Perspectives in Primary Care features writing from practitioners, activists, and community members representing organizations, practices, and institutions across the United States and around the world.


Lessons from Steward and the Need for Primary Care Reform in Massachusetts

The Steward Health Care system collapse has raised alarm bells and activated a crisis response from many levels of Massachusetts’ political and health care leadership. Through a still-evolving series of action steps, this crisis will eventually resolve. When the fire has been put out, however, an important lesson will remain: this crisis has its origins in the dangerous set of health care policies and decisions that got us to this point. As health care leaders ...

“Is the Lawyer in?”: Accessing Health Care in America

Jamal was a young, promising athlete whose coordination suddenly deteriorated, at only 12-years-old, with the onset of terrible headaches. Scans revealed a large brain mass, and he was referred to a regional academic medical center for what would be a complicated surgery. Moments before he was to be wheeled into the operating room, a nurse pulled Jamal’s mother, Lisa, aside to tell her apologetically that the procedure was cancelled. The medical center had learned that Jamal’s Tennessee Medicaid plan, TennCare, had been terminated, and he was uninsured. “I’m afraid you’ll need to take him ...

Improving Health Care Access by Meeting Patients Where They Are

Throughout the last two years, the COVID-19 pandemic has magnified many existing inequities in health care and throughout society. CommunityHealth, a free health clinic in Chicago, saw its patients face these ...

Exploring the Schism between Public Health and the Health Care System

Patients tell me all the time that our health care infrastructure needs reformation. Many people, including myself, would agree with that statement, but reformed to what? As a Patient Access Specialist at

Reframing the Debate: Health Care Access Requires Affordable Care, Not Just Coverage

Like many Americans, Hector, a resident of Revere, Massachusetts, was overwhelmed by health care costs. He had insurance through his employer, but he could barely afford his $600 a month premiums, and he quickly learned that his coverage was not enough to keep his out-of-pocket costs manageable. Needing treatment for hearing, liver and heart conditions, Hector faced deductible costs from hospital care, $175 co-pays per visit with his specialist, and ongoing prescription costs of more than $100 ...

Here’s Why Mental Healthcare Is So Unaffordable & How COVID-19 Might Help Change This

If you ask a patient to describe their experience finding a therapist or psychiatrist in the community, don’t be surprised if ‘expensive,’ ‘difficult,’ and ‘discouraging’ are some of the first words that come to mind. The decades-long separation of mental healthcare from physical health has left patients and clinicians alike with serious challenges navigating options for care. And the cost has been much more than just inconvenience—our poorly integrated system is responsible for

Investment & Innovation in Primary Care: An Update and Call to Action

We’ve all seen the headlines—primary care practices are in trouble: “America’s looming primary care crisis,” “Fewer than 10% of primary care practices have stabilized operations amid COVID-19 pandemic,” and “

COVID-19 & the Political Determinants of Health

From the earliest days of the COVID-19 pandemic, it was clear that America’s deep-rooted inequities would play a central, and likely devastating, role in the magnitude and distribution of the burden of disease. In early March, former New York City Health Commissioner Dr. Mary T. Bassett and I outlined these inequities and called for a human rights-based response focused on ...

The Corporatization of Primary Care: Unintended Consequences

There are many factors in medicine these days that have pushed primary care practice to be mostly a salaried, employed-physician model as part of a large organization. Many of the old personal autonomy benefits have been lost. Rising overhead costs and lagging fee-for-service reimbursement have made it difficult for private practitioners to fund all the required elements of the new healthcare delivery team. Additionally, there are heavy administrative burdens to achieve necessary certifications or just accomplish even simple care goals and also to follow ...