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Letter: A Key to Patient-Centered Care

To the Editor:

As a pediatrician who works in CHaD’s primary care patient-centered medical home (PCMH) at Dartmouth-Hitchcock Medical Center, I laud your decision to reprint Yogesh Khanal’s op-ed from The Washington Post extolling the virtues of that model of care at the Veteran’s Affairs health system (“VA’s Team Approach Can Serve as a Model,” Dec. 4).

Unfortunately, Khanal overlooks an essential feature of the VA that allows for the full implementation of patient-centered care — that it is a single-payer health care system. The Patient Protection and Affordable Care Act will extend health insurance to millions of currently uninsured Americans. But insurance companies do not typically reimburse PCMHs at levels that would allow us to hire the team members — like psychologists, social workers and pharmacists — that provide the kind of wrap-around care that leads to less cost with better outcomes and increased patient and provider satisfaction. And nothing in the ACA guarantees patients access to the kinds of specialists who already turn away Medicaid patients.

Nonetheless, critics who demagogue against “government run health care” (which is what the ACA is structured to avoid) would do well to read Khanal’s brief ode to the modern VA. Redesigning the nation’s primary care delivery systems must be coupled with payment reform beyond the market-based ACA to achieve what virtually all other industrialized countries achieve for their citizens: national, universal, single-payer health care.

Keith J. Loud, M.D.

Vermont Chapter, Physicians for a National Health Plan

Norwich