Commentary on Laugesen Victor G. Rodwin New York University Can the right mix of generalists and specialists produce the needed fix? For good drinks, getting the mix right is surely critical; not so for the physician specialty mix in health policy, because, as Miriam J. Laugesen argues, this is only one factor among many others typically advanced by critics of our health care system. Here I summarize Laugesen’s argument, provide some reactions about primary care, and conclude with the usual call for more research to improve policy. The Argument in Brief Laugesen delivers an effective critique to those who subscribe to the con- ventional wisdom that other countries have a better mix of generalists and specialists. Her most important contribution is to refine the policy issue beyond the content of physician specialty training to the broader functions of primary care (Starfield 1994:1129): “First-contact, continuous, compre- hensive, and coordinated care.” Laugesen’s cross-national analysis of phy- sician workforce data, allowing for inclusion of specialists who perform some of these functions, suggests that 37 percent of our physicians provide primary care. Thus, once the definition of primary care is adapted to the US context, the grounds for asserting US exceptionalism crumble because, as in other nations, “primary care physicians remain the port of first call more than half the time.” Add to this conclusion Laugesen’s recognition that nurse practitioners, and even some registered nurses, provide primary care, and we have more Journal of Health Politics, Policy and Law, Vol. 43, No. 5, October 2018 DOI 10.1215/03616878-6951211 Ó 2018 by Duke University Press Downloaded from https://read.dukeupress.edu/jhppl/article-pdf/535271/6951211.pdf by guest on 12 September 2018