Midas Muffler, Not Canada is the Model for Health Care Reform

Today's healthcare debate often focuses on helping the uninsured, the unemployed, the working poor or those who otherwise cannot afford expensive insurance or hefty out-of-pocket fees. This "under-served" population may be relatively small in number, but their easily publicized problems -- sick children needlessly suffering when parents cannot afford a $200 doctor office visit -- in many ways drives ObamaCare.

Empathy aside, ObamaCare is an extravagant, wasteful, overly bureaucratized answer to a quandary for which a less costly and more efficient solution that already exists. This solution is, moreover, totally capitalistic, requires minimal government funding, entails no life-or-death decisions made by faceless bureaucrats, nor will it transform the US medicine into bumbling, British-style Socialism-Lite. Though hardly a miracle panacea, it is way ahead of what is on today's Congressional menu.

This solution is "Convenient Care" or, more colloquially, Doc-in-a-Box, since facilities often resemble box-like fast food restaurants. It consists of no-appointment walk-in medical offices with extended hours (including evenings and weekends) with a small staff treating commonplace illnesses. A nurse practitioner runs it, though under a physician's supervision.

These MinuteClinics, Take Care Clinics or Curaquicks are cheaper than a regular doctor visit, let alone an ER trip. Prices are posted, and most now take insurance. Tests that cannot be done on-site are sent out. So, for between $50 and $75, a parent whose child suffers from an ear infection can get junior diagnosed and treated at 8:30PM Saturday versus trying to make a regular doctor's appointment days latter and paying up to $250. (Some clinics permit toll-free calling in advance to minimize waits). Mom and Pop may also want to get their cholesterol screened for under $50 each while waiting for junior's diagnosis.[1] In a sense, this is a throwback to when dozens of neighborhood gas stations fixed cars versus making an appointment with the guaranteed-to-be-more expensive distant dealer given all his specialized equipment and factory-mandated employee training.

Convenient care dates from 2000, and use has exploded. That legislators and well-paid healthcare experts have no need for such prompt, cheap services may help explain its invisibility in today's debate. These clinics are represented by a national trade association -- the Convenient Care Association -- and one industry market research firm estimated their number to be 1,200 in 2008 and predicted that this would increase to 2,400 with revenues of $2 billion by 2013.[2]  As of mid-2009, some 3.5 million people have been treated at these facilities.[3] Retail giants such as Wal-Mart and Target, national drugstore chains CVS, Walgreens and Rite Aid plus supermarket chains like Safeway and Kroger have now entered this business. Local hospitals have also joined in, a strategy that might be explained by having a sick patient pay $60 when services are rendered versus sending the patient a much larger but difficult-to-pay ER bill.

Everybody benefits. Consumers can get their sinusitis, bronchitis, throat infections, urinary tract infections and multiple other bothersome illnesses treated quickly, cheaply at a nearby strip mall or corner Walgreens. Meanwhile small facilities boost walk-in traffic that often bring sales elsewhere in the store. Retail outsiders seldom appreciate the economic benefits of drawing customers. When I was in retail 20 years ago, the standard figure given for attracting a new customer was $10 (first-timers divided by total marketing costs) so, for example, "giving away" a five minute free blood pressure screening is cost-effective marketing. One clinic has even waived fees for those who could prove that they were uninsured or unemployed.[4]

This is free enterprise heaven. That profits come from performing thousands of small services means intense pressure to improve efficiency, while price transparency will make savvy medical shopping akin to buying meat and potato commodities. Services will probably be advertised in weekly "shopper" flyers so those needing a quick flu shot will recognize bargain when they see it. 

Dozens of national chains with locations in widely varied settings also permits fine-tuning customer service such as staff language skills well beyond what huge, far-distant government supervised bureaucracies can possibly implement. Who needs dense Health and Human Services outreach guidelines? Accommodating local clienteles is just sound business-as-usual retail. So, if the local Target caters to senior citizens, just specialize in geriatrics. If African Americans favor a particular Wal-Mart, advertise no-hassle hypertension and diabetes screening. If there are lots of school-age children, offer $10 off-coupons on school supplies with every state-required vaccination and TB screening. Indeed, it is hard to imagine any currently under-served population being avoided by today's customer hungry giants. An obese NASCAR dad may finally, finally get his blood pressure checked in the corner of the NAPA auto parts store!   

Moreover, as our examples suggest, convenient care may address two problems that have traditionally perplexed today's medical system -- prevention and follow-up. Not only do essential preventive steps lend themselves to these "E-Z in and out" type treatments, but the routine nature of store visits facilitates constant monitoring. Our chubby NASCAR dad may dread wasting untold hours at a local hospital but his periodic NAPA store stopovers might encourage regular check-ups. That medical interaction can resemble a traditional corner store atmosphere will also make these encounters as threatening as regular barber shop or beauty parlor visits. And the by now familiar on-first-name-basis staff can ask about taking medications, losing weight and similar necessary follow-ups. Who knows, our medically adverse NASCAR dad might even be enticed to get a long-delayed prostate exam if rewarded by a 50% discount on five quarts of Mobil1 oil. 

In an instant, many of the costs presently absorbed by government will be switched over to the far more efficient private sector. Forget public service announcements to get regular check-ups. Just let Rite Aid troll for this business. As for the crushing paperwork that often deters physicians from taking insurance, just issue a privately administered fraud-proof debit card that any Doc-in-the-Box could process in two minutes (the parallel is how retail firms process credit cards issues by dozens of banks). And rest assured, Wal-Mart and the like are far more experienced at squeezing suppliers than some 9 to 5 inside-the-Beltway negotiator.  To make a truly profound point, convenient care facilities pay taxes, while adding to shareholder value versus absorbing nonstop government largess.

Billions more can be saved. National firms have invested millions to track customers and have years of experience, a far cry from the proposed multi-billion dollar, government pressured national healthcare data management system (Great Britain has poured billions into this IT venture and nothing seems to work).[5] Surely a firm like Wal-Mart that daily scrutinizes a gigantic inventory, thousands of deliveries, and manages a huge payroll can handle its customer's medical histories. In fact, just as millions of Americans carry on their key chains a "preferred customer" cards, they can always have their Target or Kroger "med card" handy permitting nation-wide instant access. Medical histories or records can also be encrypted in a carry along chip. Store-kept information will also be a godsend for many poor people troubled by keeping accurate medical records. The Center for Disease Control can also track daily illness levels, a key step in identifying potential epidemics.

An Even Brighter Future

This model of cheap, convenient health care can even be scaled up a bit, just as automobile service chains upgrade from simple tire changes to tune-ups and brake work. Perhaps these might be called next generation convenient care. For example, the Doctor's Office in Paramus, NJ (http://paramusurgentcare.com/) advertises the usual basic services with long hours plus more complicated services such as X-rays, physical therapy and even counseling to reduce the risks of heart disease. It also offers doctors board certified in emergency and family practice. Down the road firms may market a more specialized, more capital intensive versions -- a chain of mini-hospitals specializing in select out-patient procedures, a sort of Midas Mufflers for minor or outpatient surgery.  None of this will be government decided; everything depends on market demand and, rest assured, private firms will strive to create and satisfy demands for medical services without having to be hectored by Washington bureaucrats.    

Let us be clear: this is hardly the solution for America's health care woes. But, it does address a sizeable chunk of it, especially commonplace ills going untreated owing to a lack of inexpensive, handy medical services. When combined with a smartcard with both medical data and imbedded funds, it facilitates finely-tuned outreach sans socialism and proliferating Washington guidelines. Costs are trivial compared to top-down ObamaCare and this solution, read my lips, actually generates tax revenue. Of the utmost importance, it already exists and impediments to rapid expansion are relatively small and easily surmounted. This is not gold-plated medical care or a solution for horrific complicated illnesses. But, judged by the standard of what can be done to help millions short of mortgaging America's future and slipping into socialism, it's hard to visualize a superior solution. 

[1] Angie Marek, "Healthcare in a Hurry," Smart Money Magazine, June 4, 2009.

[2] Parija B. Kavilanz, "Wal-Mart wants your rash and step throat," CNNMoney.com. April 14, 2009.

[3] "Doc-in-a-Box Retail Clinics Popping Up in the Best of Neighborhoods, Not the Underserved," Senior Journal.com, May 26, 2009.  

[4] Angie Marek, "Healthcare in a Hurry," Smart Money Magazine, June 4, 2009.

[5] Fraser Nelson and Irwin M. Stelzer, "No NHS, Please, We're Americans," The Weekly Standard, July 27 2009, pp. 20-2.
Today's healthcare debate often focuses on helping the uninsured, the unemployed, the working poor or those who otherwise cannot afford expensive insurance or hefty out-of-pocket fees. This "under-served" population may be relatively small in number, but their easily publicized problems -- sick children needlessly suffering when parents cannot afford a $200 doctor office visit -- in many ways drives ObamaCare.

Empathy aside, ObamaCare is an extravagant, wasteful, overly bureaucratized answer to a quandary for which a less costly and more efficient solution that already exists. This solution is, moreover, totally capitalistic, requires minimal government funding, entails no life-or-death decisions made by faceless bureaucrats, nor will it transform the US medicine into bumbling, British-style Socialism-Lite. Though hardly a miracle panacea, it is way ahead of what is on today's Congressional menu.

This solution is "Convenient Care" or, more colloquially, Doc-in-a-Box, since facilities often resemble box-like fast food restaurants. It consists of no-appointment walk-in medical offices with extended hours (including evenings and weekends) with a small staff treating commonplace illnesses. A nurse practitioner runs it, though under a physician's supervision.

These MinuteClinics, Take Care Clinics or Curaquicks are cheaper than a regular doctor visit, let alone an ER trip. Prices are posted, and most now take insurance. Tests that cannot be done on-site are sent out. So, for between $50 and $75, a parent whose child suffers from an ear infection can get junior diagnosed and treated at 8:30PM Saturday versus trying to make a regular doctor's appointment days latter and paying up to $250. (Some clinics permit toll-free calling in advance to minimize waits). Mom and Pop may also want to get their cholesterol screened for under $50 each while waiting for junior's diagnosis.[1] In a sense, this is a throwback to when dozens of neighborhood gas stations fixed cars versus making an appointment with the guaranteed-to-be-more expensive distant dealer given all his specialized equipment and factory-mandated employee training.

Convenient care dates from 2000, and use has exploded. That legislators and well-paid healthcare experts have no need for such prompt, cheap services may help explain its invisibility in today's debate. These clinics are represented by a national trade association -- the Convenient Care Association -- and one industry market research firm estimated their number to be 1,200 in 2008 and predicted that this would increase to 2,400 with revenues of $2 billion by 2013.[2]  As of mid-2009, some 3.5 million people have been treated at these facilities.[3] Retail giants such as Wal-Mart and Target, national drugstore chains CVS, Walgreens and Rite Aid plus supermarket chains like Safeway and Kroger have now entered this business. Local hospitals have also joined in, a strategy that might be explained by having a sick patient pay $60 when services are rendered versus sending the patient a much larger but difficult-to-pay ER bill.

Everybody benefits. Consumers can get their sinusitis, bronchitis, throat infections, urinary tract infections and multiple other bothersome illnesses treated quickly, cheaply at a nearby strip mall or corner Walgreens. Meanwhile small facilities boost walk-in traffic that often bring sales elsewhere in the store. Retail outsiders seldom appreciate the economic benefits of drawing customers. When I was in retail 20 years ago, the standard figure given for attracting a new customer was $10 (first-timers divided by total marketing costs) so, for example, "giving away" a five minute free blood pressure screening is cost-effective marketing. One clinic has even waived fees for those who could prove that they were uninsured or unemployed.[4]

This is free enterprise heaven. That profits come from performing thousands of small services means intense pressure to improve efficiency, while price transparency will make savvy medical shopping akin to buying meat and potato commodities. Services will probably be advertised in weekly "shopper" flyers so those needing a quick flu shot will recognize bargain when they see it. 

Dozens of national chains with locations in widely varied settings also permits fine-tuning customer service such as staff language skills well beyond what huge, far-distant government supervised bureaucracies can possibly implement. Who needs dense Health and Human Services outreach guidelines? Accommodating local clienteles is just sound business-as-usual retail. So, if the local Target caters to senior citizens, just specialize in geriatrics. If African Americans favor a particular Wal-Mart, advertise no-hassle hypertension and diabetes screening. If there are lots of school-age children, offer $10 off-coupons on school supplies with every state-required vaccination and TB screening. Indeed, it is hard to imagine any currently under-served population being avoided by today's customer hungry giants. An obese NASCAR dad may finally, finally get his blood pressure checked in the corner of the NAPA auto parts store!   

Moreover, as our examples suggest, convenient care may address two problems that have traditionally perplexed today's medical system -- prevention and follow-up. Not only do essential preventive steps lend themselves to these "E-Z in and out" type treatments, but the routine nature of store visits facilitates constant monitoring. Our chubby NASCAR dad may dread wasting untold hours at a local hospital but his periodic NAPA store stopovers might encourage regular check-ups. That medical interaction can resemble a traditional corner store atmosphere will also make these encounters as threatening as regular barber shop or beauty parlor visits. And the by now familiar on-first-name-basis staff can ask about taking medications, losing weight and similar necessary follow-ups. Who knows, our medically adverse NASCAR dad might even be enticed to get a long-delayed prostate exam if rewarded by a 50% discount on five quarts of Mobil1 oil. 

In an instant, many of the costs presently absorbed by government will be switched over to the far more efficient private sector. Forget public service announcements to get regular check-ups. Just let Rite Aid troll for this business. As for the crushing paperwork that often deters physicians from taking insurance, just issue a privately administered fraud-proof debit card that any Doc-in-the-Box could process in two minutes (the parallel is how retail firms process credit cards issues by dozens of banks). And rest assured, Wal-Mart and the like are far more experienced at squeezing suppliers than some 9 to 5 inside-the-Beltway negotiator.  To make a truly profound point, convenient care facilities pay taxes, while adding to shareholder value versus absorbing nonstop government largess.

Billions more can be saved. National firms have invested millions to track customers and have years of experience, a far cry from the proposed multi-billion dollar, government pressured national healthcare data management system (Great Britain has poured billions into this IT venture and nothing seems to work).[5] Surely a firm like Wal-Mart that daily scrutinizes a gigantic inventory, thousands of deliveries, and manages a huge payroll can handle its customer's medical histories. In fact, just as millions of Americans carry on their key chains a "preferred customer" cards, they can always have their Target or Kroger "med card" handy permitting nation-wide instant access. Medical histories or records can also be encrypted in a carry along chip. Store-kept information will also be a godsend for many poor people troubled by keeping accurate medical records. The Center for Disease Control can also track daily illness levels, a key step in identifying potential epidemics.

An Even Brighter Future

This model of cheap, convenient health care can even be scaled up a bit, just as automobile service chains upgrade from simple tire changes to tune-ups and brake work. Perhaps these might be called next generation convenient care. For example, the Doctor's Office in Paramus, NJ (http://paramusurgentcare.com/) advertises the usual basic services with long hours plus more complicated services such as X-rays, physical therapy and even counseling to reduce the risks of heart disease. It also offers doctors board certified in emergency and family practice. Down the road firms may market a more specialized, more capital intensive versions -- a chain of mini-hospitals specializing in select out-patient procedures, a sort of Midas Mufflers for minor or outpatient surgery.  None of this will be government decided; everything depends on market demand and, rest assured, private firms will strive to create and satisfy demands for medical services without having to be hectored by Washington bureaucrats.    

Let us be clear: this is hardly the solution for America's health care woes. But, it does address a sizeable chunk of it, especially commonplace ills going untreated owing to a lack of inexpensive, handy medical services. When combined with a smartcard with both medical data and imbedded funds, it facilitates finely-tuned outreach sans socialism and proliferating Washington guidelines. Costs are trivial compared to top-down ObamaCare and this solution, read my lips, actually generates tax revenue. Of the utmost importance, it already exists and impediments to rapid expansion are relatively small and easily surmounted. This is not gold-plated medical care or a solution for horrific complicated illnesses. But, judged by the standard of what can be done to help millions short of mortgaging America's future and slipping into socialism, it's hard to visualize a superior solution. 

[1] Angie Marek, "Healthcare in a Hurry," Smart Money Magazine, June 4, 2009.

[2] Parija B. Kavilanz, "Wal-Mart wants your rash and step throat," CNNMoney.com. April 14, 2009.

[3] "Doc-in-a-Box Retail Clinics Popping Up in the Best of Neighborhoods, Not the Underserved," Senior Journal.com, May 26, 2009.  

[4] Angie Marek, "Healthcare in a Hurry," Smart Money Magazine, June 4, 2009.

[5] Fraser Nelson and Irwin M. Stelzer, "No NHS, Please, We're Americans," The Weekly Standard, July 27 2009, pp. 20-2.