In yesterday’s editorial, The Boston Globe correctly identifies the disturbing trend where hospitals are spending millions on new specialty expansions rather than primary care:

On the North Shore, three capital projects totaling more than $200 million are in the works. In Plymouth, Jordan Hospital in 2006 opened a $40 million pavilion, part of a $57.5 million expansion, only to see admissions drop by about 9 percent this year. Massachusetts General Hospital in Boston is planning a half-billion-dollar expansion and replacement of older buildings. In Springfield, Baystate Medical Center got the green light a year ago for a $259 million expansion that also includes replacing old buildings.

They correctly state that the impetus is the payment system that skews towards procedures, and hence, to incentivize hospital building.

The naivety of those in favor of universal coverage is exposed:

Advocates of the state’s health reform law had hoped that enrolling more of the uninsured in free or subsidized plans would lead them to build relationships with primary-care physicians. Not only would this improve their care, it would also reduce their reliance on high-cost emergency rooms for routine health problems.

They fail to mention that without adequate primary care access, the opposite is happening.

Expanding medical school enrollment by itself is not the answer. This simply will produce more specialists.

This however, may work better:

The Legislature has granted the University of Massachusetts Medical School funds to . . . waive tuition and fees for students who agree to work in primary care in Massachusetts for four years after graduating.

Someone’s starting to get it.