Budget Committee Chairman Paul Ryan (R-Wis.)”

No new taxpayer dollars will be directed to fund the law? Think about what this means. The ACA—or “Obamacare” as the GOP derisively calls it—includes hundreds of programs that in a rational world would have the support of Republicans and Democrats alike. In addition to the workforce commission, the ACA authorizes funding for primary care training programs, expansion of the National Health Service Corps, community health centers, patient-centered medical homes, primary care residency programs in non-hospital settings, and higher Medicare and Medicaid payments to primary care physicians. Republicans used to believe in these kinds of programs, for instance, in 2009, the Wall Street Journal reported that Senator Chuck Grassley, then the ranking Republican on the Senate Finance Committee, argued that “Plans to overhaul the U.S. health insurance system must make primary health care a more attractive career field.”

But now most Republicans apparently want to block funding for provisions in the ACA [to] make primary care a priority because of their single-minded opposition to all things related to “Obamacare.” The budget plan passed by the House of Representatives, which was crafted by Representative Ryan, would repeal the entire Affordable Care Act (except for cuts in Medicare payments to hospitals and Medicare Advantage plans, but that is another story), not just funding for primary care, but also, other programs that should appeal to fiscal conservatives because they have the potential to improve care and lower health care costs, like research on the comparative effectiveness of different treatments and support for prevention and wellness programs.

I don’t really believe that most Republicans are against funding for primary care, prevention, wellness, and clinical research. If each of these programs were voted upon based on their own merits, as they would be in a more rational world, most of them would have broad support from Republicans and Democrats alike. But because they are included in a broader health care reform law that Republicans have vowed to repeal, programs to increase the numbers of primary care physicians may not get funded, and the result will be longer wait times for appointments with primary care doctors, poorer health outcomes, and higher medical care costs.

Today’s question: How do you think GOP members of Congress can be persuaded to support funding for programs in the ACA to support primary care, even though they have pledged to repeal the entire law?


Harrison said...

I think that Republicans going back to President Hoover would argue that the government should have a small role in American business -- if any at all.
Republicans see health care as a service industry business.
Therefore, government should have no role in health care.

In that world, primary care, if valued by consumers, will find its own way.
Government support should not be necessary.

The ACA is opposed on the grounds that it represents an increase in government involvement in the health care industry.
There is no component of that that Republicans today can favor.

There are a lot more cynical ways to view this:
The corruption of money;
Racism against President Obama;
The very uncomfortable and fragile bond in the Republican party between social conservatives and fiscal conservatives who don't really agree on as much as they would like.

And for sure those cynical views carry some weight.
But I think that party leaders like Speaker Boehner, and Rep Ryan, and Majority Leader McConnell mostly find common ground in a goal to reduce the size of government.

From that perspective they may be persuaded to support a government role in encouraging primary care -- and the ACP should work towards that goal.


Jay Larson MD said...

If medical schools, residency programs, the AMA and specialty societies, and insurance entities(private and government)are not on board for supporting primary care because procedures and technology are so valued in our health care system...why would the GOP?

Arvind said...

If you believe that getting funding no mater how it comes, then the ACP should try convincing the Republicans. If we believe that the whole idea and methods by which the ACA was passed, then the whole thing must be dismantled. Funding primary care and other items can then be taken up individually.

jonwilson said...

Funding primary care and other items can then be taken up individually. I agree. Private health insurance can help with this. No need to burden the government.

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gujjar g said...

Thank you for share this informative post.