What happens if primary care gets treated like a public utility – something that everyone can access as easily as running water?
A new article in JAMA paints a beautiful picture of what that might look like, and even colors it in with a roadmap for how to get there.
Primary care is a critical component of healthcare. It’s also far from universal.
- More than a third of U.S. adults lack access to primary care, an eye-popping number that unfortunately makes more sense knowing primary care only sees 5 cents of every federal dollar spent on healthcare.
The authors frame up the issue perfectly.
- “Primary care has long fit awkwardly as an insurable risk in the marketplace. Insurance is designed to protect against large, unpredictable expenses. Yet primary care is largely predictable, similar to food, housing, and other common necessities.”
The proposed solution? A primary care common fund, which pools primary care spending from public and private purchasers and pays practices directly. Here’s the basic outline:
- The common fund would comprise current primary care spending from payors, and include the additional spending that states invest into primary care in the future.
- A state authority – much like a public utility – would administer the funds and pay practices directly.
- The “pluralistic financing” of primary care would remain intact. Employers and individuals would continue to pay premiums for commercial plans, and Medicaid would continue to be financed by federal and state funds. On the back end, the state would redirect the primary care portion of payor premiums (their contribution) to the common fund.
- A key point is that the common fund starts with no “new money.” Baseline contributions equal what purchasers are already spending on primary care (ex. Oregon has a primary care spending target of 12%, and would assess 12% of plan premiums).
- Payors would no longer need to compete on prices and benefits for primary care, but they’d still compete on their specialty and other lines of business.
- People remain enrolled in coverage for non-primary care services, but the common fund “assumes responsibility for coverage and payment of primary care and accountability for its spending.”
The Takeaway
If the U.S. wants everyone to have access to the benefits of primary care, a good start might be making sure everyone has access to primary care. This paper charts a path to get there straight down the middle of single-payor and free-market approaches, and a “Medicare Advantage for Primary Care” feels more doable than ripping and replacing the entire system.
