As specialties burgeoned the General Practice of Medicine became increasingly restricted—why not? As Medical Practice became proportionately complex and   medical research brought new tools, medicines and products to the fore it became difficult and finally impossible for a General Practitioner to become a master of all specialties. The lawyers rapidly discovered this money trough and encouraged disgruntled patients to seek their services. “After all, did the doctor refer you to a specialist in a timely manner?” These changes induced the GPs to narrow their fields of endeavor. It was dangerous to perform a specialty activity in the absence of having achieved Specialty Board certification. Specialists charged more than primary care or family doctors, and patients were chary of too many referrals. But Health Insurance diminished this hesitancy, and it became easier and safer for the Family doctor to refer to specialists than to compete with them. Currently the family doctor is in short supply and too often regarded as the gatekeeper who does little other than refer and write prescriptions. Yet the properly trained the Primary Care Physician is the foundation and fulcrum of the profession of medicine. That field must be rejuvenated so that at the very least the doctor is competent in practices as specified by the Health Center of Auraria CO.


The doctor must be proficient in Minor surgery, Suturing
Fine needle aspiration
General orthopedic Evaluations and Management
Ability to read x-rays or the x-ray reports at the very least
Basic rehabilitation for musculoskeletal injuries
General Dermatology
 General eye problems and Use of Slit Lamp on site
 General EKG interpretation enough to refer patient if indicated
Emergency management skills use of defibrillator on site
Allergy shot administration
General GYN expertise.

Try to imagine how many referrals would be saved with practitioners like that on the premises.

The issue of Primary Care, the Uninsured and the Public Option could be resolved were the Government aggressively add many fold to the 8000 Primary Care Centers of America currently scattered about the land.



 Originally established to provide medical care for the medically indigent, Primary Care Centers are staffed by specialists in Pediatrics, Primary Care, Internal Medicine, Gynecology and often a Dentist. The Centers are community based and funded by grants from the Feds through HRSA.  They cost about $3 million a year to maintain: 1/3 from the federal government, 1/3 from donations by State, and community enterprise and 1/3 from treated patients. They will take cash, insurance or treat for no fee at all if necessary.  Because Doctors (salaried from the grants) are federal employees malpractice litigation is defended (under the Federal Tort Claims Act) by the Office of the Attorney General, a detail that tends to discourage frivolous law suits.



 Proliferation of these Centers would make Comprehensive Primary Care Medicine and Minor Surgery available for every American Citizen whether insured or not. Look at the benefits. Nationally assured primary care; decongestion of emergency rooms, reduction of malpractice litigation, fewer referrals and side-stepping Congressional debates. 



There is no need for every patient to be INSURED if all can be ASSURED high quality Primary Care. In this scenario High Tech Medicine, Surgery and Procedures remain in the domain of HMOs.



Perhaps because they are established mainly in poor neighborhoods to provide care for the medically underserved these Primary Care Centers seem to be largely unknown to the general public. Were there enough of them to satisfy the National appetite for Primary Care, these centers would become The Public Option. Have them become your family doctor and not be insured or be insured as the case may be; or use them if your doctor is out of town, or whenever they may be convenient.


Concentrating on the Cost of Health Care Congress may end up by forcing every American to buy Health Care insurance come Hell or High Colonics. It strikes me as a little “pushy” to force each of us to buy Health Insurance. Health Insurance unlike Life Insurance, costs more for the young than it does for the elderly. That’s not right. The youth are pulling someone’s fat out of the fire. Could it be the HMOs? Or Medicare? Subsidizing Primary Care Centers over time would be the start of a beautiful friendship between the Public and Health Care. And at this juncture Insurance Companies might become creative and develop different ladders of insurance that would add Hospital and Critical Care to complement this innovative Health Care system for those currently not insured for High Tech and Hospital Care.;