Primary care doctors are in a squeeze these days. Their overall compensation is decreasing while they’re having to work more hours, see more patients, and spend less time with each patient. On the expense side, malpractice insurance premiums and office rents are increasing dramatically. Private health insurers and Medicare are clamping ever more stringent compensation constraints on primary care physicians, whether they be implemented as capitation pay or pay for performance or whatever, driving existing doctors to leave their practices and causing medical students to opt for specialties instead of general practice.

It is a big mess, but I refuse to blame the doctors themselves. I firmly believe that our employer-provided health insurance system coupled with government intervention in the form of Medicare are at the root of the problem. Because these systems are now ingrained, our citizenry is conditioned to regard health care as an entitlement. Thus, there is no easy fix. Whatever we do, whichever direction we move, it will be painful for somebody. Given that Congress demonstrably shies away from painful issues, the most likely future outcome is preservation of the status quo.

—TNT