Salus Health Care Forum: November 5, 2025

Bill G

I’m glad we’re talking about the unspoken and finally getting around to a solution that would follow the money, which we’re starting to allude to. And suppose adequate resources are just given to the community. In that case, the community itself will deal with many of the issues we’re talking about and come up with solutions that work within that community.

Many people have been saying that for a long time. However, it seems nearly impossible to fight the vested interests. As Jeremy knows, several states like Washington and Oregon have actually passed legislation now to clearly measure how little resource goes into primary care. They actually have encouraged shifting that balance. But lo these five to seven years later, neither Washington nor Oregon has actually made much progress at all in terms of actually shifting resources into primary care, even though it is an endorsed public policy.

Rich

If I can build on that. Jeremy knows this better than me, but California, for example, was a state that adopted this official government policy: raising the spend on primary care from four to 5%, which it is in most states right now, up to about 15%, which gets us closer to the 15 to 25% that the European countries invest in primary care. Which is one of the big reasons they have better outcomes.

And I think our challenge as we all try to come up with strategies collectively concerns the fact that we’re in a time right now where expertise is not necessarily valued. Trust took a big hit during COVID. And some of the trust declined because dumb things happened.

I was on a reactor group as they were beginning to roll out the COVID vaccine. And first time around, they said: This is CDC doing the talk. And they said: We’re going to send it out to the state health departments. That makes sense in terms of CDC’s usual clientele. However, State health departments have never put on anything like a massive COVID vaccine program.

And I raised my hand, I said: Wait a minute. Most people get most of their vaccines in their primary care doctor’s office. And my prediction based on what I’d seen in some of the European stuff that I’d looked at is you’re only going to get about 30 to 40% that’ll show up because you’re going to be doing it in parking garages and sports arenas. And lo and behold, three months later, it was about 30 to 40%. So they said: Well, what should we do next? I said: Get it closer to where people get their care. So then they started sending it to big systems, Kaiser and whatever. What did the big systems do? They set up the same thing, but in health buildings. So you have a single site in a town of 500,000 people that everybody had to go to for their COVID shot. And I said: That isn’t going to get you there. It finally took almost 18 months before they’ve got vaccine out to the rural and even urban-based primary care docs.

The other thing I wanted to share quickly is based on my having lived in DC and LA, which are reasonably large cities, and also in Madison for a good bit of my life, which is sort of a medium-sized city. And then in rural communities. To my eye, big cities are nothing more than a collection of rural villages. The typical Manhattanite rarely goes more than a mile in any direction on Manhattan, most of their life. And yet the resources that go to the urban centers are much greater just in terms of absolute dollars and institutions that can help out when times get tough.