President Obama’s Council of Economic Advisers (CEA) released The Economic Case for Health Care Reform on June 2. The report, which is a masterful summary of the sad and unsustainable state of US health care, overlooks the key linchpin in the journey ahead: family physicians.
First, some highlights of the report:
- Health expenditures are expected to be 18% of gross domestic product in 2009.
- Slowing the annual growth rate of health care costs by 1.5 percentage points would increase GDP by more than 2% in 2020, and by nearly 8% in 2030.
- Bringing down health care costs would increase the income of a typical family of 4 by $2600 in 2020, and by $10,000 in 2030 (in 2009 dollars).
- Extending health insurance coverage to the uninsured would increase net economic well-being by roughly $100 billion a year.
How do we realize such staggering savings? According to the CEA, the following changes are imperative:
- Slow cost growth. (At a meeting with the President on May 11, key stakeholders—insurers and pharma among them—pledged to “bend the health care cost curve” by 1.5 percentage points per year.)
- Reorient the financial incentives of providers to value rather than volume.
- Conduct comparative effectiveness research.
- Expand performance measurement and feedback.
- Reduce fragmentation, particularly in administrative services.
- Target fraud and abuse aggressively.
- Engage patients in decision making.
- Expand coverage by establishing an insurance exchange and increasing the availability and affordability of health insurance.
But these changes—and savings—can be achieved only if we have a robust, and valued, primary care workforce. The administration may need to encourage medical students to enter family practice through payment reform, provide incentives for establishing patient-centered medical homes and delivering evidence-based care, or reconfigure reimbursement for graduate medical education. Whatever steps it takes, one thing is certain: Without more family physicians, this plan is doomed.
President Obama, are you listening?