Are you saying that chronic conditions such as hypertension and diabetes are not worth treating?

And who pays for medical care when people cannot afford it?

A amily practitioner

If they do actually live longer as a result of better primary care, then they cost “somebody” more in the long run anyway. The old dog about saving money just doesn’t hunt anymore.

Medical care is a private, not a public good and private individuals should pay for their own.

…besides the specialists themselves, obviously.

As a Canadian medical student I’m amazed at the little gold mines which exist in medicine. Things like colonoscopies, cataract surgeries, and much of radiology pay-out ridiculous amounts of money given the time and skill those things take.

As more and more of medicine starts being done entirely by computers (run of the mill radiology, reading ECGs) or at least heavily assisted by computers (internal medicine), I hope whiny, obsolete specialists aren’t given the chance to stand in the way of progress.

A better analogy is car care. Most people can afford 3,000 mile oil and filter changes but still do not choose to do it. As a result, they run the risk of a major breakdown which will cost them many times more. Well, that’s their problem right?

But here’s the catch: if a patient chooses to not get check ups, such as someone with hypertension or diabetes, even if they are affordable, and then gets a major complication such as an MI, hyperosmolar coma, a stroke or renal failure, what should we do? Then we,as a society, wind up footing the bill for the care, either through higher insurance rates, medicare/medicaid, or uncompensated care.

I know someone will say, “well, it’s the patient’s responsibility” but that is a moot point. The patient is then sick and needs more expensive care, and someone has to pay for it.

A family practitioner

Primary care, when stripped of the extra overhead and inflated prices of third party payment, is not expensive enough for most patients to need a prepayment system. Many of our patients spend more on their cable and cellphone bills than they would keeping their blood pressure under control.

For those with many complicated illnesses and the destitute, of course we’d need a safety net of some type. Everyone should have a catastrophic policy of some type. But that’s no reason to keep primary care trapped in layers of bureaucracy.

This is more likely to save primary care than any complicated medical home schemes. It may keep enough physicians in primary care to offer patients an alternative to just midlevels.