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A Plan to Save Primary Care


My recent column on the grave peril in which American primary care finds itself and my simple plan to reverse the tide has really struck a chord with many of you.

What I propose doing to "save" primary care is to put PCPs at the center of all American healthcare, where I think they belong. The idea -- which is meant only as a starting point point for a conversation -- is for Medicare to insist that all beneficiaries have a single PCP, and then set a date certain (10 years hence, say) after which it will cease paying for any service not previously approved by that patient's PCP (with appropriate exceptions, like for emergency care).

My proposal sparked a dialogue, as I'd hoped. Many physicians wrote me directly -- some to agree with me, some to agree in part while pointing out some holes in the idea, and others to flat-out tell me how nuts I am. Great stuff, all, and whatever we can fit will appear in the June issue of the magazine. I urge you to read the column yourself and take part in the conversation.

Meanwhile, I'm posting most of the letters I received here, in the comments section of this post, and some of responses to these missives. Please feel free, readers, to post your own ideas and comment on mine and others. This conversation is meant for everyone.


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