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How New Jersey Public Policy Fails Primary-Care Physicians


Healthcare policies and laws that favor special interests are bad news for physicians and the public. New Jersey is a more extreme example.

The echo of Governor Chris Christie's announcement that he is running for president has barely died down. As the media spotlight turns to New Jersey, it will eventually shine on state healthcare laws and policies that are, at best, neglectful, and, at face value, favor powerful special interests that run contrary to the best interests of New Jersey residents.

At the heart of the matter are state laws and policies that starve primary-care physicians, whose job it is to prevent and manage chronic diseases that CMS says cost the U.S. about $2.7 trillion last year, $2 trillion of which CMS says are preventable or manageable.

New Jersey ranks 49th in the U.S. for the per capita amount spent on primary-care physicians, according to the latest CMS data (from 2009). Things are so bad that I'm told by a reliable source that every single member of the entire primary care graduating class of 2015 from every medical school in the state plans practice elsewhere.

Add payments to the physicians who treat the consequences of those same chronic diseases, and New Jersey jumps to third in the nation in per capita cost.

The implication of jumping from 49th in primary care pay to third in overall physician pay that a weak and underfunded primary-care structure leads to higher expenses is not conjecture. Domestic and international evidence is overwhelming (that would be from every one of other of the 27 "developed" nations) that supporting and enabling primary care with the resources to do their jobs properly provides much higher quality care at half the cost.

To be sure, this is a national problem. It is just easier to see in the most densely populated state in the nation. Whether by design, neglect, or ignorance, health laws and policies that starve, constrict, and minimize the most effective weapon we have against rampant chronic disease are a profound failure of politicians and policy at both the state and federal level. These failures needlessly hurt the public and the economy.

There is only one very powerful, influential, and wealthy class that benefits from policies that allow chronic disease to progress: those who receive the bulk of our healthcare resources to treat the consequences of them.

New Jersey legislators claiming ignorance of the value of primary care falls as flat as their continuing failure to protect their own citizens from predatory, out-of-network billing practices. The state senate president is peddling a bill to take several hundred of the states' remaining primary-care physicians from the public and pay them over $200,000 per year each to only care for teacher union members.

To be fair, Gov. Christie did not sign the key policies leading to New Jersey's exaggerated lopsidedness of laws favoring special interests into law and would be highly unlikely to support them given his record.

Nonetheless, Christie, like virtually every other governor in the nation, has not called out or pressed the legislature to meaningfully put their citizens first.

The more the federal government focuses on getting more people to pay for an over-regulated and wasteful U.S. healthcare system, the more big healthcare, providers, and payers alike, are spurred into a consolidating feeding frenzy to bulk up enough to preserve the status quo. Those working both innovative and proven healthcare delivery models that sustainably deliver high quality care at steeply reduced cost threaten these forces, and increasingly do so at their own peril.

Candidates at the federal and state levels have to pick a side this election cycle - physician groups working to deliver quality and better health at affordable cost or super-sizing what we have now.

Even the federal government can't print enough money to cover the latter.

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