Strong primary care is the foundation of a high-performing health system, proven to control costs and improve population health. Yet the country’s chronic underinvestment in primary care has weakened that foundation and worsened the healthcare crisis in America.
Without primary care, minor health issues can spiral into life-threatening chronic diseases. Over 60% of U.S. adults have at least one chronic disease, and over 40% have two or more. In 2023, the U.S. spent $4.9 trillion on healthcare, with more than 75% of costs related to preventable chronic conditions, which remain the leading cause of death among adults. Primary care accounts for roughly 35% of healthcare visits but only 3% to 6% percent of total healthcare spending. At the same time, access is decreasing. Workforce shortages are projected to grow (PDF) in the years ahead.
Moreover, the U.S. healthcare system is structurally designed to favor higher-cost, procedure-driven care over prevention and continuity that are at the heart of primary care. Payment rewards volume more than relationships and often incentivizes intervention after illness develops, rather than investment in preventive care that keeps people healthy and reduces more costly care like emergency department visits.
We need a triple-double to rebuild primary care
In basketball, a triple-double is when a player reaches double-digit numbers (10 or more) in three of the five main statistical categories—points, rebounds, assists, steals or blocks—in a single game.
We are applying those principles to healthcare: double investment in primary care, double the reach of primary care, starting with community health centers, and double the share of clinicians entering primary care. Our ask of lawmakers is to align policy, financing and recruitment efforts around what we know will help patients: better access to community-based primary care.
Correcting course will require more than incremental reform. It requires coordinated action across investment, access and our workforce at the same time. Here’s how we can make this a reality.
Double primary care investment
At least 10% of total health expenditures should support primary care. This isn’t about spending more—it’s about spending smarter. We know that fee-for-service payment alone cannot support the team-based, continuous care that defines high-performing primary care. More prospective and predictable payment models are needed so practices can invest in care coordination, needed services like behavioral health integration and proactive community health.
More than 20 states have already adopted or are pursuing primary care spending targets of 10–15%, and Rhode Island (PDF) showed it can be done within five years while keeping overall costs budget neutral. The tools are available. The ball is now in our court.
Double the reach of primary care
A third of U.S. adults and over 10% of children don’t have a usual source of primary care. Expanding access requires building on what already works. Community health centers (CHCs) are uniquely positioned to deliver high-quality, cost-effective primary and preventive care to populations with limited access to healthcare. CHCs serve 54 million people nationwide, including many people living on low incomes and one and three people living in rural America.
Scaling the reach of CHCs so that they serve 20% of Americans annually would be one of the most direct and cost-effective ways to improve access to healthcare. For policymakers, this means sustained and predictable investment in primary care infrastructure, workforce and capacity. This is not a leap into the unknown, but an investment in a proven model that already works (PDF).
Double the share of new clinicians entering and staying in primary care
America cannot strengthen primary care without training and keeping more primary care clinicians. However, only one in five physician graduates enter primary care practice, and even fewer in underserved communities. Funding for proven workforce programs, like Teaching Health Center Graduate Medical Education (THCGME), the National Health Service Corps and other initiatives that help recruit, train and retain clinicians in rural and under-resourced areas, are often done through patchwork reauthorizations and generate uncertainty.
That misalignment must be corrected so that we are investing more in community-based training programs where people live and work—not just exclusively in academic medical centers—reducing financial barriers and creating stronger pathways into primary care careers.
What policymakers should do now
Federal and state policymakers should strengthen primary care spending targets, expand community health center and primary care capacity, reform graduate medical education funding to prioritize primary care and support workforce programs that reduce financial barriers while training clinicians in community-based settings.
For decades, efforts to strengthen primary care have been scattered across states, sectors and stakeholder groups, producing progress that has been meaningful but uneven. The Triple Double framework provides a vision and a shared set of goals that can align policymakers, payers, health systems, training programs and health organizations around a coordinated, national strategy.
A test of policy priorities
The choice is straightforward: continue directing resources toward the most expensive parts of the healthcare system or invest in the foundation of care that prevents illness, manages chronic conditions, improves long-term health outcomes and lowers costs.
Americans consistently value access to trusted primary care clinicians who can provide continuous, relationship-based care. Doubling investment, access and workforce capacity is ambitious, but the evidence supporting these goals is strong, and the policy tools to advance them already exist. The challenge is no longer identifying solutions. It is whether policymakers will make primary care a national priority. Patients are counting on it.
R. Shawn Martin is executive vice president and CEO of the American Academy of Family Physicians.
Kyu Rhee, M.D., is the President and CEO of the National Association of Community Health Centers.