The dire state of primary care in Vermont is now serious news, drawing the attention of everybody from the Legislature to the Vermont Medical Society to Vermont Public Radio to the Green Mountain Care Board.

We can add that problem to the problem of the outrageously high cost of health care that discourages even insured Vermonters from seeing a doctor because they can’t afford their deductibles and co-pays.

Our health care problem is deepening and expanding because it’s virtually impossible to solve a problem when you ignore all the facts about that problem. Rather than diligently searching for the best solution to the health care problem, whatever that solution might be, we have been trying to find an answer that is politically acceptable, one that won’t unduly upset the people and businesses that profit from the current system.

The “acceptable” answer we have landed on is that we need to get away from fee for service and arrive at some goal called “value-based care.” That’s now pitched as the cure-all for everything.

But there is no real-world evidence that fee for service is the major culprit in either the overall cost of health care or the shrinking number of primary care doctors. Continue reading…