Beyond the Affordable Care Act: Alternative Futures for Family Medicine and Primary Care

BACKGROUND: Changes in the landscape of medical practice in recent years, accelerated since the passage of the Affordable Care Act (ACA) in 2010, have led to further fragmentation of primary care and disruption of the doctor-patient relationship for many millions of Americans. Patients face escalating costs of care and restricted choice of physician and hospital in a largely corporatized health care system. The goals of family medicine are compromised by these system trends. The ACA is unsustainable for a number of reasons, including lack of price controls and cost containment, unaffordable costs for patients and taxpayers, widespread underinsurance, and massive administrative waste. Financing reform through single-payer national health insurance will bring a fairer system of universal coverage for comprehensive care of higher quality at less cost, while enabling a renaissance of family medicine and primary care as an expanding base of our health care system.