Justice Group Underscores Need for Primary Care Infrastructure

The nation's inability to build and sustain a primary care infrastructure has led to a disjointed and fragmented health care system that is incapable of addressing the nation's growing health care needs. That's according to former Surgeon General and family physician David Satcher, M.D., Ph.D., and other speakers who addressed a press briefing convened by the National Summit of Clinicians for Healthcare Justice here on Oct. 23.

Satcher described primary care as a "critical part of the health care system." But, he noted, primary care has been "so underfunded, under-supported and abused in so many ways, it cannot play the role in making this health care system work in terms of bringing together treatment, prevention and health promotion."

"There is no excuse for not having a primary care infrastructure in this country that serves all the people," said Satcher, the current director for excellence on health disparities and head of the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta.

U.S. medical schools continue to produce subspecialists at the expense of primary care physicians, despite the shortage of primary care physicians, Satcher said. And that situation will never change as long as health care is treated as a commodity available only to the highest bidder.

"In medicine, you have this dichotomy," said Satcher. "You have the highly-paid specialists and the lowly-paid primary care providers -- so where do you think students are going to go, especially when many of them are loaded with debt when they get out (of school)."

"We have to find a way to provide incentives for people to go into primary care," he added. "And we have to see health care as a right in this country and make sure it is available to everybody."

This will entail some changes in physician payment systems, acknowledged Satcher. But as he explained, "what is wrong with paying for what we need? When we go to the store, we pay for what we need; we don't pay money for something we don't need. I don't see anything wrong with those who are spending tax dollars saying, 'We are going to put America's dollars where America's health needs are."'

The two other speakers on the panel, Mary Carol Jennings, a Jack Rutledge legislative director for the American Medical Student Association and George Rust, M.D., M.P.H., a professor of family medicine and director of the Center for Primary Care at the Morehouse School of Medicine, also decried the lack of primary care physicians while touting the benefits of a primary care-based health care system.

"Primary care doctors are the ones who keep America healthy, and they are the ones who keep other nations healthy," said Jennings.

"When you have a primary care foundation for your health care system, the health care system is more cost effective, and it produces better health outcomes," said Rust.

All three speakers also lamented the persistently high numbers of uninsured and under-insured in this country. The United States spends about $2.3 trillion a year on health care expenditures, an increase of $1.1 trillion from 10 years ago when he was surgeon general, said Satcher. Yet, nearly 47 million Americans remain uninsured, including 9 to 10 million children. Another 25 million are under-insured.

"The uninsured in this country -- regardless of what anyone says -- don't get access to health care, certainly not (access to) a medical home," Satcher said. Consequently, mortality rates among the uninsured are much greater; as many as 20,000 to 25,000 uninsured people die each year because they are uninsured and lack access to health care services, according to Satcher.

Rust noted that every industrialized nation, aside from the United States, has found a way to cover the uninsured, and this country should do the same. "If you like a private insurance model, let's go to the Netherlands or Germany or Switzerland," said Rust, citing some examples. "If you like private ownership of the medical system, let's go to Japan. Basically, whatever model you like, there is one out there that covers everybody."