January 4, 2009, 11:04 am

Primary Care: Profit is not a Dirty Word

Okay, who made the mistake of asking Dr. OSoloMio what he sang for his “Idol” audition?

I bet is was that guy right behind him. Doesn’t he just look like a trouble maker?

I swear that is “Frasier” to his right.

Here, at the annual luncheon of the Clean Plate Club Specialists, our medical colleagues are discussing profit in healthcare, which just happens to be the theme of this week’s “Grand Rounds”.

Unfortunately, this led Dr. Vince McVocal to belt out a rousing rendition of Donna Summer’s “…they work hard for the money; so hard for you honey! They work hard for the money so you better treat ’em right!”

It could have been worse. They could have been discussing gastrointestinal disorders, leading to that top-of-the-chart musical number: “Heartburn, nausea, indigestion, upset stomach, diarrhea, Pepto Bismol!”


There is one aspect of health care I will never comprehend, and that is the unwillingness to pay primary care providers what they are worth.

The foundation of health in this country is primary care.

And that is what is wrong with our system.

The foundation is crumbling.


Health care is not a “right”. Health care is a necessity. It isn’t free. Never has been. Never will be.

But we are going about it the wrong way.

We are spending money “downstream” – after health issues have turned into major complications, and after the patients have fallen into the rapids.

But if we keep patients out of the water by putting the focus on health and the prevention, in other words, spending our money “upstream”, we get more bang-for-the-healthcare-buck.

And that bang-for-the-buck translates into primary care for everyone.



Primary care is not about disease, it is about health. The maintenance of health.

A relationship with a primary care provider who knows you, your family, your issues, your concerns.

This is what every American should have.

And no, I do not live in a “Marcus Welby, MD” fantasy world.

We can have this.

And I would recommend the steps listed by the Physicians for a National Health Plan to put it in place.


Let me quote the following from the PNHP site (all emphasis is mine).

Here is how the plan would be funded:

A universal public system would be financed in the following way: The public funds already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees’ health care, which would be eliminated. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments. For the vast majority of people, a 2% income tax is less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly if a family member has a serious illness. It is also a fair and sustainable contribution.

Here is what would be covered:

All medically necessary care would be funded through the single payer, including doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental care. We also advocate a sharp increase in public health funding.

Here is how it would be run:

There is a myth that with national health insurance the government will make the medical decisions…In a public system, the public has a say in how it’s run. Cost containment measures are publicly managed at the state level by elected and appointed agencies that represent the public. This agency decides on the benefit package and negotiates doctor fees and hospital budgets. It also is responsible for health planning and the distribution of expensive technology. Thus, the total budget for health care is set through a public, democratic process. But clinical decisions remain a private matter between doctor and patient.

(PS: For staff nurses, this is where we come in.  Our negotiated salaries would be included in the total budget allocated to our hospital, per PNHP.)

Here is why we all need to be covered under the same plan:

Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. If the wealthy are forced to rely on the same health system as the poor, they will use their political power to assure that the health system is well funded. Conversely, programs for the poor become poor programs. For instance, because Medicaid doesn’t serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important.

(All quotes are from Single-Payor FAQ/Physicans for a National Health Plan)


I’m not a doctor.

I don’t even play one on TV.

And I realize I have not even addressed the use of advance practice nurses in primary care.

But I see doctors everyday. From ER specialists to family practitioners to neurosurgeons .

There isn’t enough money in the world to compensate them for the awesome responsibility they take on when they earn that MD.

And so no, it isn’t wrong for them to want to make a decent living, or a profit, if you will.

The altruism that leads them to choose medicine is becoming smothered by the bureaucracy and capriciousness of our current system of compensation.

If we can change that through a single-payor plan; if we can make it easier to actually practice medicine, we will see an increase in the number of doctors who choose to be primary care specialists.

And we will all profit from that.


  • GrumpyRN

    January 4, 2009 at 3:27 pm

    Sounds very like the NHS.

  • Maureen

    January 4, 2009 at 4:35 pm

    I know the system is broken, we all know that, but I had no idea how to fix it. If your solution could be put into action. perhaps we could have a medical system we could be proud of in this country. Thanks for putting forth a suggestions, instead of just complaining!

  • Candy

    January 5, 2009 at 8:30 am

    Very well articulated! Now call Tom Daschle and fill him in…

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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