Senate Panel Diagnoses Primary Health Care Crisis

A Senate panel today examined a "major crisis" in primary health care at a time when 30 million more patients will soon get health insurance under the Affordable Care Act and worsen an already acute doctor shortage.

One in five Americans today live in areas where they do not have adequate access to primary care due to a shortage of providers, according to Sen. Bernie Sanders (I-Vt.), the chairman of the Senate Primary Care and Aging Subcommittee.

"In our country today we are spending almost twice as much per capita on health care as any other major country yet our health outcomes in terms of life expectancy, infant mortality and disease prevention are not particularly good," Sanders said. "One of the reasons for that is that we have a major crisis regarding primary health care access which results in lower quality health care for our people and greater expenditures."

According to a report released at the hearing, as many as 45,000 people die each year because they do not have health insurance and do not get to a doctor on time. A significant reason for the lack of access to care is that less than one-third of all doctors in America today practice primary care, down for half of all physicians 50 years ago. The problem is likely to get worse because many primary care doctors are nearing retirement and fewer and fewer medical students are interested in becoming family practitioners.

Dr. Claudia M. Fegan, the chief medical officer at Cook County Hospital in Chicago, told the subcommittee she sees evidence every day of patients without primary doctors. "Every single day, people without a physician line up across the street from our hospital to be seen in our walk-in clinic ... They hope to be one of the lucky ones who will be given a physician of their very own, who will get to know them and take care of them and be available when they have a problem or question, someone to help them meet their medical needs, someone to help them navigate our complicated health care system to get what they need."

Another witness, Princeton economist Uwe E. Reinhardt, said Medicare and Medicaid payments should be realigned to address the acute shortage of primary care physicians.

Tess Kuenning, executive director of the Montpelier, Vt.-based Bi-State Primary Care Association, testified that community health centers could provide affordable care for more patients. The 2010 health care law included a Sanders provision that authorized $11 billion to double the number of patients cared for at health centers. Funds needed to reach that goal, however, have not been committed.

In Vermont, Kuenning said, more than 110,000 patients receive care at one of eight community health centers throughout the state. With additional funding, she added, three more communities "are fully poised to apply for competitive federal funding to bring medical, dental and behavioral health services to communities in need."