This observation isn’t new. But with the way that primary care is treated, I don’t expect anything to change soon:

Reviewing a Dartmouth Medical School study that found higher mortality rates in areas that spent the most on Medicare, professor Elliott Fisher concluded that “perhaps a third of medical spending is now devoted to services that don’t appear to improve health or the quality of care “” and may make things worse.” This means that the United States is wasting more than $650 billion a year “” half again more than the entire Defense Department will spend this year, including the cost of the war in Iraq “” on unnecessary and often harmful care.

How can this be? One factor is specialists. Both U.S. and international studies show that the more a health-care system relies on primary care, the better the outcomes and the lower the cost. But American medicine is heavy on specialists and getting heavier. In just the last eight years, the number of graduates of U.S. medical schools choosing careers in family practice and adult primary care has plummeted by more than half.