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THE HECK WITH FIXING HEALTH INSURANCE. HOW ABOUT BUILDING A HEALTH CARE SYSTEM? by Michael Fine, MD

This article is more than 11 years old.

Today, I do her pap smear, and get her a mammogram. Another day we work through her insomnia. Yet another day we figure out how to fix a knee that hurts.

I sell primary care. I’m proud of my work – it’s the only medical service that improves life expectancy, that reduces the cancer death rate, the heart disease death rate, and increases life expectancy. It’s the only medical service that meets people where they are, as they are, and tries to listen.

I don’t sell health insurance. Health insurance costs between $500 and $1000 per person per year for the paperwork alone. Primary care, on the other hand, costs $150 per person per year.

Our political candidates believe that we can create access to health care for all Americans by working with, or remodeling, our health insurance marketplace. But 60 years of health insurance, uncontrollable costs, expenditures that now comprise almost 17 percent of the Gross Domestic Product – more by far than any country in the industrialized world-- 47 million uninsured, and population health indicators that leave us ranked between 25th and 75th in the world, all suggest that our problem is not in fixing insurance; indeed, our problem may be with our failed attempt build an insurance system before we built a health care system.

Every country in the world that is effective at controlling costs and improving the health of populations achieves this result by providing primary care to everyone in the population. Primary care is affordable and incredibly effective. It’s also a stable, predictable cost, with reliable and meaningful outcomes.

We spend about $700 billion a year on Medicare and Medicaid. If we could save 30 percent of that, we’d save $210 billion. A robust primary care system costs $120 billion a years, and servers everyone in the US, not just people with Medicare and Medicaid.
We can provide a primary for all Americans with little addition investment. If we do so, we will decrease the cost of health care by 30 to 40 percent, and improve the measured health of all of us.

Instead of arguing over an irretrievably broken insurance system, let’s give primary care to everyone. Instead of arguing one payer or many payers or health savings accounts, lets agree to provide all Americans what we know works.

Our presidential candidates should be telling the American people that we can improve the health of all Americans, reduce our costs, and care for the uninsured, just by giving all Americans primary care.

And then we’d have a health care system.

If not now, when?

Michael Fine, MD
Physician-in-Chief, Dept. of Family and Community Medicine, Rhode Island Hospital
Co-Author of "The Nature of Health"

This program aired on May 10, 2008. The audio for this program is not available.

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