Congress must really like you. On income tax day, they passed a bill to undo (temporarily) the 21-percent cut in your Medicare payments that had actually kicked in for a few days – and to do it, they spent money they don't have. What's that if not love?

Of course, the government's inability to afford you (plus normal inter-party sniping) is what held up previous attempts to pass a stopgap bill like this. But at least for now, you're back to driving the government into debt with every Medicare patient you see. You're a tax-paying American citizen. Why shouldn't you be entitled to your own little piece of the deficit?

Seriously, it's a pretty uncomfortable position to be in, isn't it? If you're like most family physicians, Medicare represents a good-sized chunk of your revenue. Chances are you're not eager to pay enough in taxes to cover what the government has to borrow to pay you, but at the same time you're not overjoyed to see the national debt grow on your behalf. You're caught in your own version of the squeeze that the whole country feels. To a certain extent, I suppose, it's because Medicare is an entitlement and because the 65-and-older population is growing. But that's not really it. The problem is health care expenses, plain and simple. Employers are less and less able to afford health care insurance for their employees. Employees are less and less able to afford their share of the premium for employer-subsidized plans. The insured who have neither the government nor an employer helping are even less able to afford their individual policies. The uninsured can afford only minimal sickness care, if that. We just have to spend less on health care, period.

Fortunately for family physicians, the best way to spend less on health care without sacrificing health seems to be to promote primary care. There are even some small moves in that direction in the new health care reform bill, as suggested by FPM's interview with Kevin Burke in this issue – a 10-percent boost in Medicare payments for primary care evaluation and management services that at least some family physicians should be able to benefit from, a temporary boost in Medicaid payments for primary care services in some states, and at least a gesture toward paying a care management fee for something resembling a patient-centered medical home. None of that is going to reverse the growth in health care expenditures, but maybe it's a start toward getting you off the list of the Fed's deficit expenditures.