You’ve probably seen articles like this one (originally from the Wall Street Journal) about how Wal~Mart is starting to open in-store medical clinics. Could this idea, combined with something like the new Massachusetts “univeral health insurance” plan, solve our growing health care problems?

I was once in the Army, where you went to sick call run by non-MD medics when you didn’t feel well. Most of the time, they gave you aspirin and sent you back to duty. If you were seriously ill, though, you would get treated, possibly even by a real doctor — who only spent 10 seconds with you because there was a room full of people out there waiting to see him. This was clinic care at its most impersonal, the kind doctors’ groups warn you we’ll all get if we allow “socialized medicine” to take over from our current free enterprise system.

I didn’t mind Army medical care — except for the long waits.

A commercial, Wal~Mart-type clinic would need to figure out a way to make sure hardly anyone ever waited more than 30 minutes to see a doctor or physician’s assistant. Give Wal~Mart’s expertise in supply chain management and business process management in general, this shouldn’t be a problem.

A large nationwide clinic-style health care provider could negotiate favorable prices from specialist physicians, hospitals, medical laboratories, pharmaceutical companies, and others in the medical profit chain. A Wal~Mart-sized one might even think about operating its own labs — and possibly even its own hospitals — at some point.

Quality of care might or might not be a factor. If there are a number of clinic groups competing with each other — Walgreens and other drugstore chains are experimenting with in-store clinics, too — the free market would take care of the quality problem as customers shifted from ones that offered poor service to ones they liked. And there would still be a market for private physicians; there is no reason why those who don’t like an impersonal clinic setting couldn’t pay more for personal service, just as those who don’t like to shop at Wal~Mart (and can afford better) are free to shop at Nordstrom’s, Macy’s, and other high-end stores.

The fallacy that underlies so many of our current medical care problems is that we have gotten the idea into our heads that we are all entitled to “the best” medical care, and are entitled to it at rock-bottom prices. In reality, we need to accept the fact that we can’t all have the top graduate from John Hopkins Medical School’s class of 1998 at our beck and call 24 hours a day, nor can we all expect to get multiple organ transplants for free every time we feel a little run-down.

If we want low-cost medical care, we’re going to get Wal~Mart-level service, not boutique-level service. We’ll need to be satisfied with generic drugs most of the time; with as little surgery as possible; and we may need to do without super-expensive “end of life” treatments that allow us to live a little longer in an intensive care unit bed instead of going quietly. And the doctors we see may have graduated from Podunk State, not a “prestige” institution, which may alarm some patients even though all doctors need to pass the same exams to practice, and from what I have read high grades are not a good indication of doctor quality, especially after they’ve had a few years of actual, hands-on work in the field.

I’ll take the discount care, thank you

I don’t ask my doctor for a lot of hand-holding. My one chronic illness, Diabetes, is controlled by medication and diet. I go in for regular checkups to make sure nothing drastic is happening, and those checkups could just as easily be done by a nurse or PA (physician’s assistant) unless my blood tests show something evil. Then, sure, call me and set me up with a doctor.

Even if I need extra care, I’d like it to be as simple as possible. Given a choice between a medical or a surgical solution, I’ll choose the medical solution every time.

If I’m in the hospital, barely breathing, in pain, and unlikely to regain full brain and at least partial body functions, don’t perform “heroic measures” to keep me barely breathing and in pain for any longer than necessary. I’d just as soon take plenty of strong pain medication and fade away in a haze — with representatives of at least a dozen religions praying for me in case there’s an afterlife.

Note that I’m not saying you should prefer minimal medical care because I do. All I’m asking is that this level of medicine should be available for those of us who don’t want — or can’t afford — the current American treatment system.

I’m also saying that people who have their medical care paid by the government, under whatever program, must learn to accept simple, clinic-based medicine, because there is no other way we can go on offering universal medical treatment in an America with an aging population and a rich-people class that has decided its only financial responsibility to the rest of the country is to take money out of it without putting anything at all back in.

This entry was posted on Friday, April 21st, 2006 at 4:16 pm and is filed under Politics. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.