Primary Care

Kaiser Permanente unveiled plans Thursday for a $10-million medical office building that will offer primary care, some specialty care and other services to 80,000 South Los Angeles residents who are members of Kaiser's healthcare plan. Kaiser's 15,000-square-foot South Los Angeles medical offices are expected to open in 2011 on the southeast corner of West Manchester and South Denker avenues. A vacant building on the site will be torn down to make way for the new facility. Construction is scheduled to begin soon.

The Senate and House are inching closer to extending health insurance to millions of Americans. Access to insurance, however, does not necessarily mean access to healthcare. What is also needed is a sufficient supply of primary-care doctors. As an internal-medicine physician who works in multiple clinical settings, I repeatedly witness the consequences of patients not having that access. When I was working in an emergency room a few months ago, for example, a middle-aged man with hypertension came in with a paralyzing stroke.

Cable news channels have devoted hours of airtime this week to the rancorous debates about healthcare reform at town halls across the country, supplementing the coverage with alarmist commercials about rationing and government-run care. Notably, opponents of the reform effort haven't tried to defend the status quo. Instead, they've spent their time painting exaggerated pictures of what the system might look like in the future -- a world of "death panels," delayed treatments and lethal cost-cutting.

Americans like to complain about the healthcare system, but they're unnerved by many of the proposals for improving it. More than 90% of those surveyed last fall by the Deloitte Center for Health Solutions said that healthcare costs are a threat to their personal financial security, and 80% gave the system a mediocre grade or worse.

Amber Eyerly, 32, says she's never been much good at saving money. But with only minimal raises, at best, expected for 2009 at the Los Angeles public relations firm where she works, Eyerly carefully studied her health insurance benefits package this year to see where she could trim costs. She made one cut for 2009 by signing up for a medical flexible spending account, which takes money, pre-tax, from each paycheck to spend on healthcare costs and reduces her taxable income.

Re "Why the doctor won't see you now," Column One, Dec. 15 This is a timely article, as healthcare reform becomes more likely with the incoming Obama administration. However, any comprehensive effort to change our fragmented healthcare system will run aground if our primary care crisis is not dealt with. The American College of Physicians reports that from 1997 to 2005, the number of U.S. medical graduates entering family medicine residencies dropped by 50%. That is likely to continue as medical school debt increases well beyond $100,000 per graduate and primary care physicians continue to receive low payment rates from Medicare and other insurers.

Your article ["The Push to Label," Nov. 5] put forth the many conflicting and confusing bits of information a parent has to sift through when making the difficult decisions about intervention for a child who is struggling. As a parent who has experienced this dilemma, and as an educational therapist who works with families dealing with these issues, I am grateful for such a well-researched and unbiased discussion. Medicating a child is not a simple choice.

After practicing medicine for 25 years, Dr. Jeffrey Duckham was almost ready to hang up his stethoscope. The high cost of maintaining a solo family practice coupled with low reimbursement rates from insurers required the Silicon Valley doctor to maintain a roster of 2,500 patients to stay in business. He couldn't give people the time he thought they deserved -- or that his training taught him they needed, he said.

Mothers, not only do you have your own day this Sunday, you also are the primary beneficiaries of a growing body of laws and court rulings that grant workplace protections to caregivers. California is among several states and cities that are passing or considering legislation banning job discrimination against workers with the responsibility of caring for children, aging parents or ill spouses.

A majority of Los Angeles County primary care practitioners are failing to advise their Latino patients -- who are at high risk for HIV infection -- to get tested, according to a UCLA study released Thursday. Only 41% of the 85 surveyed primary care providers -- including doctors, nurses and physician assistants -- had regularly offered advice about sexually transmitted diseases during the six-month period covered in the study, which was conducted in 2004 by the UCLA AIDS Institute.