The August 31, 2006 NEW ENGLAND JOURNAL OF MEDICINE has an article with the above title by T. Bodenheimer, M.D., Professor at the Center for Excellence in Primary Care, U. of California, San Francisco. He reports that ''The American College of Physicians recently warned that 'primary care, the backbone of the nation's health care system, is at grave risk of collapse.''' — ''that could spell disaster.'' Patients as well as physicians are dissatisfied with the system. Less medical school graduates are going into primary care. Reimbursement for primary care physicians is based on quantity of assembly line numbers rather than quality. Physicians are essentially being ''watched'' at every turn to see that they are performing according to someone's concept of required care. Interestingly, it is estimated that it would take 18 hours per day to provide the evidence-based preventive care ''required'' for the average patient population of a primary care physician. And, that, of course, does not include providing medical care for the problems which the patient presents to the physician! Half of patients with chronic diseases, which take the patients to the physician, leave the hurried appointments with no understanding of what the physician said!! And, patients do not go in for ''preventive'' care, nor are they particularly interested. The third party (I wrote THIRD PARTY RAPE 14 years ago) not only pays poorly for all primary care but pays even less for the so-called preventive services. Indeed, the third party motto is primarily ''Delay, Delay, Delay, Deny'' as an article in the NEJM headlined well over 12 years ago. Dr. Bodenheimer concludes, ''action is needed to calm the brewing storm before the levees break.''

The suggestion that the medical system is similar to New Orleans at the beginning of Katrina is appropriate. Remember the Surgeon General reported 3 years ago that ''The American Medical System is on the verge of collapse.'' The storm has been brewing since at least 1965! Ultimately there is NO SOLUTION that can possibly work without bankrupting the country, if we continue to attempt to supply even current inadequate medical expertise to maintaining diseases that are the result of irresponsibility! Obesity and smoking remain the top 2 ''causes'' of illness and death. These are not treatable and many of the diseases they create are not curable with drugs or surgery.

This same date, August 31, 2006, The NEW YORK TIMES featured a significant article, ''Live Long? Die Young? Answer Just Isn't in Genes.'' In several major studies of many thousands of twins, researchers concluded it is not more than 15% genes and the rest is ''random.'' RANDOM? Interestingly they ignored the single most important factor in health and death – attitude, attitude, attitude! Dr. Hans Eysenck's 20+ year study of over 13,000 people revealed that approximately 99% of the people who die of heart disease or cancer have lifelong serious depression, anger or both. All the medical care in the world cannot fix anger and depression. Anger and depression lead to unhealthy behavior, as well as producing inherent toxic effects. Is it these same factors that lead 97% of Americans to avoid one to 4 of the essential habits – no smoking, body mass index 19 to 24, 5 servings of vegetables or fruit daily, moderate exercise at least 3 days a week??

I would love to know what percentage of you, readers of this newsletter, have all 4 of the essential basic health habits. Just with that question alone, please write to – and let me know. If after 2 years of my writing this column, less than 3% of my readers have the 4 basic habits, then I seriously question the value of this type of education! Then it is not only primary care that is going extinct. The changes in health required will require a crisis far worse than Katrina

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