Improving Health Care: The Doc-in-a-Box Option

The current debate over government-subsidized health care seems unsolvable -- there is just not enough money to give everyone what they demand. Nevertheless, this circle can be squared, at least partially, and in a way that will satisfy both free market conservatives and champions of helping the poor. The solution depends on is how health care is viewed and what constitutes “accessibility.” Moreover, this could be accomplished quickly and, in fact, much of it already exists without budget-busting machinations. While admittedly far from perfect, it will certainly help millions of Americans gain better and more affordable health care.

“Health care” should be viewed as a consumer product comparable to food, housing, clothing and other marketplace commodities. So, just as some people of equal incomes daily patronize McDonald’s for cheap burgers, others will skimp for monthly steakhouse filet mignon. In medical terms, some with a medical problem will insist on costly physician at a university-based hospital for their upset stomach; others just buy Pepto-Bismol and pray. Yes, the latter choice might be ill-advised, but choice is choice and it’s the consumer, not a government bureaucrat, who ultimately decides, and this autonomy deserves respect. If there is to be a role for government in this marketplace, it ought to be educational, perhaps warning those with chronic stomach disorders to visit an MD.  

Second, health insurance availability should not be conflated with improved quality of life (one might mistakenly gather from the mainstream media that legislators still enamored of ObamaCare believe that its repeal will deprive Americans of eternal life). Even single-payer Medicare-for-all, the Left’s disingenuous socialized medicine, will not improve the nation’s health if consumers disdain treatment. Put graphically, how many older Americans demand, and will actually use, free colonoscopies? One might predict that even generous “free” health care will not entice millions to no-cost annual check-ups. Again, subsidized health insurance does not automatically translated into better health.      

Third, despite the heated rhetoric about how the cancer-stricken face certain death if the Affordable Care Act (“ObamaCare”) is repealed, most illnesses are far more humdrum and these should be an important element for government-assisted medical care, particularly for those on limited budgets. Yes, these maladies seldom kill and being generally exempt from government compilations of illnesses, rarely draw much attention, but they are the day-to-day conditions that can make life miserable. Just ask a parent whose child is suffering from a throbbing ear infection. Everybody is familiar with low-level injuries such as sprains, back pains and lacerations, minor burns, insect bites and rashes, allergic reactions, coughs and flu, nausea, diarrhea, asthma reactions, ear infections, severe headaches, urinary tract infections and multiple other “minor” illnesses whose numbers go unnoticed in congressional debates over government-subsidized health care. 

Fortunately capitalism has come to the rescue with thousands of neighborhood min-clinics that handle those maladies, usually quickly and at a reasonable price. This is a rapidly growing industry with many of the firms organized into the Convenient Care Association (founded in 2006 but with the first businesses going back only to 2000). The Urgent Care mini-clinics are typically located in malls, stand-alone buildings on highways (often nicknamed “Doc-in-a-Box”) and in high-traffic stores such as Walmart and Target. The drugstore chain CVS is making convenient care central in its expansion.

According to 2015 data, there were some 6400 such facilities and they are growing at the rate of 700 per year. Regarding care quality, the tough-minded American College of Physicians (ACP) endorses the role of these mini-clinics though the ACP warns about over-relying on them. 

They are truly the McDonald’s of health care, some even more so since they are available 24/7 and require no advance appointments. Moreover, their upfront price list is a godsend to patients unable to navigate complicated hospital bills where an itemized invoice continue for pages and the sum typically paid after negotiations may not reflect the initial charge. A 2014 PricewaterhouseCoopers study reported that the average urgent-care visit, for patients with or without insurance, averaged $121, and can include blood tests, urinalysis, X-rays, and basic metabolic analysis. An emergency room visit, by contrast, averaged $499, and this figure excluded the cost of lab work, which can run into the thousands. Many hospitals appreciate Doc-in-a-Box for this very reason -- they free up already overburdened ERs.

As in the restaurant business, a wide range of quality exists. In some instances, the clinic is associated with a leading full-service hospital (and here) while more down-market facilities supply only a nurse practitioner who might refer you to a hospital if the illness is beyond his or her competency. Also as is true in the restaurant industry, clinics target the local clientele, for example, if lots of gays reside nearby, the available “menu” would features test for HIV/AIDS and shots for sexual transmitted diseases. And for good measure, urgent care facilities, like restaurants, are often rated by previous customers. 

Such localism also facilitates decent care for populations (including those who avoid “government” facilities) all too often underserved by megahospitals or specialized MDs. In fact, many of these customers might be fearful of applying for insurance. A CVS facility in an Hispanic neighborhood will probably employ Spanish-speaking doctors better acquainted with illnesses that disproportionately afflict Hispanics, for example, asthma. These local CVS employees may also cultivate personal ties with their clientele and families not possible in impersonal hospitals with dozens of staff doctors.       

Ironically, the very existence of these readily available, low-cost facilities may well discourage buying insurance and such rationality undermines the coerced coverage characteristic of government-subsidized health care plans. After all, why pay hundreds per month in premiums and with large deductibles when an unexpected illness can be treated cheaply at the nearby Walmart? Yet again, capitalism defeats what is government run or mandated.

Lastly, if Washington wants to subsidize health care for the low-income, it can be accomplished quickly and cheaply -- adjust Electronic Benefit Transfer (EBT) cards (the same cards that provide “food stamps”) to allow charges at government-certified convenient care facilities. This straightforward needs-based solution would be dramatically cheaper and less cumbersome than the current system of private, paperwork-heavy insurance and would be totally transparent. If you have a pesky rash, just Google for a local Doc-in-the Box (or use the Yellow pages), request open hours, if they treat this condition and for how much?  No worry about co-pay or if Cigna will eventually send the payment -- cash or credit cards eliminates all the hassles and cuts waiting time to a minimum. 

This does not, of course, provide solutions for catastrophic illnesses such as cancer or stroke. Those comparatively rare though fiendishly expensive illnesses are far beyond convenient care and must be addressed differently. In the meantime, however, the market-driven urgent care solution dramatically improves health care to those in need and at a reasonable cost with barely any costly bureaucracy and paperwork. Not even Rand Paul or Bernie Sanders can object to that.       

If you experience technical problems, please write to