Over the last two years, there has been much heat generated over "health care". In broad terms, the political parties have squared off, looking to score points on whether the law will produce a more fair distribution of benefits or the type of death camps associated with communist states. This rather misses the point. All the average person really wants is access to care of reasonable standard at a price that can be afforded. In fact, we already know how to achieve this result. There is clear evidence both in the US and the majority of other countries around the world that if the primary care service is working well, it improves health and lowers costs. Why is this? Well, it comes down to two factors.

First, a local doctor can get to know you and build up a picture of your lifestyle and health issues over time. If you go into an Emergency Room, you see a doctor for just that one incident. It's the difference between taking a single photograph and a video recording. This leads to a key advantage. Once your primary care doctor "knows" you, it is easier to spot changes in you. In general practice, more people are diagnosed early for heart disease, cancer and other serious diseases and disorders. Similarly, more people go through preventative treatments and are counseled on lifestyle changes. Hospitals do not have the time, or the inclination, to talk about alcohol and tobacco, diet and exercise. Second, primary care is better set up to deal with chronic conditions in the community. The evidence shows about three-quarters of all people on Medicare have multiple long-term health issues. Instead of waiting for appointments with different hospital departments, people receive better care from a local doctor and community-based nurses. Yet, in the ten years up to 2006, the number of graduates entering general practice dropped by 50%.

This is due to low pay and even lower status. These are doctors with vast numbers of people on their lists. Insurance companies want their policyholders seen on a quota system. This is stressful and reduces the quality of care doctors can give. This can be reversed but it needs a major political shift. Instead of favoring the hospital specialist, primary care doctors should be paid the same amount and supported by additional nursing staff. If health insurance companies can be persuaded that they will save long-term costs by investing in more preventative care through the primary care service, the balance will start to change. The Affordable Care Act is a step in the right direction, but more political will is needed. There should be a focus on improving patient understanding and gently encouraging a change in lifestyles. Investing money into prevention is always better than waiting for major health problems to emerge before reacting. With federal and state government incentives, costs can be controlled and health insurance plans can offer better value for money. This is not the comprehensive reform actually needed, but it will improve the current state of affairs.