28th National Conference on Primary Health Care Access: Charles Q. North, MD and Jeremy Fish, MD: “Assessing Access to a Primary Health Safety Net”

north-300On Monday, April 10, 2017, the first day of the 28th National Conference on Primary Health Care Access, the first plenary panel will follow individual presentations by Doctors David Sundwall and John Geyman, relating to the status of the Affordable Care Act.

The first plenary panel will be comprised of Charles Q. North, MD, MS of the University of New Mexico and Jeremy Fish, MD of the Contra Costa County Medical Services in Martinez, California.

Doctor North’s Presentation

Doctor North, a Senior Fellow of the National Conferences on Primary Health Care Access, served as a career officer in the United States Indian Health Service.

In a “Great Debate” about whether the Patient Protection and Affordable Care Act [ACA] could be considered a success that took place in the 26th National Conference in 2015, Doctor North took the opposition position [see Time Will Tell”: the Proceedings of the 26th National Conference – The Great Debate: Obamacare has been a Great Success, Part 2 (North for the Negative)]

Dr North argues that the debate about how health care should be financed has obscured the debate about how the delivery system should be reformed to assure access to comprehensive, continuous health care that recognizes the importance of community-oriented medicine, and public health and its social determinants.

He has found that many of his patients, who previously had had access to most of the health services they needed through the Bernalillo County-financed health care system based in Albuquerque, have since the passage of ACA, found themselves assigned to prohibitively expensive insurance plans with narrow provider networks that do not meet their needs.

A fundamental error in Obamacare has been the imperative of enrolling patients in insurance plans that are basically designed as “risk pools” whose fees are priced to cover the expenditures required for the  health care needs of all the persons covered in the plans.

Yet, when very sick people, whose care may previously have been subsidized by government funds, sign up for a given plan, the costs of care to the very sick are shifted from “taxpayers in general” to the specific persons enrolled in the plan. The increase in costs shouldered by the plan’s recipients, it can be argued, are not the fault of sick persons who were seeking ways to manage their health care costs coverage, but are the result in defects in the legislation.

Before enactment of the ACA, the health care costs of many “uninsured” persons were absorbed by various publically-financed programs, most of which continue to function, but, for some programs in some states and communities, are partly channeled through the health care plans.

Currently, the federal government re-insures the private insurance companies by paying for catastrophes through government insurance (Medicare, Medicaid, the Indian Health Service [IHS], the Veterans Administration [VA], the Department of Defense [DOD], End Stage Renal Disease [ESRD], Ryan White, etc.) and by subsidizing local hospitals through trauma care support and other disease specific schemes (Breast and Cervical Cancer screening program.)  These are all “work arounds” that avoid the appearance of the taxpayer paying for re-insurance and to allow for a private for-profit insurance industry to survive.

Doctor Fish’s Presentation

Jeremy Fish, MD John Muir Health, Walnut Creek, California
Jeremy Fish, MD
John Muir Health, Walnut Creek, California

Doctor Fish is the founding family medicine residency program director at a new residency program based John Muir Health, in Walnut Creek.

Previously, Dr Fish served as the residency director for the health system for California’s Contra Costa County, one of the early leaders in the creation of comprehensive county-financed health services. The Contra Costa County family residency program is part of a unique Registrar model for training traditional full-spectrum family physicians.

The new John Muir program will open in June 2017 and will focus on a clinic-first, new model full-spectrum family medicine, that will include the local population of all ages, genders and conditions (a feature of most family medicine programs, and all payer residency practice, which is planned to serve 50% Medicaid, with the goal of providing seamless care across the payer spectrum.

The residency program’s primary purpose is to develop graduates to “joyfully provide comprehensive Family Teamcare”, including common office procedures.

Dr Fish describes himself as passionate for the all-payer aspect. He argues that the multi-payer, single payment model should be the next step beyond ACA, since he believes that we are likely decades away from a single payer financing system

Dr Fish intends to highlight what is precious to primary care medicine in ACA that must be preserved, and what are the opportunities might exist for legislative improvements to strengthen primary care.

ACA’s commitment to assuring health care for all should continue as a national priority, whatever revisions might be made to its legislative format.

The ACA includes features that, fully implemented as originally envisioned, should improve the quality of the health care system.

Strategic Initiatives to Promote Access

The panel will introduce one of the themes that will continue through the plenary sessions of the three National Conference days – an examination and celebration of strategic initiatives that have proven successful models of entities that provide and enhance access to comprehensive primary health care.

These thematic presentations will include discussion of community-oriented health centers, community-based primary care physician residency programs, Area Health Education Centers, and teaching health centers.