Much of this blog was developed from Chapter 2 of the National Academy of Engineering, Science, and Medicine Consensus Study Report on Implementing High Quality Primary Care (“IHQPC”). References are to specific pages within the document.
Have you ever considered Primary Care an essential component to achieving the basic American values of “life, liberty, and the pursuit of happiness”? While I certainly value and have dedicated my professional career to making high-quality primary care available to hundreds of thousands of Americans, casting it in this lofty light has made me rethink the opportunity we are pursuing at Crossover.
As I wrote previously in the “Primary Health is . . .” series, there is a growing interest in characterizing the foundational services offered by Primary Health as a “Common Good.” When thinking about primary care in these terms, the health of the nation can be treated like an important asset that should be protected like any other key resource. Much like capital stock that needs to be replenished through moderated consumption so that savings can be accumulated in order to make future investments, the health stock of a country should be considered an asset to be prized, prioritized, and planned for in order to protect, nurture, and grow it over time.
This effectively puts primary care in the same category as public education, which becomes a “Common Good to be assured, not a personal service to be delivered” (IHQPC, pg 48). I am not naive to the many challenges with this analogy, or to public education specifically, but given the “documented salutary effects for population outcomes and equity (and contribution to inequity when missing or inadequate) within the United States, and the considerable evidence of Primary Care’s contribution to relative improvement in health outcomes in other developed countries, support the goal of making Primary Care a public benefit rather than a health service.” This approach could create the necessary public interest and political support to better highlight the national interest in protecting the foundation of our nation’s healthcare infrastructure.
The call to reframe the investment in High-Quality Primary Care as a Common Good in order to increase our capacity to care for our citizens is also an urgent call to action. The evidence supporting the unique importance of Primary Care relative to other healthcare services is strong and convincing (Basu et al., 2019; Levine et al., 2019; Macinko et al., 2003; Shi, 2012). Furthermore, our primary care “system” was heavily exposed during the COVID-19 pandemic—lack of access, lack of equity, lack of payment models, and a general lack of resiliency to provide for basic services. Much like other supply lines that were equally exposed, the US has an opportunity to increase the capacity of primary care by making key investments, introducing new payment models (see my next post), bringing forward more compelling research, and putting together a public policy and legal framework to assure the health and wellbeing of the nation.
Having articulated the “why” and the “what,” we must now muster the “will” to make it so. It should be considered every sovereign nation’s opportunity and obligation to protect, preserve, and promote this sovereign asset for future generations.
Scott Shreeve, MD 