Make Primary Care Free For All

March 20, 2016

 Vermont Digger

Editor’s note: This commentary is by Deborah Richter, M.D., a practicing physician who lives in Montpelier.

For the past 25 years, Vermont has searched for ways to better manage health care costs. In all that time a solution – one that has worked everywhere it has been tried – has been overlooked: Make primary care free to all.

Primary care is the care received from family doctors and pediatricians and, in Vermont, includes mental health care and substance abuse treatment. Where it is freely accessible, it improves the health of a population and the quality of health care while lowering overall costs.

There is a ton of evidence to this effect. Even without it, the idea appeals to common sense because much of what primary care practitioners do is help prevent the progression of disease, addressing problems before they become expensive illnesses.

Primary care is comparatively inexpensive. Of the estimated $5.6 billion we expected to spend on health care this year, less than 5 percent goes to primary care.

For a relatively small investment we could achieve what we have spent decades striving to do and failing.

Here’s how it would work.

Every Vermonter would get a card entitling him or her to free primary care.

Some positive effects would be:

• There would be no cost barrier for anyone seeking primary care.

• Health insurance premiums would go down proportionately.

• Vermonters would be freed from worrying about the cost of routine health care.

How do we know it would work?

Almost all other industrialized countries have better access to primary care than we do. One result is that their overall costs per person are half of ours. Also, lifespans are longer, fewer babies die in their first year, and general health outcomes are better than ours. [1]

Almost all other industrialized countries have better access to primary care than we do. One result is that their overall costs per person are half of ours.

Last year, the Vermont Legislature began studying this idea. The findings, released in December, showed that for $48 more per person per year than what we are now spending on primary care we could make primary care free for all.

Beyond the obvious (better health, better outcomes, better cost management over the long term) there are other advantages.

The proposal fits in nicely with ongoing reforms. In fact, the two main reforms in their infancy (the accountable care organization and all-payer model) depend directly on a strong primary care sector.

Management of cost trends in health care can only effectively take place on a sector basis. Choosing population groups by age or income will help members of those groups, but it does not help with overall management of cost trends.

Primary care is an important sector. It is where your health care starts. There are other sectors, such as hospitalization costs. But hospital care is 38 percent of overall health care spending. Its size makes it tougher to address.

Primary care is far, far smaller, and is the most promising candidate for positive change.


[1] For an interactive chart comparing countries see the Organization for Economic Co-operation and Development (OECD)’s “Health Statistics 2014.” A small selection of other unpaywalled studies and articles can be found here, here, and here. These articles are paywalled, but offer useful synopses: here and here.