By Christopher P. Childers and Thomas C. TsaiJuly 10, 2026
Childers is a surgical oncologist at the University of Washington and directs the Payment and Outcomes Research Lab. Tsai is a general and gastrointestinal surgeon and medical director for health policy research for the American College of Surgeons.
In March, the Medicare Payment Advisory Commission (MedPAC) released its annual report to Congress on Medicare payment policy. The data related to physician payment are clear: By every metric we track, primary care in America is succeeding, and it has been for years. Nearly all Medicare beneficiaries have a primary care provider (PCP). Over three-quarters can see their PCP within two weeks. Patients in rural environments have less trouble finding a PCP and even shorter wait times. Services and spending on evaluation and management codes are increasing, and compensation among PCPs is rising faster than the rest of the field.
Yet this runs counter to the pervasive narrative that investing more in primary care is the key to solving the American health care crisis.
We have all seen the graphs comparing U.S. life expectancy to other developed countries and the graphs showing our spending nearly twice as high as peers. But life expectancy is a crude instrument. When researchers disaggregate the mortality gap between the United States and peer nations, the story that emerges is not one of inadequate primary care access. As a health care system, the U.S. actually performs remarkably well — vaccine rates, cancer screenings, and management of diabetes and hypertension are all above average compared with our peers.
