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Monday Apr 17, 2017

Finding Purple: Creating Nonpartisan Paths to Advance Primary Care

 Has anyone ever asked you, "What is your favorite color?" It's a simple, open-ended question that can spark conversations and bring people together.

These days, you are more likely to hear a different kind of question regarding colors: "Blue or red?" Unless you are at the paint counter at The Home Depot, this one is more likely to start a divisive debate than a collaborative conversation. Politics aside, I find it hard to choose one over the other. After all, how can you not appreciate the brilliance of a bright blue sky or the wonder of an amazing red sunset? More importantly, how can you not be filled with awe when the two combine to create majestic purple mountains?

Lynne Lillie photo
This watercolor by my mother, Mary Lillie, reminds me that we could use more "purple" in our society and less partisan squabbling.

I think the more important question to ask today is not "Red or blue?" but rather, "How can I make purple?"

David Wasserman recently wrote a post-election piece for FiveThirtyEight that was aptly titled "Purple America Has All But Disappeared." Wasserman's point is that more and more communities in this country are either deep red (Republican Party) or deep blue (Democratic Party), with little overlap. In fact, less than 10 percent of U.S. counties were decided by single-digit voting margins during the 2016 presidential election.

Wasserman points out that "more than 61 percent of voters cast ballots in counties that gave either Clinton or Trump at least 60 percent of the major-party vote." That's up from 39 percent of voters who lived in such one-sided counties in 1992. Wasserman concludes by asking what influence the increasing polarity will have on future generations of voters.

It's a provocative question. What will our future look like if large groups of voters are no longer exposed to opposing viewpoints? Similarly, what will the future of health care in the United States look like if one side makes all the decisions?

I was fortunate to be raised in an environment rich in thoughtful, respectful discussion on political policy -- including health care policy -- that drew input from all sides. People I care about care deeply about and advocate strongly on behalf both the red and blue perspectives. Although this can make for interesting holiday dinners and summer barbecues, it also leads to a deeper appreciation for hearing more than one perspective on important issues.

More importantly, it leads to a strong desire to find a pathway to a common purpose and to create win-win scenarios.

Family medicine is uniquely positioned to provide these sorely needed win-win solutions to solve our health care crisis. As physicians, we must lead conversations and create paths that ensure not only better coverage, but greater access to primary care.

The Patient Protection and Affordable Care Act increased the number of insured Americans, but many of these new plans have high deductibles that are simply too costly for many patients. For example, my 31-year-old son would need to spend more than $11,000 before his plan would cover any health care other than preventive services. Although this plan would be beneficial in a catastrophic health care situation, it does not provide the proven return-on-investment of comprehensive primary care.

We need a pathway that combines the best of "blue" (health care for all) with the best of "red" (lower costs). Family medicine and primary care are the true "purple" solution (improved outcomes) to the health care crisis.

To achieve greater access to primary care, we need to transform health care delivery. We need to start by inverting the physician workforce, moving primary care from the top of the pyramid (at 6 percent to 10 percent of the workforce) to the base (30 percent to 50 percent of the workforce). We need to incentivize student choice in family medicine and preserve wellness in our current workforce.

Last but not least, we need to incorporate solutions that address social determinants of health along with the biologic determinants. The AAFP recently took steps to do just that with the launch of the Center for Diversity and Health Equity, an initiative that will focus on addressing the social aspects of health care.

The vision of the AAFP is to transform health care to achieve optimal health for everyone. We are family physicians. We choose more. We do more. Now is the time to lead more and transform our vision into action.

You can get involved by participating in the Family Physician Action Network, and you can learn how to be an effective advocate for our specialty by attending the Family Medicine Advocacy Summit May 22-23 in Washington, D.C. 

Lynne Lillie, M.D., is a member of the AAFP Board of Directors.


Family Physicians are Royal Purple as we serve Red and Blue. The biggest mistake made by family medicine since the 1970s is that we have deserted the work to build coalitions to support what most Americans need and are losing most - basic health access. Coalitions with Red and Blue Counties left behind are the solution to our financial design deficits. We have coalitions with all the wrong entities - easy and meaningless coalitions. The hard work that is rewarding is at the local and county level.

We remain about 30 per 100,000 across all populations. We are more important for lowest physician concentration counties that include the Red Counties and dozens of very Blue counties that have a majority of the population that are Black, Hispanic, or Native. Family Physicians are most important for these counties as 36% of active physicians are found serving this 40% of the nation in 2621 lowest physician concentration counties.

Family medicine should take advantage of the opportunities to point out how much we do for Red Counties and how much more we could do with real support.

The rest of the specialties are located Blue as they concentrate together in higher concentrations of people, income, and health care spending. Blue concentration effects are seen in academic settings, institutions, associations, corporations, foundations, and veteran plans - all the ones that work out poorly for us, and for most Americans.

Posted by Robert C. Bowman, M.D. on April 18, 2017 at 06:13 PM CDT #

I love, love, LOVE this article! It so happens my favorite color is purple. And in a world where we are increasingly told what divides us, I wholeheartedly agree we need a lot more purple. It requires effort, patience, and a humility to be willing to do so (in my opinion).

Posted by Angie on April 21, 2017 at 05:22 PM CDT #

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