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 <title>Mother Jones - Comments for &quot;Unrealistic, Impractical, Utopian Health Care Reform Plans&quot;</title>
 <link>http://motherjones.com/mojo/2009/07/unrealistic-impractical-utopian-health-care-reform-plans</link>
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 <title>Health Care For The Earth Is Health Care For All</title>
 <link>http://motherjones.com/mojo/2009/07/unrealistic-impractical-utopian-health-care-reform-plans#comment-181614</link>
 <description>&lt;p&gt;The health of the earth is being damaged with no hospital for it to go to; no alternate plan for the earth&#039;s largest remaining temperate rain forest; &lt;a href=&quot;http://blogdredd.blogspot.com/2009/07/obama-looses-my-vote-for-reelection.html&quot;&gt;Obama admin reverses Clinton Administration&lt;/a&gt; and allows logging in Tongass; STOP IT!!!!&lt;/p&gt;
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 <value>Thu, 16 Jul 2009 15:51:35 -0700</value>
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 <value>Dredd</value>
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 <value>comment 181614 at http://motherjones.com</value>
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 <title>Invest in primary care -- the least utopian idea out there</title>
 <link>http://motherjones.com/mojo/2009/07/unrealistic-impractical-utopian-health-care-reform-plans#comment-181575</link>
 <description>Here&#039;s the least utopian plan out there: Shift the debate over health care from *how* we get our care--public plan to compete with private, co-ops, expanded Medicare, etc.--to *what kind* of care we want and need. The most effective, revolutionary health insurance plan on the table right now won&#039;t change the fact that we have a terribly misaligned health care system. 

Whereas European medical systems have a roughly 50-50 balance of subspecialists and primary care physicians, the US is 70-30 toward subspecialists. 90 percent of medical school graduates bypass primary care and subspecialize. 50 percent of PC docs said in a November poll that they would leave primary care if they could. There will be a demand of 40,000 PC docs in ten years if this trend continues.

As such, existing PC docs are like hamsters in a spinning wheel: they get 10 to 12 mins with each patient, and instead of spotting chronic exacerbations or early disease signs at the start, these docs become referral factories. ANd that&#039;s because compensation rates and reimbursement totals are dismally low for PC docs. And that&#039;s why health care costs won&#039;t decrease much at all until we shift to a medical culture that stresses proactive care, not reactive care.

The CBO can&#039;t score preventive care (a major flaw on their part), but the government should invest heavily in primary care. Realigning our system is really the only way to contain costs; and, as study after study after study has shown, more primary care access equates to increases in the quality of care and decreases in cost.

It&#039;s a no-brainer. And maybe not so utopian after all.</description>
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 <value>Thu, 16 Jul 2009 13:34:00 -0700</value>
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 <value>Andy Kroll</value>
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 <value>comment 181575 at http://motherjones.com</value>
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