An unprecedented strain of bird flu is spreading among dairy cattle in the U.S. An outbreak of a flesh-eating bacteria has infected more than 1,000 people in Japan. At least 13 communicable diseases including measles, dengue and polio have surged past pre-pandemic peaks in regions across the world. The threat of COVID-19 may have subsided, but myriad public-health challenges have emerged in its wake. So far, none poses as serious a risk. Yet the U.S. public-health system is woefully underprepared for another pandemic.
Once-reliable sources of funding have lapsed amid partisan theatrics. The health-care workforce, after four years of intermittent crisis, appears depleted and demoralized. To its credit, Congress managed to pass pandemic preparedness legislation in 2022. But absent adequate appropriations, many of its far-reaching ambitions — from strengthening the pharmaceutical supply chain to modernizing data collection — will remain unrealized.
Fighting off the next pandemic will require lawmakers to set priorities. A good place to start would be the nation’s long-underfunded and often overlooked primary-care sector.
Primary care is often a patient’s first point of contact with the health system. It includes preventative measures, such as blood pressure and cancer screenings, treating common illnesses and managing chronic diseases. Decades of research show that regular access to primary care improves a patient’s overall health.
Early primary-care interventions also save money. The average cost of a trip to the emergency room is 16 times higher than a visit to the doctor. Health officials in Oregon determined that a $1 increase in primary-care spending was associated with $13 of savings for other services, including emergency department, inpatient and specialty care.
Primary-care workers were vital during the pandemic. As COVID spread, they administered tests and vaccines, and they encouraged masking and social distancing. Many practices embraced telehealth innovations, expanding access to millions of patients, including in rural and underserved areas.
Yet the outbreak took a toll. The deluge of life-threatening, chaotic and often thankless work drove doctors and nurses to quit in droves. Many primary-care practices shuttered or dramatically reduced services as patients stayed home. Forgone primary-care treatments, from vaccinations to routine cancer screenings, may have caused thousands of avoidable deaths.
Funding from Congress helped stabilize struggling practices. Yet the U.S. still invests far less on primary care as a percentage of health spending than other rich nations, even as the demands of an aging population grow. Per-capita costs remain among the highest in the world — driven by expensive, often unnecessary procedures — with some of the worst health results.
The primary-care workforce has also been slow to recover, largely thanks to recruitment challenges that predate the pandemic. Lower reimbursement rates (and therefore salaries) relative to specialties such as dermatology and orthopedics have long steered many medical-school graduates away from primary care. The industry expects a shortage of up to 40,000 primary-care doctors by 2036. Already, a third of Americans don’t have one.
The U.S. needs to narrow these gaps before the next pandemic. For starters, Congress should extend common-sense telehealth provisions that are set to expire, including allowing Medicare beneficiaries to receive such services in their homes. It should also support programs — like Baltimore’s door-to-door nursing pilot — that encourage more people to seek primary care. Finally, it should pass bipartisan legislation that aims to rebuild the workforce, including through targeted loan forgiveness for primary-care doctors and funding for nurse training.
A stronger primary-care system won’t prevent the next pandemic. But strengthening the nation’s frontline defenses will save money and lives — and help keep strange outbreaks at bay.
— Bloomberg Opinion
