So Close to a Great Idea

When I saw the CNN headline "Obama looks to sell health care at grocery store," I thought, now there's some change I could believe in!

"Bending the cost curve" requires rethinking assumptions along the whole supply chain. While we lament the passing of the country general store, the efficiencies created by national chains like Target and Wal-Mart have a lot to do with why poverty is now defined almost entirely by lack of access to healthcare, education, and housing in a safe area, rather than the lack of indoor plumbing, hot meals, a car, or cable television.

But while the butcher shop, green grocer, and dry-goods store have all faded into history, the layers of hospitals, specialists, doctors, nurses, and pharmacists has changed much less. Yes, we expect the doctor to see a lot more patients, and the payment system is far more complex, but the methods of production and provision are basically the same.

In recent years, pharmacy chains have started adding cash-for-care clinics inside stores, where a nurse practitioner can diagnose and prescribe drugs for a wide range of common conditions, or provide a physician referral where recommended. These clinics have proven extremely popular with the uninsured, because $50 to get your kid's ear infection looked at is a lot more reasonable than $500/mo for family insurance, but also with well-off professionals, who are happy to pay cash on top of their insurance for the convenience of walking in anytime they can.

I do believe that there are ways to reduce costs while preserving or even increasing the quality of care. We are surrounded in our daily lives by products and services that are more reliable and less expensive than they were a decade or three ago. The standout difference between all of them and healthcare is that both the supply and demand sides of healthcare are more tightly regulated than anything else in our lives.

Sadly, the CNN headline turned out to be nothing more than Obama appearing at a grocery store to campaign for his single-payer-in-drag model, which would serve largely to preserve the current system in amber. That may bend the cost curve, but surely not down.