Will the Baucus health plan save primary care?

Senator Max Baucus introduced a health plan meant to give guidance to the Democrats in their upcoming reform attempt. It essentially mirrors the Obama plan, except that it includes individual mandates, similar to Massachusetts’ and Hillary Clinton’s approach.

I’ll leave the discussion of mandates to wonks like Ezra Klein and Maggie Mahar, but let’s see if there is enough language to satisfy primary care physicians.

Here is the policy paper (it’s about 100 pages). Some choice quotes are below, and you’ll find it repeats some of the concerns and solutions frequently mentioned on this blog:

Primary care is the keystone of a high-performing health care system. Access to primary care that successfully manages and coordinates patient care, particularly for the chronically ill, is a proven determinant of high-quality, cost-effective care.

Yet America’s current system undervalues primary care relative to specialty care. This has caused fewer medical students to choose careers in primary care, and has created access problems that will only worsen as more Americans get health care coverage. Increasing the supply of primary care practitioners and redefining their role in the health system “” by using Federal reimbursement systems and other means to improve the value placed on their work “” is a necessary step toward meaningful reform.

That almost sounds like something I could have written. There’s more:

The Baucus plan includes several initiatives to improve our primary care system: ensuring accurate prices for primary care services in Medicare, providing an add-on bonus payment for primary care services, and encouraging further testing and implementation of the medical home model. The plan would also ensure the viability of community health centers and rural health clinics that provide vital safety net functions and serve as a true medical home for thousands of patients across the country.

There is acknowledgment that any changes will spread the wealth are “budget neutral,” meaning that there will be significant resistance from the AMA and specialist organizations:

Budget-neutral changes to Medicare payments mean that any increase to primary care providers requires a corresponding cut to specialist services. This approach has the potential to create significant controversy among physicians, however. Any reforms along these lines must be crafted in collaboration with the entire physician community and other practitioners to ensure appropriate valuation of, and access to, primary care services.

Also important is that the approach is explicitly not single-payer or Medicare for all, as Senator Baucus stated in his press conference:

I don’t think a single payer health care system makes sense in this country. We are America, we will come up with a uniquely American health care system that’s a combination of public and private.

I haven’t read the whole thing yet, but my initial reaction is cautious optimism. If this plan is the foundation for future legislation, it is reassuring to know that primary care will be the centerpiece of reform.

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