Salus June 4, 2025

Jack

Bill B, you asked, is there something in healthcare that works in one part, such as the antibiotic that works in one part, but hurts some other part. An easy example of that is fee-for-service payment. Fee-for-service works really well at times. You do something, you get paid. But it also then hurts, because suddenly, it drives more widgets rather than health. So, you’re buying sick care, and you’re buying sick widgets rather than creating health. And so, that’s one example of one part helping and one part hurting.

Bill B

Antibiotic would mean it literally attacks something that’s actually very healthy. What would be an example of attacking something in healthcare that’s actually quite healthy?

Jack

Well, I would say fee-for-service does. Fee-for-service financing really hurts primary care and a lot of direct clinical care, because it creates an incentive for doing more rather than better. And so, I would say that it does. It’s a great analogy.

Bill B

That’s assuming primary care is a good thing.

Jack

I don’t think you have to assume that. There’s outstanding evidence that of all the things in healthcare, the only thing that’s been shown to improve life, expectancy and quality of life, is the amount of primary care that’s delivered in a community.

Bill B

If I’m a critic of primary care, I don’t want to hear that.

Jack

There’s strong evidence of that.

Bill B

I know. So, it’s important that primary care be dismissed. Otherwise, we have to recognize we’re doing real damage.