Primary care needs a bigger budget, broader reach and a stronger workforce
Primary care sits at the center of a high-performing health system, but chronic underinvestment has left the U.S. with weaker access, higher costs and a more fragmented path for patients who need routine care before small problems become major ones. In this case for a “triple-double,” R. Shawn Martin of the American Academy of Family Physicians and Kyu Rhee of the National Association of Community Health Centers argue that the country must act on three fronts at once: double investment in primary care, double its reach and double the share of clinicians entering the field.
The argument is not abstract. More than 60% of U.S. adults live with at least one chronic disease, and over 40% live with two or more. In 2023, the U.S. spent $4.9 trillion on healthcare, with more than 75% tied to preventable chronic conditions. Primary care handles roughly 35% of healthcare visits while accounting for only 3% to 6% of total spending. The imbalance is stark: the part of the system best positioned to prevent deterioration receives only a sliver of the money.
Payment still favors procedures over relationships.
That structure rewards intervention after disease has advanced, while leaving preventive, longitudinal care underfinanced and underbuilt. Team-based primary care requires coordination, behavioral health integration, proactive outreach and enough stability to manage patients over time. Fee-for-service payment rarely supports that model well, which helps explain why access is shrinking even as the burden of chronic illness rises.
Spending targets aim to rebuild the base of care
Martin and Rhee call for at least 10% of total health expenditures to flow to primary care. The target is meant to change the economics of care delivery, not simply add another line item to the budget. More prospective and predictable payment models would give practices room to invest in care coordination, community outreach and services that are often essential but poorly reimbursed under volume-driven payment.
The policy case already has precedent. More than 20 states have adopted or are pursuing primary care spending targets of 10% to 15%, and Rhode Island has shown the approach can be implemented within five years while keeping overall costs budget neutral. The logic is straightforward: when the system pays for prevention, continuity and early intervention, it can avoid more expensive downstream care in emergency departments and hospitals. For a field so closely tied to chronic disease management, the financing model determines what kind of medicine is possible.
Community health centers carry much of the access burden
A third of U.S. adults and more than 10% of children lack a usual source of primary care. Community health centers already operate as one of the most visible access points for patients who face economic, geographic or insurance barriers. These centers serve 54 million people nationwide, including many people with low incomes and one in three people living in rural America.
Expanding the reach of community health centers would not require inventing a new model from scratch. It would require sustained support for a model that already delivers cost-effective, community-based care. The proposal to serve 20% of Americans annually through community health centers would represent a major expansion of access, especially for patients who otherwise drift between urgent care, emergency departments and delayed specialty referrals. In practical terms, broader primary care access means better blood pressure control, more diabetes follow-up, earlier cancer screening and fewer lapses in medication management.
A larger footprint changes what patients can expect from the system.
The workforce pipeline remains the limiting step
Even a better-funded and more accessible primary care system cannot function without enough clinicians to staff it. Yet only one in five physician graduates enters primary care, and even fewer practice in underserved communities. The workforce challenge is not only about headcount; it is about where training happens, what incentives shape career choices and whether clinicians can afford to enter and remain in front-line care.
The proposed solution centers on programs that have already shown value, including Teaching Health Center Graduate Medical Education, the National Health Service Corps and similar efforts that recruit, train and retain clinicians in rural and under-resourced settings. These programs often depend on patchwork reauthorizations, which creates uncertainty for institutions and trainees alike. The authors argue for a more durable approach that strengthens community-based training where people live and work, rather than concentrating formation exclusively in academic medical centers. That shift matters because clinicians who train in community settings are more likely to understand the realities of long-term, relationship-based care and the social barriers that shape outcomes.
Policy choices will decide whether primary care remains peripheral or central
The broader policy message is direct: federal and state leaders should strengthen primary care spending targets, expand community health center capacity, reform graduate medical education to favor primary care and support workforce programs that reduce financial barriers. The Triple Double framework offers a shared agenda for payers, policymakers, health systems and training programs, but the article makes clear that coordination, not slogans, will determine whether the strategy succeeds.
For decades, efforts to strengthen primary care have been scattered across states and sectors, producing uneven gains. The call here is for a national strategy built around funding, access and workforce at the same time. Each element depends on the others. More money without more clinicians does little. More clinicians without access points leaves patients stranded. More access without predictable financing makes the system brittle.
The policy challenge is concrete: keep directing resources toward the most expensive parts of healthcare, or invest in the foundation that prevents illness, manages chronic conditions and lowers long-term costs. Patients already value continuous, trusted relationships with primary care clinicians. The unresolved issue is whether lawmakers will treat primary care as core infrastructure rather than a side branch of the system.