What’s missing in the US candidates’ healthcare proposals: Primary care is nowhere to be seen, either as a problem or a solution

Abstract

Although the Iraq war and more recently the sad state of the economy have dominated the political campaign for US president, healthcare problems have continued to be cited by voters as a big concern. Each candidate has a retinue of healthcare advisers, and their websites are full of position papers and multi-point plans on this topic.

Everyone agrees about the nature of the problem. Health care now consumes 16% of the US gross domestic product, and costs continue to climb. We spent about $7000 (£3518; 4719) per person on health care in 2006, over $2 trillion in all. Around 45 million Americans have no health insurance for at least part of the year. The population is ageing. We baby boomers, who expect and consume lots of health care, are now beginning to turn 65 and are going to be a big problem.

But despite all of the money we spend . . .