Last week, STAT published a perspective piece from two ACS Fellows—“The Primary Care Crisis Paradox.” The article provides another look at evidence showing that increasing primary care funding in the Centers for Medicare & Medicaid Services Medical Physician Fee Schedule will not deliver the anticipated public health dividends.
Authors Thomas C. Tsai, MD, MPH, FACS, Medical Director for Health Policy Research in the ACS Division of Advocacy and Health Policy, and Christopher P. Childers, MD, PhD, a member of the ACS General Surgery Coding and Reimbursement Committee, outline how the 2026 report from the Medicare Payment Advisory Commission (MedPAC) challenges the common narrative that inadequate primary care is the principal driver of poor US health outcomes.
According to the report, Medicare beneficiaries generally enjoy strong access to primary care: nearly all have a primary care physician, most can obtain appointments within 2 weeks, and evaluation and management services, spending, and primary care physician compensation continue to increase.
Drs. Tsai and Childers argue that these gains have not translated into improved national health because the underlying causes of excess mortality in the US lie largely outside the healthcare system. Compared with peer nations, the US performs well on preventive care, including vaccination, cancer screening, and chronic disease management. Instead, lower life expectancy is attributed primarily to drug overdoses, alcohol use, suicide, violence, traffic injuries, and broader social determinants of health, including poverty, housing instability, and inequitable access to care.
For surgeons and other specialists, the article's central concern is Medicare's budget-neutral physician payment system, which creates a zero-sum environment in which increases in primary care reimbursement often come at the expense of specialty care. The authors argue that this framework has contributed to worsening access to specialists, as reflected in declining Consumer Assessment of Healthcare Providers and Systems scores and other MedPAC findings. Delays in specialty care can postpone diagnosis and treatment for patients with complex conditions, leading to more advanced disease and greater healthcare utilization.
The article emphasizes that primary care and specialty care should not be viewed as competing priorities but as complementary components of a functioning healthcare system. Patients with cancer, advanced kidney disease, and other complex surgical conditions require timely access to multidisciplinary specialty care as well as effective primary care, for example.
As Drs. Tsai and Childers conclude, addressing health gaps in the US will require, among other upstream solutions, “a payment system that stops treating specialist access as a luxury and starts recognizing it as an essential component of a functional healthcare infrastructure.”
