Health Care at Walmart
Mar 12th, 2008 by Dave
I went in to the doctor the other day for the routine checkup thing; hadn’t had a checkup since 2005, but since I was considering switching to a higher deductable, much lower premium plan it seemed like a good idea to scope out the risks. I’m switching from an employer paid plan to one where I pay the premiums, and I have a lot more options now, so suddenly it makes a lot of sense for me to shop around for the best deal. One of the options, since I’ve started my own (small) company, is to do a group plan with my wife and me. There are a lot of benefits to that arrangement, namely the opportunity to do a HSA or health savings account where you set aside some of the savings (with a higher deductible) in a pre-tax account to pay your medical expenses. This isn’t a section 125 where you use it or lose it - it continues to grow year after year and you can cut back on your contributions if the balance gets large enough. Check with your professional if you’re in a similar situation.
I said that I was thankful that under this plan I’d still get insurer negotiated rates, and he responded that I’d be negotiating directly with the providers; but that I’d have a lot more choice in the provider I could choose, that if say I needed a CAT scan, he could give me guidance on where I could go to get a decent rate. He said this was the wave of the future, that there is going to be a lot more direct negotiation of rates between us and our health care providers. “So you mean I might go to Tijuana and get a CAT scan because it’s cheaper?” I joked. He responded seriously that I might - it all depended on the equipment and certifications of the operators using the equipment. I said I didn’t think most people would shop around for medical care - and even if they did, there wasn’t a lot of visibility into rates on the web. And even if we had the rates, we wouldn’t have the knowledge of being able to judge the qualifications of the various providers. He responded that in a couple of hours of searching I could find all the rates I needed on the web, and that more and more sites are being developed to give consumers visibility into health care provider ratings. He talked about health tourism - where you go to a foreign country, say Singapore, to get elective surgery at a fraction of the cost you’d pay in this country. He is on a board that provides accreditations, and says that more and more foreign medical facilities are seeking US accreditions to be better able to compete with US institutions.
“What we’re more concerned about, or should be, is Walmart” he said, which floored me. I knew they operated pharmacies but had no idea that they offer more than that, but apparently they do, at least according to this article 20 Surprising Ways Wal-Mart Clinics Will Affect US Healthcare. “So I should just wait for the blue light special on my elective surgery?” I asked, again with the joke. I said I thought Walmart might be handle the easy things - like the flu or a minor infection - but didn’t think patients would flock there for the more complex elective surgeries. He responded that Walmart might negotiate a volume rate, say for 5,000 elective surgeries, and pass along the rock bottom price to their customers, at a rate the smaller providers couldn’t compete with.
“What do you think about the whole universal health plan?” I asked. I told him that in his waiting room I’d read the story of Mitt Romney, who had instituted a health care reform plan while governor of Massachusetts. The gist of the article was that Romney had had his people look into the data and found that, contrary to the usual assumptions, the typical uninsured wasn’t a poor unwed mother who couldn’t afford the expense of insurance, but single employed males who were eminently insurable - and that it was just a matter of convincing them that it was in their best interests to insure (through tax incentives and publicizing choices). The article deemed Romney’s reform of healthcare in Massachusetts a success, said it was not all that different from Hillary’s (compulsory) healthcare program, and questioned why Romney hadn’t used the ostenbible success of his healthcare reform in his presidential campaign. My doctor said that the plan, or any national plan for that matter, would ultimately fail due to out of control costs. Cost control seems to be a central bugaboo of all these plans - no one has yet come up with a completely equitable way to allocate health care; if you have access to all kinds of tests and medical care at virtually no marginal cost, what’s to stop you from ordering up expensive tests for the most obscure diagnoses? Other countries with socialized medicine, say Canada, allocate health care through queues - long waits for service. Our country has one of the most expensive systems of providing health care in the world - but our facilities have access to the best and latest technologies in the world, which explains why those citizens of socialized countries who can afford it will fly here for medical care.
Much has been made of the rival healthcare proposals of Hillary Clinton and Barack Obama; a main difference between the two is that Hillary’s plan is compulsory where Barack’s is not. I don’t think government should make any program compulsory, even if it does cost a little more to give us the freedom to opt out, and it will cost more to opt out. Schwarzenegger’s plan to reform health care addresses the big issue of the uninsured going to ERs for even the most minor issues - since the ERs are required to take them where a private physician would turn them away due to lack of insurance. This type of reform makes a lot of sense - it is far more expensive to treat someone in the ER than in a walk-in medical clinic.