Primary care is in crisis, and it's time to face the hard truth: our healthcare system is failing its foundation. But could doubling spending on primary care be the bold move we need?
In a groundbreaking effort, state officials have launched a 25-person task force to tackle this issue head-on. Their mission? To reevaluate reimbursement rates, address workforce shortages, and set a clear target for how much insurers should invest in primary care. And this is the part most people miss: the task force’s initial proposal is nothing short of revolutionary—doubling the state’s primary care spending to 15 percent within five years. To put this in perspective, Massachusetts currently spends just 6.7 percent of its healthcare dollars on primary care, far below the 14 percent average in other high-income nations.
David Seltz, executive director of the state’s Health Policy Commission, framed this as a fundamental rebalancing of our healthcare priorities. “We’re putting the health of our residents and the stability of our world-class system first,” he said. But here’s where it gets controversial: can we truly double spending without raising overall healthcare costs or premiums? The task force insists it’s possible, though details on how remain scarce. One possibility? Shifting funds from administrative inefficiencies or cutting reimbursements to specialists—a move that’s sure to spark debate.
To give this plan teeth, the task force is urging the Legislature to pass a bill setting the new spending target. This would empower the Health Policy Commission and the Division of Insurance to hold payers and providers accountable. After the initial five years, the commission could set new targets, ensuring long-term commitment. But is this enough to fix a system where patients in Boston wait an average of 40 days for a primary care appointment—twice as long as in other cities?
Massachusetts isn’t new to this fight. In 2020, then-Governor Charlie Baker called for doubling spending on primary and mental health care to 30 percent over three years. Yet, those plans were sidelined by the COVID-19 pandemic. Since then, access to primary care has only worsened, with patients increasingly turning to emergency departments as a last resort. And this is the part that should alarm us all: despite having the highest number of physicians per capita, Massachusetts ranks fifth lowest in primary care doctors. Half of these doctors are over 55, raising concerns about an aging workforce.
Lora Pellegrini, CEO of the Massachusetts Association of Health Plans, emphasizes that success hinges on health systems’ cooperation. “Insurance carriers can’t do this alone,” she warned, pointing to resistance from hospital systems. But is collaboration enough, or do we need more concrete actions, like setting a minimum reimbursement floor for primary care?
Eric Dickson, CEO of UMass Memorial Health and a task force member, voiced skepticism. “It’s hard to imagine doubling spending without driving up overall healthcare costs,” he said. He also worries that this mandate could divert funds from innovative care models that reduce hospital visits. Is this a necessary trade-off, or are we missing a smarter way to allocate resources?
Despite these concerns, the proposal has garnered enthusiastic support from a diverse group of stakeholders, including Dr. Kiame Mahaniah, the state’s health and human services secretary, and Ashley Blackburn of Health Care For All, who called it “timely and important.” But what do you think? Is doubling primary care spending the solution, or are we overlooking deeper systemic issues? Share your thoughts in the comments—this debate is far from over.
