*5.2.2 Continued underinvestment in primary care*

Primary care visits in the U. S. account for 35 percent of health care visits but make up about 5 percent of health care expenditures, compared to an average of 14 percent of all health care spending in OECD countries [47]. A promising development now is the expected introduction of legislation by Senator Bernie Sanders

#### *Primary Care in the USA: The Long Struggle to Build its Foundational Role DOI: http://dx.doi.org/10.5772/intechopen.98792*

authorizing 14,000 new Medicare-supported residency programs over seven years. That bill, if enacted, would also importantly establish new criteria for the distribution of residency slots, with one half allocated for primary care [48].

Another way that the government could, and should address the shortage of primary care physicians is to establish ways that can cover their debt, now averaging \$200,000 for medical school graduates, if they enter primary care. Reimbursement policies should also be changed to more highly value time-intensive care involved in primary care with fewer currently overly reimbursed procedures driving high costs of care by other more procedurally oriented specialties [49].
