Salus Health Care Forum: November 5, 2025

The best way I can contribute to this dynamic of trying to make a change, is to reflect back on where we came from, at least in family medicine. So, family medicine, as some of you probably remember, was a result of post-World War II commissions. There were three of them, Willis, Folsom, and Millard commissions. All three national commissions came to the same conclusion. We’re losing sight of taking care of the whole person. We need a new specialty, which they called family practice then. And lo and behold, you had the Marcus Welby television show with Tom Stern, who was the first residency director of the program that I trained at, at Santa Monica, as a medical advisor to that program. And interest in family medicine went up, you know, to stratospheric heights. It’s still the number one recruited specialty in America. Most people don’t know that.

But America changed. We went through the Reagan years and Gordon Gekko years, you know, greed is good. And what were we seeing by the 90s? It was ER. It balanced a lifestyle with a high income and made-for-television excitement. Well, that skyrocketed. People entering the medical field selected emergency medicine, which right now is almost catatonic. Something like 80% of emergency physicians are literally owned by private equity companies. And the morale is as low as it’s ever been. They’re really discouraged. They’re frustrated. They’re having the staff cut. That’s a private equities strategy for improving profitability, cut the staff by 10%.

So, I think books and film and podcasts and a whole variety of strategies can be helpful in reframing this discussion in a way that resonates with the average American. It’s more than just having access to a transplant. Yeah, if I had a heart transplant, I’d want it here in the United States.We do a great job with heart transplants. But I’d rather be in a health system where I can avoid the heart transplant, the need for it in the first place. That’s where we don’t do a very good job.

I get excited by these discussions, especially with so many experienced and varied perspectives and all like that. But for me, it’s going to ultimately be kind of reframing the whole discussion so that everyday people who vote, who purchase, who persuade employers, begin to understand that there’s a lot more to healthcare than having access to a heart transplant unit.

Bill B

Often, there are really just a series of neighborhoods in large cities. Each has its own distinctive healthcare issues. Interesting and important distinctions should be drawn regarding differing healthcare services and outcomes in specific neighborhoods. Some cities are, like you say, a set of small neighborhoods, not just because people only go two or three blocks, but because that whole neighborhood is itself a support. Whereas other cities are not made up of neighborhoods. In California, San Francisco has neighborhoods. Los Angeles doesn’t, other than some ethnic communities.

It’s important to see that some cities really can successfully engage some of the things that we have been talking about. You can treat these cities as a series of small neighborhoods. For other cities, this doesn’t work.