Free Health Care

This past weekend, Wal-Mart was offering health care screenings to male customers at no charge. Sam’s Clubs across the country gave any customer willing to take the time:

• BMI Index measurements,
• Blood pressure tests,
• Cholesterol readings,
• PSA (prostate cancer) tests, and
• TSH (thyroid stimulating hormone) tests.

And that’s not all. Sam’s Clubs have more free screenings planned for the future. Here’s the schedule:

This past weekend, Wal-Mart was offering health care screenings to male customers at no charge. Sam’s Clubs across the country gave any customer willing to take the time:

• BMI Index measurements,
• Blood pressure tests,
• Cholesterol readings,
• PSA (prostate cancer) tests, and
• TSH (thyroid stimulating hormone) tests.

And that’s not all. Sam’s Clubs have more free screenings planned for the future. Here’s the schedule:

• July: Kids Health Screenings
• August: Vision Health Screenings
• September: Diabetes Screenings
• October: Women’s Health Screenings
• November: Digestive Health Screenings

Further, at the store I visited there was no waiting. And if there happened to be a wait, I suspect it would be handled the way Wal-Mart handles prescription drugs. In order to reduce both the time cost and the money cost of care, Sam’s Club Pharmacy promises:

• Hundreds of generic prescriptions for just $4,
• Prescriptions filled in just 20 minutes, and
• Text alerts to tell you when your prescription is ready, so you can shop while you wait.

Now if this doesn’t knock your socks off, you must be living in a cave somewhere. Certainly, you haven’t been paying attention to health policy news.

How many times can a man turn his head
And pretend that he just doesn’t see.

Under the health reform bill that was enacted last year:

• In just three years you are going to be forced to buy insurance coverage for the very services Wal-Mart is giving away for free!
• My rough guess is that you (though your premiums) and your health plan (directly) will pay $500 to $1,000 for these services alone; and if you can get them with only 20 minutes of waiting at a doctor’s office or community health center, be sure and tell the rest of us your secret.
• I would also guess that after getting your blood drawn at a conventional site, you will wait at least a week before you learn the results — in contrast to the almost immediate feedback at Sam’s.
• As for the drugs, ObamaCare will probably force you to buy first-dollar coverage for a whole slew of generics and the cost will be a lot more than Sam’s $4 charge.
• Texas Medicaid, for example, pays a fee of more than $7 to pharmacists just to dispense a prescription — on top of the cost of the drug!

What’s happening at Sam’s Clubs is yet another instance of a general trend I have noticed. Almost all of the things health reformers say they want to happen are already happening — outside the third-party payer system. They are happening not because of the third-party payers, but in spite of them! Consider that:

• Concierge doctors are consulting by email and telephone, keeping electronic medical records (EMRs), prescribing electronically and offering same day or next day appointments — all characteristics of the Commonwealth Fund’s vision of ideal primary care.
• Walk-in clinics are posting (transparent) prices, using evidenced-based medicine by following computerized protocols, and keeping EMRs as well.
• Cosmetic and Lasik surgeons routinely offer “bundled” prices, compete for patients based on price and quality and have lowered the real price of their services over the past decade.
• There are lots of successful examples of coordinated care, integrated care, managed care, medical-home care and home-based care (see, for example, here) — almost all of it developed despite third party incentives not to do so and in some cases saving third-party payers millions of dollars without a dime’s worth of compensation.
• And now we have primary care without deductible or copayment!

Isn’t the lesson here obvious? There’s nothing wrong with the market for health care. It’s the third-party payers, stupid.

Now I want you to close your eyes and try to imagine how a rational world would deal with all this information. Here are some of my fantasies:

• Commonwealth Fund press release: “Karen Davis Praises Wal-Mart; Says ObamaCare endorsement was a mistake.”
• HHS press release: Secretary Cancels Millions in Pilot Project Funding: “Why spend money looking for answers Wal-Mart has already found.”
• Texas HHS press release: “State to Contract out Medicaid Services to Wal-Mart.”
• New York Times Economix blog: “I was wrong” is the lead for the latest Uwe Reinhardt column.
• Incidental Economist post by Austin Frakt: “On Wal-Mart, show me the evidence.”