Tuesday, October 19, 2010

The Antidote to Obamacare? Dr. Wal-Mart, Retail Clinics and Strip Mall Medicine Are Booming in U.S.

Following this morning's report on the second CVS retail clinic in the nation's capital, here are two more new reports on market-based alternatives to government-run health care:

1. "Shopping List: Milk. Bread. Paper towels. Motor oil. Blender. Physical. 

Now along with the typical shopping list, people have access to health care inside the North Topeka Walmart. Walmart and Stormont-Vail HealthCare on Monday announced the opening of The Clinic, located inside the lobby of the North Topeka Walmart (pictured above).  With the opening of this clinic, there will be 98 in-store clinics in Walmart stores across 22 states. This is the first one in Kansas." (Source)

2. "Promising convenience and consumer-friendly pricing, urgent care clinics such as Physicians Medical are quickly becoming a ubiquitous sight along highways and in strip malls across America. The Urgent Care Association of America estimates the number of clinics has reached 8,700, up about 8 percent since 2008 despite the recession. Within a 50-mile radius of downtown Jacksonville (FL), at least 32 clinics provide walk-ins with timely care.  

The clinics tend to offer care during regular doctors' hours and at nights and on weekends. "Most cases when you get sick on a Friday afternoon, they can't see you until Tuesday," said Michael Critzer, director of operations for Physicians Medical. "Nobody wants to wait. We live in a world of instant gratification, so that's where we come in."

And urgent clinics charge far less than their main after-hours competitors: emergency rooms. A 2009 study of Minnesota patients seeking treatments for ear infections, sore throats or urinary-tract infections found that the bills averaged $156 at urgent care clinics vs. $570 at emergency rooms." (Source)

36 Comments:

At 10/19/2010 3:22 PM, Blogger Walt G. said...

Do the urgent care clinics have to treat everyone without consideration of ability to pay like emergency rooms?

 
At 10/19/2010 4:32 PM, Blogger juandos said...

Hey Walt G, these are 'retail' clinics not emergency rooms...

Its a state by state basis unless the particular clinic is for some odd reason covered by EMTALA...

 
At 10/19/2010 4:54 PM, OpenID American Delight said...

Dems will find a way to credit the president for the Wal-Mart clinics.

 
At 10/19/2010 6:23 PM, Blogger Hydra said...

Let me know when you get your discount triple bypass at Walmart.

 
At 10/19/2010 6:36 PM, Blogger juandos said...

"Let me know when you get your discount triple bypass at Walmart"...

Well just as soon as ObamaCare 'tightens up those insurance rules', triple bypass will be on the menu...

 
At 10/19/2010 9:49 PM, Blogger Hydra said...

Let me know when the rules get tightened.

Meanwhile how about a little reality.

For thirty five years I and my employers paid for health insurance. The first time I had more than a minor claim I was sick enough to lose my job and my health insurance. Then, I had a people existing conditions that precluded buying any coverage at any price.

I then bought a policy to cover my wife. After eighteen months it was rescinded retroactively after her doctor ordered a colonoscopy.

The insurance company claimed she lied on the application but refused to tell us what they thought she had not disclosed, cosidering the application granted full access to 'her records.

I, and my employers paid premiums for thirty six and a half years. Premiums that were used to pay other peoples claims. Then when my time came in the queue, the insurance company arbitrarily closed the line.

Twice.

Now I am employed again and I have the same insurance company, which now pays circle the same doctor and the same meds they previously refused.

But, the next time I get laid off they cannot cancel me. They may charge me more than the coverage I receive, but they cannot consign me to the round file.

Maybe that benefits costs more, but it still costs less than paying for NOTHING.

 
At 10/19/2010 9:56 PM, Blogger Hydra said...

This morning my wife lost her cell phone. She had used it before she oft the house, and only drove to the neighboring farm.
Since it was gone, she was convinced it had literally disappeared. Poof. Disassimilated.

No amount of logic or fact could convince her otherwise.

She is almost as nutty and unreasonable as juandeos.

 
At 10/19/2010 10:10 PM, Blogger Hydra said...

Look, I agree that we are not going to have unlimited healthcare for everyone. Anyone who thinks Obama style universal insurance coverage means unlimited health care has rocks in his head. We are not doing full body replacements on 95 year Olds even when technology allows it. Some kind of rationing is going to be necessary. But the mind of rationing that happened to me makes no sense. Why throw a productive middle age person into the medical bankruptcy cesspool?

I understand the arguments for Juan dose style Darwinian economics, but I think they are insufficient and unrealistic.

Like my wife's explanation for the missing phone.

 
At 10/20/2010 9:06 AM, Blogger Walt G. said...

juandos,

I don't think we can compare the $156 to $570 amount using your information. The $156 amount is collected from those who are treated and pay whereas we have no idea how much of the $570 is written off by those unable to pay or added to the insurance bills for those who can.

To compare these two business models, we would need to know how many had a willingness and ability to pay the $570 amount but opted instead for the clinic's $156 charge.

I am not saying the clinics are not a good idea because I think they are. I just don't think we can compare the costs for two different markets just because they both deliver approximately the same types of the basic health care.

 
At 10/20/2010 9:51 AM, Blogger juandos said...

"Meanwhile how about a little reality"...

Well hydra there's a first time for everything but your tale of woe here is at best problematic if your previous comments are anything to go by...

There is nothing credible to back it up...

I mean I can't be the only one in this country that has never had a problem with my health insurance companies....

"But, the next time I get laid off they cannot cancel me. They may charge me more than the coverage I receive, but they cannot consign me to the round file"...

Well you can thank the unwilling citizens who'll have more of their earnings extorted to finance ObamaCare...

 
At 10/20/2010 10:16 AM, Blogger juandos said...

"I don't think we can compare the $156 to $570 amount using your information"...

No doubt Walt G, hence the reason its a 'state by state' situation...

"we have no idea how much of the $570 is written off by those unable to pay or added to the insurance bills for those who can"...

You know Walt I'm sure many people in the industry do have some very good ideas of what the ratio of costs are...

For instance consider this Blue Cross/Blue Shield bit: What Drives Up Health Care Costs?

I don't know how factual the numbers listed in that web posting are but do you think Blue Cross/Blue Shield does and the reason why they put out stuff like that?

"...we would need to know how many had a willingness and ability to pay the $570 amount but opted instead for the clinic's $156 charge"...

Hmmm, interesting comment...

I guess a lot of it would depend on what individual needs are at the time of going to a clinic or ER but also the comfort level some folks might get by just going to the ER since those have been around so much longer...

I've been perusing the subject for several days now and I've noticed that there is this idea of how retail clinics can handle some of the ER visit overflow...

Still there hasn't been much in the way of how the uninsured would be handled if such a model were to come about..

From the Cato Institute: How Much Will Universal Coverage Cost?

 
At 10/20/2010 10:35 AM, Blogger Walt G. said...

juandos,

My observations were about the article. There's really not enough information in it to draw any conclusions because clinics, emergency rooms, and their patients because are different.

The $156 and $570 amounts stated are rather useless for any analysis, but it does make a sensationalistic statement to sell papers and magazines to a public that wants a sound bite answer to a complicated problem. Just do this: Go to store clinics, get rid of unions, get rid of illegal aliens, stop imports . . . and your problems will all be solved.

Thanks for the links.

 
At 10/20/2010 10:55 AM, Blogger morganovich said...

hydra-

unless your employer was self insuring, you could easily have mitigated the whole thing through COBRA.

i don't mean to belittle what sounds like an awful experience, but it sounds to me like you simply did not take advantage of what was legally required to be available.

much of what you describe is mostly illegal. insurers simply cannot do that without either your not re upping or some significant mitigating factors in the case of your wife.

if things were as you describe, you had epic lawsuits against them.

i get the feeling you are leaving information out.

i've never even had a private insurer blink about paying for serious illness or surgery, and i've had 4 GA surgeries for various sports injuries.

regarding the triple bypass, asia is probably a lot cheaper than even wal mart could be. even mexico is. clearly, you have to be sure about the doc, but that's getting easier and easier.

yet another industry getting driven out of the US by our spectacular regulatory and liability burden...

 
At 10/20/2010 11:16 AM, Blogger juandos said...

"There's really not enough information in it to draw any conclusions because clinics, emergency rooms, and their patients because are different"...

Oh yeah Walt G, no argument from me...

Let me pose a 'devil's advocate question to you, do you think the insurance companies really want to let out that sort of info?

"but it does make a sensationalistic statement"...

Well Walt, just how many folks are sold or persuaded by bumper sticker type slogans?

"Just do this: Go to store clinics, get rid of unions, get rid of illegal aliens, stop imports..."...:-)

Well I think if we apply the K.I.S.S. theory we could simplify things a bit:

Revert to 'original' Constitutional law...

That would be mean deporting illegal aliens and getting our collective heads together for some sensible immigration laws...

Getting rid of unions, hmmm as a union person of 34+ years I see both upsides and downsides to that...

Unions and especially union leaders could use a thorough does of education in basic economics though...

Imports? We can't do without imports but can we continue to have laws and regulations that make opening up or keeping what industrial base we still have more problematic and expensive day by day?

 
At 10/20/2010 11:56 AM, Blogger Hydra said...

Well just as soon as ObamaCare 'tightens up those insurance rules', triple bypass will be on the

--------------------------------

It is a material misrepresentation to convict Obama not on what he has done but what he might do.

 
At 10/20/2010 11:59 AM, Blogger Hydra said...

There is nothing credible to back it up...

===================================

There is nothing credible to back it up except my life experience, which according to you is a lie.


You go right ahead and live in never never land. Someday life will smack you in the face.

 
At 10/20/2010 12:22 PM, Blogger Hydra said...

" I can't be the only one in this country that has never had a problem with my health insurance companies...."

==================================

Probably not. I never said insurance companies don't have some tranactions that are fair and reasonable. But there are hundreds of thousands of stories like mine and worse, which you can only deny by retreating into nonsense.

We can make health insurance better. We cannot afford to make it perfect. Same with the Environment, National Defense, or anything else.

Obama and the democrats railroaded some fixes in and prevented other changes, the republicans gained some concessions to the democratic agenda. What we have is going to cost more, but it will also provide more benefits. If we are very lucky, total costs will go down, and total costs includes all the out of pocket expenses for people like me that otherwise are not considered.

Fundamentally, I agree with your concept of Darwinian economics, but you go to far and oversimplify. You don't junk a perfectly good car just because the alternotor died. You don't have all the insurance on your car cancelled because you ran over a nail and had a flat. Yet that is what we do with people's health insurance: get arthritis in your feet and your heart insurance is cancelled.

You may not believe it, but that does happen.

As far as the health insurance situation goes, we did something. it remains to be seen if it was good or bad, or whether we can afford it. If we can't then you have nothing to worry about and it will get revised.

The real problem is that we have not got to an honest discussion about the root of the problem. Universal health insurance coverage (which we won't have) is not the same as unlimited health care. We are going to have to figure out how to make that distinction. Darwinian economics is one way, arbitrary decisions by insurors is one way, insuring only people well enough to work is one way.

I think we can do better.

 
At 10/20/2010 12:27 PM, Blogger Hydra said...

." I just don't think we can compare the costs for two different markets just because they both deliver approximately the same types of the basic health care."

I don't think they make much difference because basic helath care isn't the problem. Anyway, it would be much less of a problem with universal insurance. people going to the emergency room go there because they have no insurance. People who go to Walmart may still make a claim against their insurance.

In any case, the fact that there are such clinics says nothing about whaqt is wrong with our insurance system.

 
At 10/20/2010 12:30 PM, Blogger Hydra said...

"But, the next time I get laid off they cannot cancel me. They may charge me more than the coverage I receive, but they cannot consign me to the round file"...

Well you can thank the unwilling citizens who'll have more of their earnings extorted to finance ObamaCare...

===================================

How is that any different from the thirty six years of payments I made that went to pay other peoples claims?

Yes, they will pay more, but when their turn comes to be in my shoes they will also get SOMETHING, which is more than the NOTHING, that I got.

 
At 10/20/2010 12:45 PM, Blogger morganovich said...

hydra-

if you want to find hundreds of thousands of hard luck health insurance stories, they are easier to find in countries with socialized care.

ask the canadains and brits who die waiting to get an MRI or see a specialist or in substandard hospital care.

ask the french who die because the government won't pay for chemo and all the europeans who limp because they can't get hips and knees replaced.

every system has problems.

 
At 10/20/2010 12:47 PM, Blogger Hydra said...

much of what you describe is mostly illegal.

==================================

You are wrong. One reason the rout against Obamacare has been so successful is that most people are as clueless as you are and have not been through the mill.

In this state it is perfectly legal, or was before Obamacare regulations.

I fought this all the way through the insurance comissioners office and to the governors office. the response I got from the insurance commissioners office was esentially that the insurance company had all the rights and I had none.

I tried to engage an attorney who said I had no case. I would have gone to court on principle, knowing it would cost me more than the claim was worth. but not having a case just means it is OK for the insurance companies to steal, as long as the amount is small.

Isurance companis in this state could rescind your insurance retroactively for up to two years. The way it works is this: you fill out a one page application that summarizes your health history, and includes permission for the insurance company to search your records.

The insurance company performs no search and issues a A (conditional) policy. Then, if they later don't like your claims history or see something that might become problematical (my wifes colonoscopy) they then dig into your records and find something that was not included on the one page application.

In my case the insurance company refused even to tell us what it was they found. I had to pry that out of the insurance commissioner which took six months, and a toe to toe screaming match.

Turns out they claimed she had asthma based on a fifteen year old note in the doctors notes (not in her diagnosis) that during a visit for a chest cold she has "some asthmatic sounds".

She had no way of knowing that note existed, yet not reporting it was sufficient for the insurance company to cancel her and the insurance commisioner backed the company.


Disbelieve it if you like,the story is accurate.

 
At 10/20/2010 12:59 PM, Blogger Hydra said...

i've never even had a private insurer blink about paying for serious illness or surgery, and i've had 4 GA surgeries for various sports injuries.

================================

Most people are satisfied with their coverage. Your state rules may be different, or you may have held your policy more than two years.

The fact remains that there were (and still are) serious problems that we could do better with.

I don't like excessive regulations any moer that you do, but I recognize that business brings them on themselves by chiseling and cheating instead of offering a fair product at a fair price.

My experience with insurance in general has mostly been bad. It is the only product you buy and then have to sue to collect. Took six years to collect on a claim against my own uninsured motorists insurance.

 
At 10/20/2010 1:10 PM, Blogger Hydra said...

and i've had 4 GA surgeries for various sports injuries.

==================================

One way to cut down on health care costs is to charge more for people with bad lifestyle decisions.

Of course, someone would have to write a regulation to make sure i did not have excess money extorted from me to support your habits.


Ever conside badminton?

 
At 10/20/2010 1:19 PM, Blogger Hydra said...

Curiously, at the same time my state was telling me to stuff it, the neighboring state was suing the same insurance company over the same practices.

 
At 10/20/2010 1:37 PM, Blogger morganovich said...

hyrda-

i was speaking mostly about your case. all you needed was COBRA.

obviously, i don't have the info to make a full commentary, but again, if you think that sucks, try having to suffer with a curable disease in canada because national health won't pay or because it takes 18 months to see a specialist. all systems have their problems. it sounds like your experience was a pretty heavy outiler though. it's hardly a typical experience.


regarding health coverage for sports injuries, that's a bit complex. sure, play sports for 25 years and you'll get banged up some, but it also means you're fit, have low blood pressure, and never get sick, so it's not entirely straightforward as to whether it costs or saves money in the long run.

besides, those injuries come when you are young when you are already overpaying, so it's not a bad way to get your own back from the older folks you are subsidizing.

 
At 10/20/2010 4:06 PM, Blogger juandos said...

"You are wrong. One reason the rout against Obamacare has been so successful is that most people are as clueless as you are and have not been through the mill."...

Well as usual hydra you get it wrong but you do it with pride...

The only salient fact about ObamaCare that you need to remember is that other people are tired of carrying the load for parasites...

Then again I'm guessing you think the General Welfare clause is for people to reach into the pockets of others...

BTW what is an, 'alternotor'?

 
At 10/20/2010 4:13 PM, Blogger Ron H. said...

""I just don't think we can compare the costs for two different markets just because they both deliver approximately the same types of the basic health care."

Unless I'm misunderstanding something here, it sounds like we can compare, as long as you mean price and not costs. I don't really care what the costs to the provider are, only the price to me. In this example, I can choose between paying either $156 or $570 to have my urinary tract infection treated. All else being equal, (I know, big assumption) I would almost certainly chose the lower price.

"The $156 amount is collected from those who are treated and pay whereas we have no idea how much of the $570 is written off by those unable to pay or added to the insurance bills for those who can."

And we don't really care why the emergency room price is higher, only that it is. As customers we are looking for the best price. (again, assuming that all else is equal, including quality of care)

The emergency room could offer a similar choice if they wanted to. $156 cash, or $570 if they bill you or an insurance company.

 
At 10/20/2010 4:21 PM, Blogger Ron H. said...

"BTW what is an, 'alternotor'?"

Well, juandos, I can only tell you this: If you ever have your 'alternotor' die, you will WISH you still didn't know what it is. There is nothing worse that can happen to your car, and you just might be tempted to junk your perfectly good car. :-)

 
At 10/20/2010 5:05 PM, Blogger juandos said...

"There is nothing worse that can happen to your car, and you just might be tempted to junk your perfectly good car"...:-)

Oh my! Ron H you're on roll man!

Could that be like cash for clunkers but marginally less expensive?

 
At 10/20/2010 5:21 PM, Blogger Ron H. said...

"Could that be like cash for clunkers but marginally less expensive?"

It's EXACTLY like C4C except more expensive for you as a car buyer, and less expensive for me as a taxpayer.

I could rant on at great length about C4C, one of my favorite example of government incompetence, but I won't, except to say that the only winners were junkyards - maybe. The list of losers, starting with taxpayers, is too long to include here.

But then again, it IS a lot cooler these days because of several ounces less CO2 coming from tailpipes in the last year, and the economy has been jump-started into a veritable dynamo of growth.

 
At 10/20/2010 9:51 PM, Blogger juandos said...

"But then again, it IS a lot cooler these days because of several ounces less CO2 coming from tailpipes in the last year, and the economy has been jump-started into a veritable dynamo of growth"...

Oh Ron, global warming commentary commentary now?...:-)

 
At 10/20/2010 10:03 PM, Blogger Ron H. said...

Good old Carbon Man. What is he up to these days? I don't hear much about him anymore.

Apparently it hasn't been necessary to actually take all those draconian measures to save the planet after all. Just the THREAT of action was enough to cool temps.

 
At 10/21/2010 10:04 AM, Blogger juandos said...

"What is he up to these days? I don't hear much about him anymore"...

Actually Ron H, the SUPREME GORON is rattling around in California according to CBS News: Al Gore Urges California to Vote No on Climate Initiative

October 20, 2010 2:52 PM

(there's a short video clip)

CALIF. -- The future of climate change legislation in the United States could rest in California, where voters will decide on Nov. 2 whether to pass Proposition 23, a ballot measure that would roll back the state's ambitious greenhouse gas emissions targets.(there's a bit more)

 
At 10/21/2010 9:11 PM, Blogger VangelV said...

You have to love capitalism. Health care is too expensive so in steps Wal-Mart to grab a share of the market by offering quality care at low prices. Given what it has done for the poor and middle class why isn't Wal-Mart being nominated for a Nobel Peace Prize? The company is certainly more deserving than Gore and Obama were.

 
At 10/21/2010 9:45 PM, Blogger W said...

Retail clinics are great and will bring down the prices of urgent care significantly. But high prices for urgent/emergency in the health system are not the main driver of cost growth. That would be the increasing use of medical technology throughout the system. For retail clinics to be a sufficient "antidote" to what the author terms "Obamacare", the clinics would have to deliver cost effective cancer treatment, treatment for heart failure and similar conditions, cheaper alternatives to MRIs and CT scans, etc... Basically, if the author is saying that retail clinics alone can lower healthcare costs sufficiently to have a shot at balancing the budget, he is completely incorrect.

 
At 10/28/2010 7:42 AM, Blogger arshad said...

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