Unrealistic, Impractical, Utopian Health Care Reform Plans

Here'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'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's because compensation rates and reimbursement totals are dismally low for PC docs. And that's why health care costs won't decrease much at all until we shift to a medical culture that stresses proactive care, not reactive care. The CBO can'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's a no-brainer. And maybe not so utopian after all.