WHO COULD NOT LOVE
THIS HEALTH CARE SYSTEM?

Journal of Healing – Oct. 26, 2005

By Mary Koch

I had this “eureka!” moment when I read a news report that Wal-Mart is trying to enter the banking business. Bankers naturally are alarmed. Enter today, take over tomorrow.

            What next for Wal-Mart, I mused. Health care? HEALTH CARE!? Eureka! It’s the answer to our nation’s health care dilemma.

            Our president likes to describe the U.S. health care system as the best in the world. Never mind that the World Health Organization ranks the U.S. in 37th place. What does the world know? The President has a point. Everything about our health care system is upward bound: the costs, the number of uninsured, related mortality rates, the proportion of money spent on (mis)management, the complexity of our fragmented, byzantine billing procedures.

            We all know it. The politicians all promise to do something about it. But we can’t seem to solve it. As my friend (a little name dropping here) Kathleen O’Connor writes in her book, “The Buck Stops Nowhere: Why America’s Health Care is All Dollars and No Sense:”

“When it comes to changing health care, we are trapped by our ideology and our view about the role of government.”

*     *     *

            AT ONE EXTREME are the private enterprisers who believe the problem will be best solved in a free market place. On the other extreme is the demand for universal access via a single payer system (read “government”).

            But what if Wal-Mart were that single provider/payer? Both sides would be happy. There is no place more market-oriented than a Wal-Mart store. As for universal access, Wal-Mart captures us all with the promise, “always the lowest prices. Always.”

            Oh, sure. There are those snooty communities that have given Wal-Mart the bum’s rush. So let them have their boutique clinics. For the rest of us, for the masses, I can see it now: An enormous concrete bunker of a building sprawling along the highway north of town, the sign proclaiming: WAL-MART SUPER CLINIC.

*     *     *

            WHAT WILL IT be like in this Son of Sam clinic of the future? Surely you’ll find a friendly greeter at the door, distributing gurneys and wheelchairs.

            “I’m looking for a knee replacement,” you’ll tell him as you flash your Wal-Mart HMO card.

            “Aisle 437,” he’ll instruct and give your chair a helpful shove. Sure enough, a half-hour later including two rest stops, you reach aisle 437 where the sign says, “Body Parts.”

            When a young fellow in a Wal-Mart blue vest passes by, you tell him you’d like to see a doctor.

            “No doctors. No nurses. We’re all associates here,” he answers cheerfully.

            “Well, I need a knee replacement,” you say.

            “Darn,” he says. “You should’ve come last month. We had them piled to the ceiling – a real deal. Sold out in no time. But they’re seasonal y’know. We won’t have them in again for six, maybe eight months. All depends on how successful we are at squeezing, er, I mean, encouraging the manufacturer.”

            “So let’s talk hips,” he continues, pointing to a stack of boxes. “These are just in from China and they’re an excellent buy – with only a small up-charge for an unconditional, 10-year warranty.”

            Not interested, you say, but he’s not giving up.

            “Well, be sure to take a look two aisles over. We’re offering a two-for-one defibrillator deal this week and check out the special on Aisle 783 – a full body scan free with every colonoscopy.”

            At the end of the day you leave the store, fibrillated, oscopied, and scanned. But, hey! The check-out lines are quick and it’s all tallied up on one, easy-to-understand bill with the lowest prices. Always.

TRUTH IS STRANGER THAN FICTION
BUT NOT AS FUNNY
Journal of Healing – Nov. 2, 2005

By Mary Koch

  When I wrote last week about an imaginary Wal-Mart Super Clinic, I WAS JUST KIDDING! I had no idea Wal-Mart really, truly is considering putting health care clinics in its stores.

            Just as I was kidding around about Wal-Mart, that prodigious purveyor of stuff announced it will expand health coverage at a lower cost for its workers – excuse me! I mean, “associates.”

            Critics smelled something fishy. Sure enough, the very next day the New York Times, aided and abetted by a group called “Wal-Mart Watch,” revealed an internal memo that laid the company as bare as those concrete walls that encase its “super” stores.

            The apparent generous expansion of health care benefits turns out to be a decoy, part of an ambitious corporate shell game devised to hold back spending on health care and other benefits. But let’s not stop there. The plan also involves the right kind of “spin” to get positive PR while shaping the nation’s debate over health care.

*     *     *

            IT’S ALL LAID out in the 12-page memo to Wal-Mart’s board of directors from M. Susan Chambers, executive vice president for benefits. Don’t know what the “M” stands for. Machiavelli, maybe?

            Ms. Chambers’ memo, with proposals that were received “enthusiastically” by corporate executives, is fascinating. The company intends “to identify the best doctors” and make sure employees see only those doctors. Who, pray tell, defines what makes the “best” doctor?. And about those clinics in the stores, read on:

“Wal-Mart is starting an effort to put clinics in stores, a strategy currently framed as a real estate opportunity.” But, the memo continues, “these clinics could become an important part of our healthcare strategy, especially as a substitute for emergency room visits.”

So I’m in a car crash and end up at Wal-Mart. I wonder what kind of care I’d get. Judging from the memo’s attitude toward employees there’s only one word for it: callous.

Critics who complain about Wal-Mart’s treatment of its workers “are correct in some of their observations,” Ms. Chambers admits. But benefit improvements, such as they are, are planned not because it’s the right thing to do, not to enhance loyalty to the company, but to “better withstand external scrutiny.”

*     *     *

            WAL-MART, it appears, doesn’t really care about loyal, long-term employees. Employees with long-term tenure cost too much. The company wants to hire younger, healthier workers.

            But I’m not sure Wal-Mart can claim to be the best working environment for anyone who wants to STAY young and healthy. According to its own statistics, Wal-Mart’s work force is aging faster than the national average and gets sicker than the national population, particularly in obesity-related diseases. Diabetes among Wal-Mart workers has increased by 10 percent compared to the national average of 3 percent.

            Gee, could there be any relationship with the miles of aisles displaying junk food or the high-calorie, high-cholesterol offerings in the coffee shop?

            And then there’s the Medicaid thing. The memo admits that “a significant percent of Associates and their children” receive public assistance for health care. And that will continue to be the case: “Because many of these programs will offer more generous health insurance than Wal-Mart provides, many Associates will still choose to enroll in Medicaid, leaving the door open for continued attacks.”

            The answer? Wal-Mart intends to “help shape the outcome of the public debate about the healthcare crisis in a way that is at least somewhat advantageous to our interests.”

            “Establishing Wal-Mart as a leader on this critical issue will help deflate our critics,” says the memo. And they’re right. It sure takes my breath away.

© Mary Koch, Omak, Washington 2005

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