Help Move U.S. Health System to Primary Care Base

If you're like many Americans, you've been glued to your TV set for many an evening this month, watching presidential candidates challenge one another on issues, including our top pick: health system reform.

This is a "change" election the likes of which we've never seen, and a Kaiser Family Foundation poll in late December showed that health care is the top domestic issue the American public wants presidential candidates to discuss.

What's driving the demand for health care change? Rising costs, pure and simple, according to the "2008 Environmental Scan" prepared by the Washington-based consulting firm GMMB and presented to the AAFP Board of Directors in late 2007. The Academy contracts for the scan each year to get a third-party view of the health care environment. To receive a copy of the scan, send an e-mail to ann@aafp.org requesting the "2008 Environmental Scan."

According to the scan, workers' health insurance premiums skyrocketed 100 percent from 2000 to 2007, while workers' earnings crept up only a little more than 20 percent. Rising health care costs have hit employers as well, and employer-sponsored coverage declined from 80 percent in 1980 to 60 percent in 2007.

In 2006, 47 million people went without insurance coverage, up from 44.8 million in 2005. Uncompensated care for people without coverage adds to rising costs.

Everybody wants to find a solution. Clearly, the door is opening for health system reform. We know reform won't happen this year because Washington is in "policy lockdown" until after the election. But there already have been encouraging signs, including increased media focus on the importance and power of primary care.

A good example is a Nov. 1 New York Times editorial that responded to a Commonwealth Fund survey of patients in seven industrialized nations. One-third of American respondents said they felt our system is so dysfunctional that it needs to be rebuilt completely. "The findings underscore the need to ensure that all Americans have quick access to a primary care doctor and the need for universal health coverage -- so that all patients can afford the care they need. That's what all of the presidential candidates should be talking about," the editorial concluded.

Some presidential candidates are indeed speaking up for primary care and preventive medicine, even touting the benefits of the personal medical home. (Visit "2008 Presidential Campaign" on the AAFP Web site for more on candidates' positions.)

What should the AAFP and you do to keep the reform fires burning, both before the election and after? The 2008 Environmental Scan offers several suggestions, including these:

Change is a process, not something that has to be done all at once -- so initiate one change in your practice. Get it up and running. Then move on to another. This stepwise approach makes change less daunting and more manageable.

The AAFP offers myriad resources to help as you make these necessary changes, including

With transformed practices and with powerful advocacy by the Academy and its allies, family medicine can win the health reform battle. Thank you for playing your critical part.