In his recent book about Lincoln as a writer, Fred Kaplan described Lincoln’s disdain for the “linguistic dishonesty” of leaders of the Confederacy, who attempted to divide the nation with “a barrage of verbal propaganda that corrupted the relationship between language and truth.” Strong words, but not unlike the verbal propaganda that has created a schism between primary care physicians and specialists, which is impeding solutions to the nation’s physician shortage.

We are told that patients in areas with more primary care physicians and fewer specialists spend less on health care but get better quality, use fewer hospital and outpatient services, achieve better health status, and incur fewer end-of-life expenditures. They also have decreased all-cause mortality, lower mortality from cancer, heart disease and stroke, decreased infant and maternal mortality, and increased life spans. All quite remarkable.

While one can find a kernel of “statistical truth” in some of these studies, the associations apply uniquely to family practitioners but not general internists, who practice in the same manner. This curious anomaly results from the preference for family practice in states along the northern tier, from Maine to Washington (where poverty is sparsely distributed), coupled with an historic preference for internists in the Northeast (where there is dense urban poverty) and the low numbers of all physicians across the South (where poverty is pervasive).

It’s not surprising, therefore, that most associations between primary care and better population health disappear once race and poverty are considered. Indeed, the superior outcomes in areas with more family practitioners have everything to do with the merits of Minnesota over Mississippi and of Portland over Newark and little to do with the merits of primary care.

But what about the old saw that primary care physicians can deliver specialty care better and cheaper than specialists? Commenting in Robert Wood Johnson’s “The Future of Primary Care,” Sheldon Greenfield, who led these studies in the 1990s, acknowledged that they lacked adequate risk adjustment, and subsequent research has shown that specialty care generally yields better outcomes, particularly for patients at greater risk, although with greater costs.

These conclusions run headlong into the Dartmouth’s Atlas, where outcomes (such as satisfaction, quality, and mortality) in the region with the most specialists and spending are “not necessarily better” than in the region with least. Yet even a casual inspection of Dartmouth’s map shows that the “high-spending region” is a scattered collection of America’s largest metropolitan areas, while the “low-spending region” encompasses the vast northern tier.

Aggregating patients living at the extremes of wealth and poverty in the former causes their average outcomes to resemble those of patients residing in the upper Midwest, but the inordinate health care expenditures associated with poverty give added weight to urban spending. What has been characterized as waste and inefficiency is, in fact, the sad result of poverty ghettos and social depravation.

What about state studies? How often have you heard that “states where more physicians are specialists have lower-quality care and higher costs?” While widely cited, this is simply the output of scrambled statistics. While Mississippi and Nevada do have low quality, they certainly do not have an abundance of specialists, as depicted graphically and portrayed to politicians. Indeed, they have the fewest specialists in the nation.

Finally, what about the belief that health care reform will get rid of waste and inefficiency – the $700 billion that Peter Orszag has assured us will be saved? Is it as he says? Do communities use more care because they have more specialists? Or do they have more specialists because they need to provide more care?

Despite 50 years of debate, economists have failed to make a convincing distinction, but maps tell the tale. It turns out that most of the “wasted” care is provided to low-income patients, particularly in the poverty ghettos of major cities. In fact, they use so much more care that it’s hard to find the “waste” that is so apparent anecdotally. And that has led to poor policy choices.

But take note. Obama has arrived from the land of Lincoln with the clear message that language and truth must be reunited. And Lincoln would probably add something about what happens when a profession is divided against itself.

Primary care physicians don’t need to be advertised as better “specialists” than specialists, nor as the fountain of long life, and falsely denigrating specialty care doesn’t make primary care physicians more valuable. Patients know their value already. And experts know that health care is better when primary care physicians and specialists work together and best when there are more of both.

The tasks at hand are to end the “verbal propaganda” that divides disciplines and confuses politicians and concentrate on expanding the supply of physicians and other health professionals so that future generations will have access to the technologically-advanced, socially-equitable health care that this nation deserves.

Richard A. Cooper, M.D., is a professor of medicine in the School of Medicine and senior fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania. He formerly was Director of Penn’s Cancer Center and Dean of the Medical College of Wisconsin. cooperra@​wharton.​upenn.​edu; 215–667-9806; http://​buzcooper​.com