The Cavalry Isn't Coming: Dispatches from the First Healthcare Renaissance Summit: Primary Care for All Americans

I have attended many primary care gatherings throughout my career. Most are a rally cry to the converted, with primary care talking to itself about itself, reiterating the value and importance of primary care. 

This event was different. With standing room only – the result of unexpectedly high attendance – the venue was packed with an unusual mix of people who don’t usually share a room. Primary care clinicians, community organizers, a mayor, state legislators, students, and people with no healthcare background at all gathered to answer a simple question: If primary care is so important, yet so many people don’t have it, what’s getting in the way and what can we do about it?

Primary Care for All Americans (PC4AA) is a small but rapidly growing organization focused on building a social movement of community organizing to ensure everyone in America has a primary care relationship. I’m on the board, and on May 20th, 2026, we achieved a milestone: our very first in-person summit. 

We planned for 50 people. One hundred showed up. 

As I looked around the room and listened to the speakers, I realized that the unexpected attendance and the diversity of the audience were sending a strong signal: our movement is catalyzing, and this issue matters to people.

The Cavalry Isn’t Coming

Family physician, public health expert, community organizer, author, founder, and PC4AA board chair Dr. Michael Fine launched us into the day’s events with his keynote speech, highlighting three invisible facts the healthcare industry doesn’t want you to know: 1) primary care is incredibly affordable, comparable to what cities spend on roads, water, and fire protection; 2) 57% of Americans don’t have it; and 3) if they did, we would save hundreds of thousands of lives and likely cut national healthcare expenditures by 25% (or more). 

The fact is that the healthcare industry spends up to $1B annually in lobbying costs alone to ensure things stay exactly as they are. Dr. Fine’s conclusion is that the cavalry isn’t coming. If we are going to solve our primary care conundrum, it will take a social movement, built community by community, the way every other major American social transformation has broken us free of the status quo. This country has a remarkable track record of achieving incredible change through social movements. Is there room for another one?

What “No One Can See You Now” Actually Looks Like

PC4AA has provided free playbooks helping local and state workgroups learn how to organize and start doing this work, beginning with understanding the scope of the issue. A powerful illustration of the work in action was a presentation by Dr. Neda Ashtari and Pamela Kavanaugh about Pam’s local PC4AA workgroup in New Bedford, MA. Pam and her group set out to assess the primary care capacity in her community of 102,000 residents. What they found shocked us all: of 36 primary care clinicians, only 15 are physicians; 10 of those are pediatricians, and four of the remaining five all work in nursing homes. This left a single physician (one!) for the remaining adult outpatient population in the entire city. One practice reported a 4,000 patient waiting list, and as many as 25,000 patients had no PCP at all. This staggering shortage is repeated in communities all over the nation, and it is sobering – yet necessary to wrap our arms around the scope of the issue –- to face the numbers.

Direct Primary Care as a Tool for Community Organizing

Dr. Sara Pastoor addresses “Direct Primary Care as a Path to Universal Access” for a packed room at PC4AA’s first summit

I had the opportunity to speak to the audience about direct primary care (DPC) as a tool for community organizing. In DPC, primary care operates outside of the insurance machinery and is paid directly, in a subscription model. Many think of direct primary care as a solution that only works for those who can afford it or whose employers will subsidize it. And it is true that, left to market forces, DPC doesn’t automatically reach everyone. But it could. Equity always requires deliberate design. Through collective financing by community stakeholders with resources and influence, DPC can become structural and guaranteed. Unions, service clubs, faith organizations, municipalities and others can work together to build a community-owned utility model that ensures primary care reaches even the most vulnerable members of the community. 

From Patient Attribution to Primary Care Attachment through Primary Care Investment

The afternoon keynote speaker was Dr. Jonathan Fitzsimon, family physician and Medical Lead of the Renfrew County Virtual Triage and Assessment Centres in Ontario, Canada. Dr. Fitzsimon is a researcher leading a hybrid program providing comprehensive, team-based primary care through both in-person and virtual services to thousands of Ontario residents in rural and historically underserved communities. He introduced the audience to the concept of primary care “attachment” to describe the primary care relationship -- a term that resonated for the listeners much more than our traditional terms like “attribution” or “empanelment” because it implies an affinity, not just an administrative assignment. Ontario has made a commitment of $2.1B to close their primary care gaps and ensure everyone in the province has a primary care relationship by 2029. 

This is a remarkable investment, and not one we are likely to see in the U.S anytime soon. To the contrary, Dr. Fine’s declaration that the cavalry isn’t coming rings true here, and underscores the contrast and the crucial importance of community organizing as a solution for this problem in America. Yet, despite tepid engagement at the federal policy level, states are showing tangible progress. Ann Greiner, President and CEO of the Primary Care Collaborative spoke compellingly about new state-level progress, much of it the result of a political urgency in the wake of H.R. 1 and the associated coverage losses. Ann shared that 22 states are now reporting increased primary care investments. Her framing is that grassroots (community-led efforts) and grasstops (policy work) need each other: communities provide the political base that makes policy change possible. 

Ann Greiner, Dr. Katherine Gergen-Barnett, and Dr. Michael Fine

We don’t just lack the will to change; we lack the architecture

Dr. Renee Crichlow, Chief Medical Officer at Codman Square Health Center and Vice Chair for Health Equity at Boston University’s Department of Family Medicine introduced the concept of the “free rider trap” that guarantees that the usual market forces can never fix what’s broken in U.S. healthcare. It’s the argument that when patients churn between plans at 15–20% annually, the insurer who pays for your preventive care (which primarily happens in primary care) this year loses you to a competitor who inherits the healthy version of you for free. The rational strategy for every individual actor is to wait for someone else to pay first. The result is a collective cycle of underinvestment in primary care and prevention that no amount of good intentions can overcome. 

In every other industry, insurance is designed to cover catastrophic costs, not everyday expenses. Primary care and prevention are something every person routinely needs, and it shouldn’t be paid for under an insurance model built for catastrophes. Primary care is not a catastrophe, it is the insurance against catastrophes. 

The People Who Made It Real

Three individuals were recognized with awards during the event, and each were living reminders of the kind of leadership this movement needs. Senator Cindy Friedman (D) MA was presented the Primary Care Champion Award for her legislative courage in advocating for primary care. In her remarks, she reminded us all that politicians no longer need to hear why primary care matters – they need a unified voice with a clear plan. The award for Radical Honesty and Moral Courage in Medicine was presented to Dr. Samuel Shem, a physician, novelist, playwright, and teacher whose work has helped generations of clinicians see medicine more honestly, more humanely, and with greater courage. His novel, The House of God, is about what it really takes to become a physician and has become a phenomenon for its raw, unfiltered depiction of medical training. Finally, Cassie Voll was given the Community Hero Award for her work as a community organizer leading Moms over Margins, a grassroots movement that ultimately preserved the only birthing center in her community after it had signaled impending closure.

Community Organizing: It’s an Act of Democracy

Dr. Fine had three asks to close the day: stay connected to someone you met here; invite one person to coffee and start a workgroup; ask them to bring one more person in two weeks. The message to take home: when your community takes back control of how care is delivered and paid for, that's not just a health decision. It's an act of democracy. 

Anyone in the U.S. can join our movement. Go to primarycareforallamericans.org/ and click on “join us” to learn more and get involved.