The Medical Freedom Channel

Well, now they’ve done it! Now they want to insulate the danged “minute clinics”!

According to a Boston Globe news story, the recent rise in low-cost walk-in clinics, sponsored by various chain-stores (Walgreen’s, CVS, et alia), has attracted the interest of the HMO world, at least in Massachusetts.

As the story, “Insurers to cover drugstore clinic visits,” reports, both Harvard Pilgrim Health Care and Tufts Health Plan have signed contracts with CVS Caremark, and are in negotiation with Walgreen’s, seeking to “cover” most of the costs of patient visits to CVS and similar “minute clinics,” by offering reduced “co-pays” to those under their umbrellas who seek care at the clinics.

To some, this might seem a good thing, since the programs call for much lower co-payments from the patients than those exacted for more conventional healthcare visits (doctor’s offices or emergency rooms). Instead of the $75-150 customary for ER drop-ins, the patients will likely be paying only $15-25 for a clinic appearance.

The problem is, the wider effect of this could be the perpetuation of the very thing that got us into the healthcare mess in the first place: the “employee benefit,” third-party payor, institutionalized model for maintaining wellness.

Arnold Kling of the Cato Institute has labeled this the “insurance as insulation” premise, and I see no reason to reinvent the terminology here. This “insulating” concept takes the position that ALL costs for health and wellness should somehow be paid for by third parties, either as “insurance coverage” or via tax deductions (for the copayments). As a result, we’ve come to see healthcare, not as a personal-responsibility issue (do what you can to stay well, get checkups regularly to detect problems early on … thereby minimizing the costs and even the likelihood of critical aftercare), but as a matter of “public policy.”

Where this has gotten us is to the point where the “employee benefit” model has engulfed the whole arena of doctor/patient relationships. The sheer numbers of “covered” individuals, whether as workers or as their spouses and families, have overwhelmed the effect of “market forces” on healthcare costs and accountability. When there is a fairly well-guaranteed demand for something, regardless of its cost (they ain’t paying for it) or efficacy (if it doesn’t work, try something else as well) of that procedure, it will continue to be offered in spite of its dubious value (cf. the overuse of MRI, CAT, statins, etc.).

So now, just when one segment of private industry (chain drugstores, which have at least a peripheral interest in public wellness) is trying to encourage low-cost solutions for common maladies — catch them early, instead of after significant damage may been done to the person’s body, and charge accordingly for the diagnosis — now the “providers” from the orthodox “healing community” want to make sure it’s all getting “covered”!

The net effect is obvious: People with even minor ailments will now be “insulated” from even the minimal costs of keeping well, or of monitoring the little things before they grow into something serious. While the short-term good news might be a bigger reliance on such cheap clinics for diagnosis and treatment of simple illnesses (instead of glutting the ERs with their petty issues, or ignoring problems until they become critical), the fact that they’ll still be largely subsidized out of “insurance” — instead of operating on an out-of-pocket cash-basis — could easily offset their value in terms of the effects on healthcare cost-reform.

Once again, the analogy can be made to the automobile-insurance game: NOBODY gets car insurance to cover oil-changes, or even routine maintenance. (As this editor recently discovered, even a brake-job can’t be paid for, even under an extended maintenance contract. Compare this with “catastrophic health coverage” and you’ll still fall short of the reality.) Similarly, the cost of an annual physical exam (were it to be billed only at reasonable, no-overhead rates, with fair-market prices for the 5-10 minutes a physician or NP actually physically examines you?), or a routine visit to see if that scratchy throat is more than s brief attack of the “crud” … these should be considered just part of the “normal wear and tear” of having that physical bag of skin and bones to lug around in this lifetime!

Mark my words, this latest move by the large HMOs will not improve the situation, except insofar as it encourages more people to go to the clinics. Very soon, the basic cost of a visit will go up, as these establishments are forced to spend more time on paperwork, justifying to their third-party corporate benefactors the “actual costs” and validity of the last week’s spate of snifflers and sprained ankles. And before we know it, those little cheap “minute clinics” will just be another arm of the Leviathan healthcare state, instead of the good idea they began as.

Were I the paranoid sort, I might consider this an intentional move on the part of the very same AMA-driven, allopathic-only establishment that decried the drugstores’ idea in the first place – if you can’t squash the bug, you just tame and put a leash on it!

Your comments are most welcome.