If our health care system would reward general practitioners the way it rewards, say, dermatologists, primary care would not have to suffer and overall health care costs could come down as a result of timely treatment of smaller problems that have potentially serious outcomes if neglected.

The reason dermatology is the hot specialty is because the office hours are good -- no one is ever called out for a life-threatening acne emergency at 2:00 AM -- and the money is excellent, as it is with all specialists.

Many, many Americans don't have affordable access to preventative medicine, a great deal of which has to do with a continuing relationship with a doctor or small group of doctors acquainted with the patient's history. Instead, we have people going to clinics with overworked doctors on their way to somewhere else, with little or no follow-up, and that only when there's money to pay for the visit and when there's a clinic to go to.

Then when the crisis comes, the patient is admitted to a hospital, where the emergency procedures dictate all kinds of heroic measures (which the patient may indeed want, as most of us want to live) that are very expensive. Sometimes it's a "free" state hospital, so the cost is directly absorbed by the taxpayers. Sometimes the patient has limited, not comprehensive, health insurance which covers part of the cost, the rest being passed on to the better insured, a "tax" that is often not mentioned and which was one rationale for the current state-subsidized medical coverage for the extremely poor. The thought was, if we're paying for it anyway, we might as well see what it costs rather than pay these hidden fees. Sometimes the patient skips out, in which case we pay for it the way we pay for shoplifting, again in hidden fees.

Crisis is always more expensive. To triage patients in crisis based on their bank accounts is repugnant. Who is to say that the life of a single parent of three young children working two jobs with minimal insurance who has heart disease is less valuable than the life of an executive whose company will not only pay for treatment, but for a private room? Does the latter get bypass surgery but not the former, based on ability to pay? What is the real monetary cost of such a policy, that is, who looks after the family already on the edge? We don't even have to get into the dreadful human cost to our relationships to each other as citizens and people.

If we want more affordable health care, one way to aim for it might be to forgive a sizable amount of the student loans of doctors who go into general practice. The more illness and injury that is treated in a GP's office before it becomes a stroke or blood poisoning, the lower our costs will be. Our public officials might also make some effort to seek out excellent GPs and give them public recognition, raising their status in the eyes of the public, and making the thought of general practice more attractive to children and youth thinking about careers in medicine.

We can't give GPs better hours, and often their fees must reflect what their patients can afford, but we can make the option more attractive.