David R. Henderson  

Walmart to the Rescue

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Our Poverty and Theirs... Tolerance Before Empathy...

While away on my vacation in Canada, I missed this story about Walmart and health care. Here's an excerpt:

After years of "Will they or won't they?" discussion, Walmart is making its long-awaited move into delivering primary care: The retailer has quietly opened a half-dozen primary care clinics across South Carolina and Texas, and plans to launch six more before January.

But didn't Wal-Mart already have a presence in health care? Yes, the article explains, but his goes further:
So why fuss over a handful of new clinics?

Because unlike those retail clinics -- which Walmart hosts through leases with local hospitals, resulting in mixed success -- these new clinics are fully owned by the company and branded explicitly as one-stop shops for primary care.
Because the clinics will be open longer and later than competitors: 12 hours per day during the week and another 8-plus hours per day on weekends.


Notice also that one thing South Carolina and Texas have in common is that neither has expanded Medicaid coverage as the ObamaCare law tried to make them do until the Supreme Court put a stop to it:
"Both Texas and South Carolina have primary care access problems, [but] interestingly, the access problem is specifically related to cost," she [Alicia Daugherty] says. "And neither state is expanding Medicaid, so both will continue to have a group of uninsured who will prioritize cost when seeking care. Obviously, both also have high rates of obesity, smoking, chronic conditions, and poverty."

I often hesitate to make predictions, but here's one: the wait at Walmart will be substantially shorter than the wait that Medicaid patients have in those same states.

This will be interesting.


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COMMENTS (16 to date)
Ramon writes:

In Mexico, some Walmart stores have doctors’ offices inside (I have seen them in Superama stores owned by Walmart). They charge 4-8 dollars for a doctor´s visit on a first-come first-served basis.

However this has not been the most successful model of inexpensive clinics in Mexico. There are thousands of Dr. Simi Pharmacies with a doctor´s offices or a clinic attached to it. Patients generally get a doctor´s visit for 2-3 dollars, plus the cost of generics in the pharmacy (not required to buy them but they are as cheap as they can get).

I once took my wife for an ultrasound to a Dr Simi Clinic. The service was surprisingly good. For 20 dollars included a DVD with videos and photos. A regular ultrasound in a traditional lab costs more than 100 dollars.



vikingvista writes:

The 12 hour availability is especially important to a lot of professionals who currently often must somehow find time during the busiest part of their own 12-14 hour workday to squeeze in a visit to a clinic that maintains strict 9a-3p hours just to get a prescription. The cost of lost work or missed business opportunities is usually greater than the clinic fee.

Hopefully one day soon Walmart will expand to 24/7 coverage. This will inject some much needed competition into the health care industry.

Mark V Anderson writes:

That's a good point viking, which never occurred to me. I don't put in those kind of hours, but even with my eight hour day, it is usually true that I lose more money from lost time at work than I do to the fees of the clinic. Expanded hours would be useful to a whole lot of folks.

vikingvista writes:

Mark V Anderson,

Thanks. In a personal example, the physician kept such inconvenient hours, plus dismissed 100% of his staff between 12-1pm. Not even one person was put on a delayed lunch hour to remain to answer the phone--and it was only during lunch that I had time to call. Ask to start 15 minutes early? Nope. 15 minutes late? Nope. Zero flexibility, which to me amounts to zero respect for my time. Even my dry cleaner has on occasion agreed to stay open an additional 15 minutes for me.

Now, some practices will have extended hours one day per week, which is helpful, but not common. It is an industry which, in spite of complaints of declining reimbursements, is clearly in desperate need for more competition.

RPLong writes:

viking/Mark - A few years back, Canada's Fraser Institute put out a study that concluded, based mainly on the financial cost of waiting in line for service, the poor fared much worse than the non-poor, even in "universal" health care systems designed to prevent different outcomes per economic group.

Probably no surprise to either of you, but I thought it was worth a mention.

ZC writes:

@vikingvista

"in spite of complaints of declining reimbursements"...

Interesting that you don't draw the connection between your above statement, and the offices inflexibility with scheduling you. As your insurer continues to pay your doctor less and less for seeing you, your local practitioner decides they may as well at least have the benefit of deciding when they work. Getting paid the same to see you at 2 pm on a Tuesday and 3 am on an Sunday morning, not surprising they elect not to inconvenience themselves.

You want someone to jump when you say how high? Sign up for a boutique practice. To meet the competitive demand you speak of, plenty of docs offer options where they'll give you their cell phone number and talk to you or see you any time of day at your convenience.

Don't want to pay extra for better service? Well, I guess we know who has zero respect for your time...you.

Granite26 writes:

Texas (Houston) has some truly phenomenal walk in clinics.

They are pricey as all get out, but they have good hours and almost no wait times.

I have (good) insurance, but still sometimes elect to go to one in order to get in and out on my own schedule. It's also useful when you've got a sick kid over a holiday. Spend the day in the ER, or some cash on a clinic? No brainer.

vikingvista writes:

zc,

The specific example I'm describing is an individual who is by no means cheap and within a reasonable distance has no boutique competition that I'm aware of (our I'd use it), and whose staff had the condescension to respond to my scheduling concerns with "well he doesn't even need to work, he's already made his money". Nor for this particular purpose did I have any desire to see him--rather protectionist prescription laws required it.

And you see this again and again. Dental offices are particularly problematic.

Of course he is going to make the best possible life for himself, scheduling his office hours at the least convenient times if he chooses. Who wouldn't? The problem is that he has that option. That is why more competition is sorely needed for consumers.

You can have all the sympathy you like for the producers in this industry, and I *know* state intrusion is disheartening and burdensome, but of nearly all the industries I deal with, healthcare does about the least to accommodate consumers' schedules, while simultaneously charging some of the highest prices.

Walmart recognizes this deficiency in consumer centrism, and to the consumers' rescue they come--again. And I hope they make a fortune doing it.

vikingvista writes:

RP Long,

It is not surprising that the poor suffered the worse morbidities or mortalities. But in terms of production lost during the wait, I doubt it was the poor who lost the most.

And all (assuming no arcane employment hour laws) that is need to remedy most of the lost production is to do what a lot of service industries do, and shift their work day a few hours later. But in health care there isn't even enough competition to encourage that simple change.

Mark Bahner writes:
Hopefully one day soon Walmart will expand to 24/7 coverage. This will inject some much needed competition into the health care industry.

I predict that, by 2035, more than half of the current Walmart stores will be closed. The reason? Computer-driven delivery vehicles will make it cheaper to have goods (including groceries) delivered from much smaller warehouses that are packed to the ceiling with goods, and have "aisles" that are simply paths for stacking and unstacking machines to travel.

Therefore, in the next 20 years, Walmart needs to come up with uses for more than half of its retail stores.

P.S. Of course, in 20 years, IBM's Watson will have vision and hearing, and will be a much better diagnostician and doctor than any human doctor. (In part because IBM's Watson will have perfect recall of the 100+ million patients he's treated in his lifetime.)

vikingvista writes:

Mark Bahner,

Creative destruction is a wonderful thing.

triclops writes:

@Vikingvista, Mark,

The funny thing will be that the liberals who despise Walmart will have to alleviate the cognitive dissonance that will come from seeing Walmart die while also seeing that its employment numbers are replaced with... robots.

Hazel Meade writes:

Given the number of people who claim that Walmart profits from food stamps, even if Medicaid WAS being expanded, those same people would just say that Walmart was profitting from Medicaid.

It's all an elaborate scheme to get money by offering inexpensive medical care!!!

Mark Bahner writes:
Mark Bahner,

Creative destruction is a wonderful thing.

I can't see on my monitor whether your tongue is in your cheek. ;-)

But if it's not, I'm definitely not so sanguine...over any period of less than ~50 years. This change will be so much more rapid than anything in history, it will be extremely difficult to adjust. I think literally half the people in the U.S. could lose their jobs to computers in the next 30 years.

In the long run (>50 years) so much wealth will be created that everyone can live by simply taxing a relatively small fraction of the wealth that's created. (In part this will be because most goods will become so inexpensive.)

But the 2020s and 2030s are going to be pretty rough for a huge portion of the U.S. population. It's definitely something for economists to work on (while they still have jobs).

vikingvista writes:

"I can't see on my monitor whether your tongue is in your cheek. ;-)"

Wasn't. I did predict Walmart innovating, but if something better completely supplanted Walmart, I'd be all for it. My only interest in Walmart is as a consumer.

I'm not fearful of rapid automation harming masses of people. The automation comes about only to make things more available. That means people don't NEED to work as much to acquire the same things. And to the extent people need to work, there will be plenty of new opportunities in (1) the automation industry, and (2) those industries that couldn't previously exist due to labor shortages--and labor being a scarce resource, there is a perpetual labor shortage in something, even if that something hasn't been dreamed up yet.

Take it from a man who enjoys his leisure wherever and whenever he can get it--automation is a beautiful thing.

If there are problems like you mentioned, it won't be because of automation. Although, it could be because of something that led to automation as a mitigating factor (e.g. government wage bans).

Mark Bahner writes:
I'm not fearful of rapid automation harming masses of people. The automation comes about only to make things more available. That means people don't NEED to work as much to acquire the same things. And to the extent people need to work, there will be plenty of new opportunities in (1) the automation industry, and (2) those industries that couldn't previously exist due to labor shortages--and labor being a scarce resource, there is a perpetual labor shortage in something, even if that something hasn't been dreamed up yet.

Take it from a man who enjoys his leisure wherever and whenever he can get it--automation is a beautiful thing.

I've thankfully been involuntarily unemployed only two times in my adult life. Both times I was single and with a recent degree in engineering. In the second case, I even had a decent amount of money saved. But in both cases, it was a very difficult experience. Both times involved moving out of the state in which I was living. I can only imagine what it might be for a married person with a dependent family, a less prestigious degree, and much more difficulty in moving out of town.

I think you're really trivializing the difficulties and stresses of unemployment. And particularly so if the person becomes unemployed because his/her particular area of long-time job experience is simply no longer needed anywhere in the country, due to very rapidly evolving technology.

I think Bruce Springsteen's My Hometown contains some great lyrics:

"Now Main Street's whitewashed windows and vacant stores;
Seems like there ain't nobody wants to come down here no more;
They're closing down the textile mill across the railroad tracks;
Foreman says these jobs are going boys and they ain't coming back to your hometown."

And:

"Last night me and Kate we laid in bed
talking about getting out;
Packing up our bags maybe heading south;
I'm thirty-five we got a boy of our own now;
Last night I sat him up behind the wheel and said son take a good look around, this is your hometown."

Presumably, the narrator has at least a reasonable expectation of finding work by "maybe heading south." He and his family are in real trouble if the work for which he has education and experience are no longer available anywhere in the country.

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