5 ms·

Let WalMart Fix US Healthcare

21 points by dangoldin 18y ago

dcurtis 18y ago
What a preposterous suggestion. Should we start having Taco Bell service our cars?
- alaskamiller 18y ago
  If YUM wants to switch its core competency from serving fast food to automobile servicing... why not? Snark aside, there's a current trend in "retail healthcare" that I think is really interesting. Drug stores like RiteAid and Walgreens experimented with posting a doctor at each store to provide basic diagnosis for approachable prices on a 9 to 5 scale. That combined with cheap generic prescription drugs, it's become a very good health service for people that don't have jobs that provide medical care. Will this scale to other more advanced medical treatments? Maybe. That's what the article is talking about.
  - dcurtis 18y ago
    Maybe I should have expanded a bit. I think the WalMart healthcare system would be about as good as the WalMart-branded clothing. Not good. If Taco Bell started to service your car while you were in the drive through, some men in business suits might say it's a good synergistic initiative. I mean, your car is already there in the drive through. But really, Taco Bell makes horrifically shitty tacos. Is that even meat they use? It's embedded deeply in the corporate culture to make shitty tacos, and I am positive the same philosophies they use in building their tacos would go into the quality of their in-drive-through-car-repair. WalMart, similarly, does everything cheaply and fucks with entire markets by using their power to demand certain prices or functionality. WalMart effectively morphs some companies into Wal*Mart-like companies. I think it would be stupid to assume they wouldn't do the exact same thing to healthcare professionals. Can you imagine having the same person who negotiated the price of a toilet bowl brush down from $1.99 to $0.99 by demanding the toilet brush company use half as much plastic as being the same person negotiating with the doctor to delay your xray a few days?
deleted 18y ago
[deleted]
martythemaniak 18y ago
Before swallowing this tripe, one must first believe the "government is your enemy, the market our savior" mantra. Government is a tool that can be wielded effectively or ineffectively. Though Americans haven't quite learned how to do anything with this tool (or rather, have forgotten over the last few decades), other people have and they enjoy the benefits, one of which is affordable, effective health care for everyone. Americans too can enjoy these benefits, however too many of them would rather repeat the mantra and eat their tripe, than learn from reality.
- alaskamiller 18y ago
  I don't think one needs to subscribe to a particular mantra to make healthcare effective. It doesn't matter if it's a government official or a business that getting a doctor to see you, tell you what's wrong, and fix you up, the point is that we ant something like that to happen. What's being argued continuously is how do we get that to happen given the clear disproportionate amount of doctors and resources to people.
- bokonist 18y ago
  What amazes me is that progressives simultaneously believe that 1) the U.S. government is controlled by special interests ( insurance companies, the AMA, drug companies ) and 2) we should give the government more power to regulate healthcare. If you believe 1), then doing 2) means giving even more power to the special interests. Anybody who wants the US healthcare system to look more like Europe's, must also come up with a realistic way of 1) replacing our Congressional system with a Parliamentary system, and 2) curbing the power of the lobbies. Otherwise, any plan to use government to make healthcare better will be co-opted by the special interests and end up making the healthcare worse.
  - jraines 18y ago
    Well, we'd like to curb the influence of special interests before giving the government more power. And while I'm at it, a moon base would be pretty cool, too.
  - nazgulnarsil 18y ago
deathbyzen 18y ago
"The goal, everyone agrees, is to maximize coverage, heighten competition and cut costs. Good goals, all." No, the goal is to save lives and provide EVERY American with health care in order to improve the quality of their life. This isn't about being "cost effective," it's about doing what is right,
- yummyfajitas 18y ago
  If you want to save lives, you are wasting your time with medicine. http://hanson.gmu.edu/CutMed.htm http://hanson.gmu.edu/CutMed.htm To save lives and improve the quality of life, you'd be better off providing EVERY American with access to a gym. Exercise adds 15 years to your life. It's pretty difficult to show statistically that marginal medical treatments (medical treatments that people purchase if they are cheap, but not if they are expensive) do anything.
  - Retric 18y ago
    Early healthcare tends to reap huge benefits. AKA prevent someone dieing at birth and you add ~70 years. Older patents and random accidents reduce the possible gains. The second cheapest group to save is emergency room patents where minimal treatment can have dramatic effects. Exercise falls into the next group where huge investments in time reap huge long term benefits. (Someone making 50$/hour * 3 hours a week * 50 weeks a year = 7500$ / year.) A 5$ per month medicine is a lot cheaper than exercise so it's long term benefits don't need to be on the same magnitude to be vary worthwhile.
    - yummyfajitas 18y ago
      Well first, the link I provided discusses marginal medicine, or medicine people choose not to buy if it will cost THEM lots of money. Emergency care tends not to be marginal. As for the opportunity cost of exercise, it is only $2850 (average wage is about $38,000/year, http://www.ssa.gov/OACT/COLA/AWI.html http://www.ssa.gov/OACT/COLA/AWI.html) if people substitute exercise for productive work. It's not obvious that that is what would happen. I suspect most people would substitute exercise for TV. Lots of people watch 3 hours of TV per day. Squeezing out 3 hours/week would be easy. For gods sake, 9.9 million people sit on their asses watching The Biggest Loser (a weight loss game show). People can exercise more.
aneesh 18y ago
The title is misleading. Wal-Mart can't fix US healthcare. But Wal-Mart can make big inroads into fixing prescription drug access. But there are so many problems in healthcare that Wal-Mart isn't positioned at all to fix. Tens of millions of Americans need health insurance (though the 47 million number that is thrown around includes many who are young and don't want insurance, and many people in between jobs and temporarily uninsured). If Wal-Mart can't insure it's own employees, I don't think they'll become the health insurance provider for underserved Americans. That said, here is another problem that Wal-Mart can "fix": It's too hard, and too expensive to see a doctor for a minor illness. CVS' MinuteClinic and related offerings by Wal-Mart are trying to exploit this niche. But basically, there is too much wrong with healthcare for any one entity (incl the gov't) to "fix" it. As an administration official said (privately): "The great thing about health policy, is that your education & training is still useful. The issues we're facing now are the same ones we were facing 30 years ago!"
- alaskamiller 18y ago
  What you're really saying is: there's no money. Insurance is basically a means of pooling together money then someone has to assign to fix the people that need it. That's not what's wrong with healthcare. What's wrong with healthcare is that the lower middle to middle class don't have much money to be taxed with or to contribute to healthcare. At the end of the day what needs to be done is someone needs to figure out how to get money and spend it wisely. Both the government and businesses do a shitty job with this.
  - aneesh 18y ago
    Not just that. Healthcare has so many players that all need to be pleased to make anything happen. It's complicated because the payer and customer are different, unlike most other industries.
- Prrometheus 18y ago
  I don't think the title is misleading. The author claims that Wal-Mart can lower health care costs and increase access to more people. Do you have any specific argument against that? > If Wal-Mart can't insure it's own employees, I don't think they'll become the health insurance provider for underserved Americans. Nobody said that they would, including the author. However, if Wal-Mart can work their magic on basic health care, then it becomes much easier to get by on a high-deductible catastrophe plan for most people.
dhbradshaw 18y ago
WalMart can help by offering inexpensive pharmaceuticals. I don't know if they can help overcome a larger problem. The problem seems to be that health care providers do not compete on value delivered. Until we effectively measure value (long term benefit divided by cost) delivered and compare it across providers we will have no way to use the market to stimulate improvement. Right now we don't measure long term benefits and decisions are insulated from costs. (Yeah, I drink the Kool aid: http://www.amazon.com/Redefining-Health-Care-Value-Based-Competition/dp/1591397782 http://www.amazon.com/Redefining-Health-Care-Value-Based-Com...)
- bootload 18y ago
  "... WalMart can help by offering inexpensive pharmaceuticals. ..." Inexpensive yes, effective maybe, probably no. Walmart works by dictating the price a supplier sells. This is how it gets things so cheap, screw the other guy hard. So the question is "do you want the cheapest drug or the most effective?". By effective I mean, "it does what it claims". There are huge quality problems in outsourcing pharma-products to China, India and other non-first world states. If you want to Walmart exerting it's control on drug price, the likely result is cheaper but an inferior outsourced product.
skmurphy 18y ago
Seems like there a couple of interacting problems but no one size fits all. It does seem like WalMart would be useful for high frequency low severity (adjusting for risk of some high severity situations lurking in the intake). Trauma needs a trauma center, chronic progressive conditions benefit from Kaiser's approach (and have proven amenable to pharmaceuticals in many cases). It's not clear where to put cancer, if we can't screen and catch it early we don't seem to have a good answer. Stroke and heart attack may benefit from early intervention that's one time plus physical therapy follow up. There may be some more categories. Trauma (e.g. automobile accident, gunshot, explosion) => trauma center High Frequency Low Risk (for most: cough, cold, flu) => WalMart Chronic (heart disease, diabetes, high blood pressure, gout, glaucoma, cystic fibrosis) => pharmaceuticals / Kaiser pro-active healthcare Low Frequency High Risk (cancer, heart attack, stroke, appendicitis) => medical center / surgery Getting fewer people to smoke would have a huge impact. You also need to distinguish between an intervention that gives a 1 year old another 60-80 years of life and a 72 yr old another six months, they may cost the same but the first has a much stronger impact on society. I am not saying deprive anyone of medical care, but understand there may be an enormous cost for medical care in the last year of life. Good health is dying more slowly: good medical care doesn't save your life, it lets you die of something else a little (or a lot) later.

21 points by dangoldin 18y ago

dcurtis 18y ago

What a preposterous suggestion. Should we start having Taco Bell service our cars?

alaskamiller 18y ago
If YUM wants to switch its core competency from serving fast food to automobile servicing... why not? Snark aside, there's a current trend in "retail healthcare" that I think is really interesting. Drug stores like RiteAid and Walgreens experimented with posting a doctor at each store to provide basic diagnosis for approachable prices on a 9 to 5 scale. That combined with cheap generic prescription drugs, it's become a very good health service for people that don't have jobs that provide medical care. Will this scale to other more advanced medical treatments? Maybe. That's what the article is talking about.
- dcurtis 18y ago
  Maybe I should have expanded a bit. I think the WalMart healthcare system would be about as good as the WalMart-branded clothing. Not good. If Taco Bell started to service your car while you were in the drive through, some men in business suits might say it's a good synergistic initiative. I mean, your car is already there in the drive through. But really, Taco Bell makes horrifically shitty tacos. Is that even meat they use? It's embedded deeply in the corporate culture to make shitty tacos, and I am positive the same philosophies they use in building their tacos would go into the quality of their in-drive-through-car-repair. WalMart, similarly, does everything cheaply and fucks with entire markets by using their power to demand certain prices or functionality. WalMart effectively morphs some companies into Wal*Mart-like companies. I think it would be stupid to assume they wouldn't do the exact same thing to healthcare professionals. Can you imagine having the same person who negotiated the price of a toilet bowl brush down from $1.99 to $0.99 by demanding the toilet brush company use half as much plastic as being the same person negotiating with the doctor to delay your xray a few days?

deleted 18y ago

[deleted]

martythemaniak 18y ago

Before swallowing this tripe, one must first believe the "government is your enemy, the market our savior" mantra. Government is a tool that can be wielded effectively or ineffectively. Though Americans haven't quite learned how to do anything with this tool (or rather, have forgotten over the last few decades), other people have and they enjoy the benefits, one of which is affordable, effective health care for everyone. Americans too can enjoy these benefits, however too many of them would rather repeat the mantra and eat their tripe, than learn from reality.

alaskamiller 18y ago
I don't think one needs to subscribe to a particular mantra to make healthcare effective. It doesn't matter if it's a government official or a business that getting a doctor to see you, tell you what's wrong, and fix you up, the point is that we ant something like that to happen. What's being argued continuously is how do we get that to happen given the clear disproportionate amount of doctors and resources to people.
bokonist 18y ago
What amazes me is that progressives simultaneously believe that 1) the U.S. government is controlled by special interests ( insurance companies, the AMA, drug companies ) and 2) we should give the government more power to regulate healthcare. If you believe 1), then doing 2) means giving even more power to the special interests. Anybody who wants the US healthcare system to look more like Europe's, must also come up with a realistic way of 1) replacing our Congressional system with a Parliamentary system, and 2) curbing the power of the lobbies. Otherwise, any plan to use government to make healthcare better will be co-opted by the special interests and end up making the healthcare worse.
- jraines 18y ago
  Well, we'd like to curb the influence of special interests before giving the government more power. And while I'm at it, a moon base would be pretty cool, too.
- nazgulnarsil 18y ago

deathbyzen 18y ago

"The goal, everyone agrees, is to maximize coverage, heighten competition and cut costs. Good goals, all." No, the goal is to save lives and provide EVERY American with health care in order to improve the quality of their life. This isn't about being "cost effective," it's about doing what is right,

yummyfajitas 18y ago
If you want to save lives, you are wasting your time with medicine. http://hanson.gmu.edu/CutMed.htm http://hanson.gmu.edu/CutMed.htm To save lives and improve the quality of life, you'd be better off providing EVERY American with access to a gym. Exercise adds 15 years to your life. It's pretty difficult to show statistically that marginal medical treatments (medical treatments that people purchase if they are cheap, but not if they are expensive) do anything.
- Retric 18y ago
  Early healthcare tends to reap huge benefits. AKA prevent someone dieing at birth and you add ~70 years. Older patents and random accidents reduce the possible gains. The second cheapest group to save is emergency room patents where minimal treatment can have dramatic effects. Exercise falls into the next group where huge investments in time reap huge long term benefits. (Someone making 50$/hour * 3 hours a week * 50 weeks a year = 7500$ / year.) A 5$ per month medicine is a lot cheaper than exercise so it's long term benefits don't need to be on the same magnitude to be vary worthwhile.
  - yummyfajitas 18y ago
    Well first, the link I provided discusses marginal medicine, or medicine people choose not to buy if it will cost THEM lots of money. Emergency care tends not to be marginal. As for the opportunity cost of exercise, it is only $2850 (average wage is about $38,000/year, http://www.ssa.gov/OACT/COLA/AWI.html http://www.ssa.gov/OACT/COLA/AWI.html) if people substitute exercise for productive work. It's not obvious that that is what would happen. I suspect most people would substitute exercise for TV. Lots of people watch 3 hours of TV per day. Squeezing out 3 hours/week would be easy. For gods sake, 9.9 million people sit on their asses watching The Biggest Loser (a weight loss game show). People can exercise more.

aneesh 18y ago

The title is misleading. Wal-Mart can't fix US healthcare. But Wal-Mart can make big inroads into fixing prescription drug access. But there are so many problems in healthcare that Wal-Mart isn't positioned at all to fix. Tens of millions of Americans need health insurance (though the 47 million number that is thrown around includes many who are young and don't want insurance, and many people in between jobs and temporarily uninsured). If Wal-Mart can't insure it's own employees, I don't think they'll become the health insurance provider for underserved Americans. That said, here is another problem that Wal-Mart can "fix": It's too hard, and too expensive to see a doctor for a minor illness. CVS' MinuteClinic and related offerings by Wal-Mart are trying to exploit this niche. But basically, there is too much wrong with healthcare for any one entity (incl the gov't) to "fix" it. As an administration official said (privately): "The great thing about health policy, is that your education & training is still useful. The issues we're facing now are the same ones we were facing 30 years ago!"

alaskamiller 18y ago
What you're really saying is: there's no money. Insurance is basically a means of pooling together money then someone has to assign to fix the people that need it. That's not what's wrong with healthcare. What's wrong with healthcare is that the lower middle to middle class don't have much money to be taxed with or to contribute to healthcare. At the end of the day what needs to be done is someone needs to figure out how to get money and spend it wisely. Both the government and businesses do a shitty job with this.
- aneesh 18y ago
  Not just that. Healthcare has so many players that all need to be pleased to make anything happen. It's complicated because the payer and customer are different, unlike most other industries.
Prrometheus 18y ago
I don't think the title is misleading. The author claims that Wal-Mart can lower health care costs and increase access to more people. Do you have any specific argument against that? > If Wal-Mart can't insure it's own employees, I don't think they'll become the health insurance provider for underserved Americans. Nobody said that they would, including the author. However, if Wal-Mart can work their magic on basic health care, then it becomes much easier to get by on a high-deductible catastrophe plan for most people.

dhbradshaw 18y ago

WalMart can help by offering inexpensive pharmaceuticals. I don't know if they can help overcome a larger problem. The problem seems to be that health care providers do not compete on value delivered. Until we effectively measure value (long term benefit divided by cost) delivered and compare it across providers we will have no way to use the market to stimulate improvement. Right now we don't measure long term benefits and decisions are insulated from costs. (Yeah, I drink the Kool aid: http://www.amazon.com/Redefining-Health-Care-Value-Based-Competition/dp/1591397782 http://www.amazon.com/Redefining-Health-Care-Value-Based-Com...)

bootload 18y ago
"... WalMart can help by offering inexpensive pharmaceuticals. ..." Inexpensive yes, effective maybe, probably no. Walmart works by dictating the price a supplier sells. This is how it gets things so cheap, screw the other guy hard. So the question is "do you want the cheapest drug or the most effective?". By effective I mean, "it does what it claims". There are huge quality problems in outsourcing pharma-products to China, India and other non-first world states. If you want to Walmart exerting it's control on drug price, the likely result is cheaper but an inferior outsourced product.

skmurphy 18y ago

Seems like there a couple of interacting problems but no one size fits all. It does seem like WalMart would be useful for high frequency low severity (adjusting for risk of some high severity situations lurking in the intake). Trauma needs a trauma center, chronic progressive conditions benefit from Kaiser's approach (and have proven amenable to pharmaceuticals in many cases). It's not clear where to put cancer, if we can't screen and catch it early we don't seem to have a good answer. Stroke and heart attack may benefit from early intervention that's one time plus physical therapy follow up. There may be some more categories. Trauma (e.g. automobile accident, gunshot, explosion) => trauma center High Frequency Low Risk (for most: cough, cold, flu) => WalMart Chronic (heart disease, diabetes, high blood pressure, gout, glaucoma, cystic fibrosis) => pharmaceuticals / Kaiser pro-active healthcare Low Frequency High Risk (cancer, heart attack, stroke, appendicitis) => medical center / surgery Getting fewer people to smoke would have a huge impact. You also need to distinguish between an intervention that gives a 1 year old another 60-80 years of life and a 72 yr old another six months, they may cost the same but the first has a much stronger impact on society. I am not saying deprive anyone of medical care, but understand there may be an enormous cost for medical care in the last year of life. Good health is dying more slowly: good medical care doesn't save your life, it lets you die of something else a little (or a lot) later.