American health reform - is this really new news?

American news outlets this week have been abuzz with news of the much debated, celebrated, and maligned health care reform legislation. What has caught my attention, however, is not the legislation itself, but all the hand-wringing over the costs of broader insurance cover and their effect on government spending, and the inadequacy of the current American primary care workforce to meet the needs of the nation.

None of this is really new news, but this public conversation brings to the national attention three issues we in primary care have wrestled with for a long time:

• Health care is just plain expensive, and American health care particularly so. Worse, many of those most in need of care, are those who have had to rely on personal savings, debt, or charity - or have simply gone without.

• We need more family doctors. This has long been recognized in primary care circles, as fewer and fewer students have entered primary care.

• We can't "fix" healthcare with more money, technology, or practitioners alone - we need a broad values-based consensus on what health and illness are all about before we can make progress on really knowing how to improve American health care.

I'd like to say that I have some wise and wonderful ideas for tackling these challenges - I don't. But, I do know that there are other nations, both rich and poor, around the world who do a better job of caring for their populace than does the USA. While the size and diversity of the US pose challenges not faced by many smaller countries, I am hopeful that the recently increased attention to what reform will actually mean may encourage Americans to see what others have done, and will draw the broader population into discussion of the challenges we in primary care have been facing for a long time.