

Let WalMart Fix US Healthcare - dangoldin
http://articles.moneycentral.msn.com/Investing/JubaksJournal/LetWalMartFixUSHealthCare.aspx

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dhbradshaw
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-Com...](http://www.amazon.com/Redefining-Health-Care-Value-Based-
Competition/dp/1591397782))

~~~
bootload
_"... 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.

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skmurphy
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.

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deathbyzen
"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,

~~~
Prrometheus
>This isn't about being "cost effective," it's about doing what is right.

There are a finite number of resources in this world and an infinite number of
wants and needs. It is ALWAYS about being "cost effective". Money used on
health care cannot be used on other things, such as education, transportation,
or investment in a company that provides jobs and useful services.

How much medical care should everybody get? Should we be willing to spend $1
million to extend an elderly citizen's life for a year? Should EVERYONE have
access to that quality of medical care? These are important questions. Cost
and benefit must be weighed in health care, just like anywhere else.

Life is more complex than leftist soundbites, my friend. If spending $1
trillion extra on medicine would save a thousand lives, I would contest that
it would not be worth it. The question is, how much of a reduction in the
quality of life in America are you willing to accept for an improvement in the
average quality of health care?

~~~
deathbyzen
I understand that there are limits and finite resources. If you're asking
where to get the money from how about a little less on weapons development and
a little more on medical research.

"How much medical care should everybody get?"

Well -any at all- would be a start for the millions without it. A lot of the
questions you posed (who gets what and how much) have been answered in one way
or another by the dozens of countries who already employ a universal health
care system. We should be looking to them as a template and applying their to
a new system.

Sorry, but I get a bit heated about UHC. People tend to say things like "Where
is the money going to come from?" or "The government is too incompetent to
manage such a system" which are cop-outs, imo.

"The question is, how much of a reduction in the quality of life in America
are you willing to accept for an improvement in the average quality of health
care?"

I'm willing to give up a lot more of my money for health care than for weapons
and war funding.

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yummyfajitas
>I understand that there are limits and finite resources. If you're asking
where to get the money from how about a little less on weapons development and
a little more on medical research.

Sounds great. Only one problem: money is an illusion. The issue isn't money,
it is supply of medical care as measured in units of doctor-hours.

The only way you can get doctor-hours for person X is to take them from person
Y. Doctors already work far more than full time and are unlikey to work more.
Getting more doctors will be tough, since medical schools are all full.

The issue is that medical care is a very scarce commodity. And you can't
legislate scarcity away. Any proposed solution that doesn't create new doctor-
hours (or find a substitute good for doctor-hours, such as nurse-hours) is a
fraud.

~~~
rms
Doctors are kept artificially short in supply by the US medical school system.
This is very, very fixable.

~~~
yummyfajitas
Technically it is medical schools that are kept in short supply. Most medical
schools operated at full capacity, and about 2/3 of qualified applicants are
turned away.

This is certainly fixable, though the time horizon (medical school
construction/expansion time + doctor training time = 10-15 years) is longer
than most politicians like.

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aneesh
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!"

~~~
Prrometheus
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.

~~~
aneesh
Well, healthcare != drugs. Yes, better medications are a part of providing
better health care, and Wal-Mart can help a lot with that. But there is much
more to providing quality healthcare.

I'm not criticising Wal-Mart - they're doing a great job lowering barriers to
access. I'm just saying we should recognize the limitations and not call it a
panacea for American healthcare.

~~~
Prrometheus
They also expanding into basic doctor's visits through their pilot clinic
program. It's in the article.

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

~~~
alaskamiller
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
Maybe I should have expanded a bit. I think the Wal _Mart healthcare system
would be about as good as the Wal_ Mart-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.

Wal _Mart, similarly, does everything cheaply and fucks with entire markets by
using their power to demand certain prices or functionality. Wal_ Mart
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?

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martythemaniak
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.

~~~
bokonist
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.

~~~
Prrometheus
Yes. All institutions are governed by incentives. The Government is not run by
angels, but men. Furthermore, being the largest organization of any sort in
the entire world, it has a particularly byzantine, inefficient, and wasteful
web of contradictory incentives that govern it.

It amazes me that people use such sloppy thinking when it comes to politics.
"We'll should use the government to do X" is not the end of the conversation.
We must ask how likely it is to carry out the goals given it, how much it will
cost to do so compared to alternative solutions, etc.

Edit: In Economics this line of reasoning is called "Public Choice Theory"

