Crippling health care bills, long emergency-room waits and the inability to find a primary care physician just scratch the surface of the problems that patients face daily.
问题重重的医疗保障费用，急诊室前排起的长队，以及无法找到初级护理医生，这些仅是每天要面对的问题中的一部分。

Primary care should be the backbone of any health care system.
初级护理应该是所有医疗保障体系的支柱。

Countries with appropriate primary care resources score highly when it comes to health outcomes and cost.
有充足的初级护理资源的国家在健康水平和费用支出上都获得甚佳的评价。

The U.S. takes the opposite approach by emphasizing the specialist rather than the primary care physician.
美国却反其道而行之，注重专科医生而非初级护理医生。

A recent study analyzed the providers who treat Medicare beneficiaries（老年医保受惠人）.
最近一项研究分析了负责治疗老年医保受惠人的医生。

The startling finding was that the average Medicare patient saw a total of seven doctors—two primary care physicians and five specialists—in a given year. Contrary to popular belief, the more physicians taking care of you don’t guarantee better care.
这项令人震惊的研究发现，老年医保受惠人平均每天要看七名医生----包括两名初级护理医生和五名专科医生。与公众的想法刚好相反，更多的医生给你看病并不能保证更好的医疗服务。

Actually, increasing fragmentation of care results in a corresponding rise in cost and medical errors.
实际上，医疗服务的日益分化导致的是费用的上升和误诊数量的增多。

How did we let primary care slip so far? The key is how doctors are paid. Most physicians are paid whenever they perform a medical service.
我们怎么会使初级护理如此严重地滑坡呢？关键是医生的收入。大部分医生的收入来源于他们所提供的医疗服务。

The more a physician does, regardless of quality or outcome, the better he’s reimbursed (返还费用).
医生做的越多，不管质量或结果如何，他获得的返还费用就越高。

Moreover, the amount a physician receives leans heavily toward medical or surgical procedures.
此外，医生的收入在很大程度上受到医疗或者外壳手术的影响。

 A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient’s disease.
一名专科医生耗时30分钟进行某个手术，其收入要比比一名初级护理医生花同样多的时间去讨论一个病人病情的收入高3倍。

Combine this fact with annual government threats to indiscriminately cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.
再加上政府每年都威胁要一视同仁地降低医疗返还费用，初级护理医生没有选择的余地，只好通过提升数量以增加收入。

Primary care physicians who refuse to compromise quality are either driven out of business or to cash-only practices, further contributing to the decline of primary care.
对于拒绝牺牲质量的初级护理而言，要么被迫停业，要么就只从事能赚钱的业务，这使得初级护理的质量进一步下滑。

Medical students are not blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. The recent numbers show that since 1997, newly graduated U.S. medical students who choose primary care as a career have declined by 50%.
医学院的学生对此并非一无所知。他们看到了费用返还体制是如何严重地弄虚作假，不利于初级护理。最近的数据表明，自1997年以来，美国医学院的毕业生选择初级护理作为职业的人数下降了50%。

This trend results in emergency rooms being overwhelmed with patients without regular doctors.
这样的趋势导致急诊室里人满为患，挤满了那些无法找到普通医生的病人。

How do we fix this problem?
我们怎么解决这个问题。

It starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for optimally (最佳地) managing their diseases and practicing evidence-based medicine.
首先需要改革医生费用返还体制。卸下初级护理医生每小时看更多病人的压力，对于优化病患管理和机遇病症用药给予奖励。

 Make primary care more attractive to medical students by forgiving student loans for those who choose primary care as a career and reconciling the marked difference between specialist and primary care physician salaries.
通过减免从事初级护理的医学院学生的学费贷款，使初级护理对医学院学生更有吸引力，消除去专科医生和初级护理医生薪水之间的巨大差异。

We’re at a point where primary care is needed more than ever. Within a few years, the first wave of the 76 million Baby Boomers will become eligible for Medicare.
我们对初级护理的需求从未像现在这样迫切过。在几年之内，第一波7600万婴儿潮一代将被纳入老年人医保。在未来的十年期间

 Patients older than 85, who need chronic care most, will rise by 50% this decade.
年龄大于85岁的最需要长期看护的病人数量将会增加50%。

Who will be there to treat them?
到时谁去治疗他们？