Introducing the Walmart Clinic

[medicinesux]

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http://blogs.wsj.com/health/2008/02/19/early-adopters-warm-to-retail-clinics-but-publics-still-cool/

"The clinics are typically staffed by nurse practitioners or physicians assistants"

"Wal-Mart said it would be opening its own brand of retail clinics — and that they'd be affiliated with local hospitals and health systems."

"Wal-Mart says it plans to open 400 clinics by 2010 under the truth-in-advertising brand name "The Clinic at Wal-Mart."

 

[DiveMD]

This is the beginning of the end of primary care as we know it. Yet another tragic side effect of a health care system driven by profit, not prevention.

Don't forget to grab a pizza slice, x-box game and condoms after you're done with your physician extender...👎thumbdown👎barf:

 

[AwesomO]

You should read the MSN message board it's funny as hell.

Plus I will just get charged for the office visit as opposed to the Dr's office and all the rest of the costs that go with it ..........like the rent on his building which is why some charge so much just for a 15min. office visit, and he has to pay the staff,electric,water, and yes one Dr. said once he had to make the payments for my law suits,sports car, and fancy home that is why he need to charge so much for an office visit which I thought was just wrong. In other countries Dr.'s get in the business to help people not to get Rich.
This is what the medical schools of America should be teaching the new students that they will not get rich becoming a Dr.'s and if they are in it for the money they should seek another profession this would stop all the high costs of Dr. visits because it would weed out all the bad ones and keep only the serious ones who really do care.

Nice attempt by Wal Mart to cash in though. Offering to charge people a "reasonable fee" for something that would probably get better on it's own anyway while not taking care of any chronic conditions. Then shipping off any serious condition to a real doctors office or hospital.

I'm sure this also can't be good for trying to taper down the amount of antibiotics given. In Wal Mart's attempt to make the customer happy they will "encourage" their providers to give scripts often even when not needed.

If nothing else encouraging hordes of influenza patients to flock to a store with hundreds of people inside will lead to loads of fun.
Looks like I'll be doing my shopping at Kroger and Whole Foods from here on out.

 

[PeepshowJohnny]

This is why you've got to be crazy to go into primary care these days. People will gladly go to an NP (Nurse's are the most trusted profession, after all!) or a PA and pay them, because god forbid their money go to a filthy, money grubbing DOCTOR.

 

[medicinesux]

gotta love the NP chick wearing the white coat in the pic😀 She is so fine I've decided to make her my new avatar for the time being!

this is yet further proof that primary care salaries will continue to go nowhere in the next decade. Let's do the math here: hire some NP for 40 an hour; have her see three patients an hour: 3x40= 120, so walmart profit 120-40= 80 an hour. Whereas, paying a board certified physician 75 an hour would only yield 45 an hour of profit. So as somebody already mentioned, Walmart now gets to skim off what should be the physician's fair take. Plus, Walmart doesn't have to pay for office space since they already own the space! How can a physician compete? Now, in addition to HMO's, US Govt, shark lawyers, malpractice insurers and allied professionals cutting into our pay now we have big time corporates like walmart jumping on ship. 👎 Primary care is totally doomed:

(Photo courtesy of neoarcana1 of Flickr)
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[DadofDr2B]

http://blogs.wsj.com/health/2008/02/19/early-adopters-warm-to-retail-clinics-but-publics-still-cool/

"The clinics are typically staffed by nurse practitioners or physicians assistants"

"Wal-Mart said it would be opening its own brand of retail clinics — and that they’d be affiliated with local hospitals and health systems."

"Wal-Mart says it plans to open 400 clinics by 2010 under the truth-in-advertising brand name “The Clinic at Wal-Mart.”

Is practicing medicine without a license allowable? What will Wal mart do with the malpractice lawsuits that will include them as defendants? After all who has deeper pockets than Walmart. I will bet that John Edwards will have the time now to devote to malpractice suits and class action suits against Walmart. Check the following site and cut out the insurance companies.

www.Simplecare.com

 

[yippyskippy]

They will have a license... I am pretty sure it will be operated like any other private clinic, and I am guessing it will mostly be "urgent care". While it seems like a pretty bad idea to leave health in the hands of Wal-mart, my hope is that it keeps the people who are complaining of 4 days of a URI, or 1 episode of nausea and vomiting, out of the ED! Because runny noses definitely do not require an MD!

 

[mig26x]

and thats why I decided to apply for fellowship. Im an IM intern.

 

[Faebinder]

They will have a license... I am pretty sure it will be operated like any other private clinic, and I am guessing it will mostly be "urgent care". While it seems like a pretty bad idea to leave health in the hands of Wal-mart, my hope is that it keeps the people who are complaining of 4 days of a URI, or 1 episode of nausea and vomiting, out of the ED! Because runny noses definitely do not require an MD!

Ya, until they find out that the runny nose is caused by a lymphoma... oh but there will be so few cases like that that walmart will easily tank the bullet.

 

[tetris]

NPs and PAs only??? I thought these "outfits" would have 1 MD on staff too.

 

[Rasengan]

I still dont get it, do the NP's have malpractice insurance or what? They are unsupervised as far as I can tell which means they bear the full brunt of malpractice, correct?

I dont think this is the end of primary care, because this will pretty much end up being a URI clinic. But I do worry about antibiotic resistance from overzealous NPs giving augmentin to everyone that coughs.

 

[mig26x]

I still dont get it, do the NP's have malpractice insurance or what? They are unsupervised as far as I can tell which means they bear the full brunt of malpractice, correct?

I dont think this is the end of primary care, because this will pretty much end up being a URI clinic. But I do worry about antibiotic resistance from overzealous NPs giving augmentin to everyone that coughs.

I do think this is the beginning of the end for PCP as NP's and PA's have made it clear that they want to be primary care "physicians" and they are winning the battle.

 

[yippyskippy]

Can an NP prescribe augmentin? I did think they needed an MD co-signature.

 

[Faebinder]

Can an NP prescribe augmentin? I did think they needed an MD co-signature.

FRESH MEAT!!!!

 

[core0]

Can an NP prescribe augmentin? I did think they needed an MD co-signature.

They can prescribe Amoxicillin but they need a co-signature for Clavulanic Acid.

 

[JiminyCricket]

It is time to strike! Let's see how well NP's, PA's and Walmart do then.

This is such b.s.....the govt should just pay my loans off and i'll quit.

 

[DebDynamite]

It is time to strike! Let's see how well NP's, PA's and Walmart do then.

This is such b.s.....the govt should just pay my loans off and i'll quit.

Maybe this is an opportunity for us to make some dinero. Think of the most confusing medical scenario you can present to a Wal Mart mid -level and how you can sue WM for their missed diagnosis. I get so mad about this stuff, I wish I could be that dishonest.

 

[DebDynamite]

FRESH MEAT!!!!

Oh my.

Actually the prescribing laws for mid-levels do vary from state to state. We have a vast population of patients in my area strung out on benzos and lortab thanks to their NP's. When we see the patient's PCP listed we already know why they are in the clinic. Their fix.

 

[OBandWifey]

Maybe this is an opportunity for us to make some dinero. Think of the most confusing medical scenario you can present to a Wal Mart mid -level and how you can sue WM for their missed diagnosis. I get so mad about this stuff, I wish I could be that dishonest.

Hmmm sounds like a great idea. I dont' know if this is going to last that long. Just like the fast food places in wal-mart didn't last that long...some of them still have them but alot of them have closed. you see what happened when McDonalds tried to sell tacos...just stick with what you know.

 

[DebDynamite]

Hmmm sounds like a great idea. I dont' know if this is going to last that long. Just like the fast food places in wal-mart didn't last that long...some of them still have them but alot of them have closed. you see what happened when McDonalds tried to sell tacos...just stick with what you know.

Seriously I can think of some psych scenarios that I could saunter in and throw their way tomorrow, and I swear I could be calling a trail attorney the next day. Man I wish I was that unethical. I'm just too dumb and naive to do it...but you know since I'm on a medicine sub I right now, maybe in another week or so I'll getthe nerve.

 

[DebDynamite]

Well, now I have a justification for my future WM law-suit... I can prevent a real law suit from something like, say cauda equina syndrome from happening....prevention, that's it.

 

[JiminyCricket]

Maybe this is an opportunity for us to make some dinero. Think of the most confusing medical scenario you can present to a Wal Mart mid -level and how you can sue WM for their missed diagnosis. I get so mad about this stuff, I wish I could be that dishonest.

Or maybe we could just start by staging multiple slip and fall accidents to jab Walmart in the ribs a little...haha.

But seriously, FP and GP's are barely making 150k as is, this is going to HURT their bottomline. What will happen is Walmart will start staffing these clinics with MD's by sponsoring J1 visas and soon we are going to be in retail stores like pharmacists.

If I had only been smart and gone to Dental school!

 

[DiveMD]

I still dont get it, do the NP's have malpractice insurance or what? They are unsupervised as far as I can tell which means they bear the full brunt of malpractice, correct?

Wal-Mart will have associations with local private medical groups that will provide the MD "oversight". These "supervising" MD's will not present at the clinic but will be "available" for phone consultations.

The military have been doing the same thing for years with NP's, PA's and Independent Duty Corpsmen (NAVY). They work alone in some remote clinic with "MD supervision" located miles away from the actual patient care.

 

[medicinesux]

"I am currently a nurse practiotioner employed by one of the retail clinics. I want to assure the public that we are highly trained and far exceed 2 years of training to prepare us to provide patient care. We have very well deliniated plans and scopes of care, and are well-qualified to provide medical care above and beyond what is provided in the retail setting."

-from the comments section of the above linked article

Yikes....2 years of training and you are "highly trained"? Let's see... on the traditional physician track that puts you at the end of MS II year. How many of you were/will be ready to run a clinic after just passing USMLE Step 1? You still have another 5 years to go at this point! But have no fear...this nurse practiotioner has very deliniated plans...of care!
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[fun8stuff]

http://blogs.wsj.com/health/2008/02/19/early-adopters-warm-to-retail-clinics-but-publics-still-cool/

"The clinics are typically staffed by nurse practitioners or physicians assistants"

"Wal-Mart said it would be opening its own brand of retail clinics — and that they’d be affiliated with local hospitals and health systems."

"Wal-Mart says it plans to open 400 clinics by 2010 under the truth-in-advertising brand name “The Clinic at Wal-Mart.”

at the CVS in the office building where my wife works they already have a PA on hand for urgent care stuff.. when i was there a couple weeks ago, he must have been new because he was telling the pharmacist about his "prestigious training" ... exact words i overheard

 

[tr]

http://blogs.wsj.com/health/2008/02/19/early-adopters-warm-to-retail-clinics-but-publics-still-cool/

Here's an interesting perspective on this issue:

http://www.salon.com/mwt/feature/2008/02/19/retail_health_clinics/index.html

It's not necessarily a bad thing for MDs. Anything that gets some of the viral URIs out of the ED is a good thing by me.

 

[AwesomO]

I've never had an issue with the quality of mid levels working the clinics. My issue is that if you are going to practice medicine you better be able to provide a full range of services in your field or just not practice at all. If you are going to see a patient for his sniffles you better be able to address his HTN, HL, and DM while your at it. And by address it I don't mean run a few labs and then send him to a real doctor's office when it gets hairy. According to one of those links they will not even treat Asthma. WTH are they going to do in the winter time when the clinic is flooded with kids having asthma exacerbations? Are they going to give mom her money back when they ship the kid off to the ER?

 

[Rasengan]

Here's an interesting perspective on this issue:

http://www.salon.com/mwt/feature/2008/02/19/retail_health_clinics/index.html

It's not necessarily a bad thing for MDs. Anything that gets some of the viral URIs out of the ED is a good thing by me.

Problem is, what if its not a viral URI? What if its a postobstructive pneumonia in a smoker or severe GERD in a baby?

2 years of training, as has been pointed out, was just enough prep for our Step I's... yet you're basically asking people with that level of training to make calls that doctors dont make for another 3 years after that. And that doesnt even include the relative competitive difference between the fields.

 

[deleted4401]

Let the market and evidence sort this out. If these practitioners are as awful as everyone says they are, then a few landmark misdiagnoses, mistreatments, and other screw-ups will bloat their liability and their public image. Then, some aspiring public health students and other academics can do their prospective studies and see how awful the health care is and how much more expensive and less efficient it is to hire NPs/PAs.

I have a feeling that these studies won't really show that, though. In fact ... gasp ... what if they offer improved access, cheaper care, and equitable outcomes?

People keep saying, "What if they miss this or what if they miss that?" ... Family practice docs get three years of training and basically are allowed to see/treat kids, see/treat adults, perform certain surgeries (c-sections, endoscopy) that other people have to train for far more time to do. There isn't any data coming out to say these docs are performing so poorly compared to their more well-trained peers. If there is, the specialists certainly aren't marketing it well.

Frankly, the easy stuff is ... well ... easy. Yes, 5% of it is tricky/challenging. The good NPs/PAs will have the good sense to refer to a physician or specialist when they need to. The bad ones will screw up a lot and weed themselves out, because of liability concerns.

Really though, if I was a PCP, and I had to compete with these Minute Clinics, I would not be livid about the fact they are allowed to compete with me. Bring them on. If they do a great job, then I just wasted a whole lot of time in training.

I'd focus more on what I could do to make myself more marketable and more appealing to go to. I'd want to either improve my product or re-package it. Maybe that involves more efficient payment systems, concierge type care, aesthetic services, longer office visits, a cleaner office, email/telemedicine, easy walk-in appointments, etc. I don't know. I just don't think that I can treat a URI better than a nurse can, really.

S

 

[buffdoc]

I don't see what the big deal is.

Since I currently don't have insurance, I started checking around to see if there were any of these Walmart clinics in my area in case I had to take one of my kids in for some meds.

When I did have insurance, I wouldn't have even considered it and would have just made an appt with my PCP.

The people who will be going to these clinics will chose to do so because they don't have insurance. It's not like PCPs and ER docs want these people, so why not let Walmart take care of them?

 

[group_theory]

A couple of missed DKA or rhabdo, followed by lawsuits, will have major chains think twice about their liability exposure.

Patients don't walk around going "I think I'm in DKA" ... they'll probably show up at the Minute Clinic going "I think I have the flu". Not all the midlevels will miss it, but it just takes one or two.

And think about it, what type of midlevels will want to work at walmart? The ones with extensive experience prior to PA school or NP school, the ones with tons of healthcare experiences already as a midlevel, or the ones who have little healthcare experience besides schools (aka direct-entry NP school) and can't get decent high-paying jobs due to inexperience?

 

[Taurus]

From what I have read, the Wal-Mart's and Rite-Aid's are protecting themselves from potential litigation by limiting the scope of practice of the midlevels working there. They will accept something like 33 straight-forward medical conditions. For each case, there is a template that the midlevel has to follow step-by-step. These templates no doubt would be have been reviewed and approved by some physicians that consult for these companies. It's very cookie cutter-like. If patients and their lawyers can sue a huge company like Wal-Mart which can more easily pay out millions in damages than any physician, you know they will so at the drop of the hat. These companies are trying to protect their hide as much as possible.

I am of the opinion that these clinics aren't bad for physicians overall. If the public starts to associate limited, simple care to midlevels and comprehensive, advanced care to physicians, that's a big PR win for physicians.

 

[mig26x]

the problem is that they are going to start with these 33 very easy dx to tx and by 3-4 years they are going to be asking to do more stuff etc etc.

Its just a matter of time.

 

[Taurus]

the problem is that they are going to start with these 33 very easy dx to tx and by 3-4 years they are going to be asking to do more stuff etc etc.

Its just a matter of time.

That's why every physician, resident, and med student in this country needs to be aware of these issues. Read the Mundinger article that is linked in my signature. The nurses not only want to try to take over primary care, but they also have the specialties in their sights. They're trying to twist Congress' arm into letting them enter residencies, and if that doesn't work then divert medical residency money into starting nursing residencies.

Being complacent is what will hurt the medical profession most in the long run.

 

[Rasengan]

If WalMart is allowed to have these clinics that will profit from the "easy" cases, then that completely ruins the argument people have against physician-owned hospitals (such as surgery centers). The argument there has been they only provide a specialized service taking profit from full-fledged hospitals and leaving those institutions with the less profitable surgeries or patients who cannot pay.

So in a sense, as much as this could hurt primary care doctors, it could help specialists with maintaining control of their physician-owned hospitals and imaging centers.

 

[Blade28]

As this issue more broadly pertains to Healthcare and less with residency, I'm moving it to Topics in Healthcare.

 

[kronickm]

Yeah I guess I don't really understand all the beef. These clinics are absolutely gonna have to limit who they take. There is no way in hell that Wal-mart is going to put themselves at a high risk for major liability suits. Basically I am imagining an urgent care clinic. In that case, great. People are always bitching about how everyone is dropping in the ER with a cold, have them go to wal-mart instead. I agree it might hurt the primary care docs' bottom line, but I thought nobody wanted to go into primary care anyways, and there was a major shortage? Hell, the primary care docs I know see tons of patients already, and would probably like having them just go to wal-mart when they have a URI, much like those in the ER. I mean it takes 3 months to get an appointment with your primary care doc, obviously a lack of patients isn't the sole reason they are underpaid.

As for the midlevels, doctors cannot have their cake and eat it too. If no one is going into primary care, because you would have to work harder and get paid less then a specialist, you cannot expect mid-levels not to capitalize on such a shortage. As for them getting into residencies, that is going to happen about as soon as these Wal-mart clinics have to abide by EMTALA.

 

[Trismegistus4]

That's why every physician, resident, and med student in this country needs to be aware of these issues. Read the Mundinger article that is linked in my signature.

Holy crap, that article is awful! The worst sentence:

In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional.

LOL! So DNPs are actually BETTER than doctors? They have ALL the knowledge doctors have, PLUS skills that doctors don't have?

This is an outrage. But I have to say, the medical profession asked for this by intentionally transforming itself over the past 30 years to be more "nice." Medical schools began admitting large numbers of women, selecting for all these left-wing "social justice" types who want to save the world... The older, tough-minded generation of docs, so often derided today as "dinosaurs," never would have let this happen.

 

[ExcelBillSrvc]

As a Full Practice Management Consultant, I am willing to bet that this will not work. Walmart traditionally allows for open spaces. Allowing for anyone to look in and see what is going on that includes the optical department. If the optical department is any indication how Walmart views privacy and HIPAA, this so called venture of theirs is doomed before it even begins.

Let's face it, Walmart has how many people that walk in and out of it's doors daily? Anywhere from 10-300 at any given hour. How do they plan on keeping the patient's privacy with an open door policy where everyone can walk in without doors or windows keeping the patient's private? Simply they can't.

Next item on the list, lets discuss patient records. How do they plan on keeping them secured, what about software, record management, EMR still has to be authorized and signed. It is a violation to use a MD's number if he is not present and has no knowledge of the patient in question. Walmart will have to have one physician on duty to co-sign for medications and treatment plans if needed. They can not just use PA's and Nurse practitioners, it is not possible for them to operate. Even if they ran it as an urgent care center, they would still need to have a physician on duty to check on a patients with special needs/circumstances.

Certainly Walmart can not use the current speaker system in the clinic area. It is medical practitioners responsibility to pay attention to his/her patient. That would be very hard to do with someone saying: Attention Walmart shoppers, we would like to...." every few moments.

Let's also address where the clinic staff would have a room to have discussions regarding Ms. Jones treatment where the rest of Walmart does not hear them, let alone the patients in the waiting room. To insure HIPAA Rules and Regulations are followed, it is all about security.

They will be hard pressed to enforce privacy with open areas where anyone can walk in any time they choose.

Next let's discuss blood and pathogen's. How do they propose to keep it from being on their floors of the main doors where people walk in and keep it contained where it can be cleaned. Will they have trained personnel do it or will they make some clerk do it? Then once the patient is finally inside the clinic, after he has bleed over the floors. Now there is blood in the clinic and someone has to stop to clean that up to. Then you have to wonder how long until treatment will be given?

Even after the patient is treated, what if he is to weak to leave on his own. Will the staff have supplies on hand to keep the patient alive until an ambulance shows up? Under clinic guidelines with no doctor on board, they can not give narcotics or strong medication without a doctors ok. It takes time to make those phone calls and get verification to allow that.

It is all about preparation, and with Walmart saying it will only be nurse practitioners and PA's..they are not thinking about the whole picture. They will need to reevaluate very throughly what they are proposing. They are opening themselves up to a big law suit and they have not even started yet.

 

[asuhdds]

HECK YES, FREE MARKET IN ACTION!

Strike another blow for UHC and a win for free market-based solutions in healthcare!

Pay attention, all you free market critics. That the white-collars and wealthy self-satisfyingly get the best in healthcare doesn't mean the parasitic lazy proletariats can't get a piece of that healthcare pie. These Walmart Triage's are the free market answer to the lower-ranks of society! Sure, the lack of doctors may mean a reduction in healthcare quality, but they get what they pay for. At any rate, if the parasites have a problem, all they need to do is just pull themselves up from their bootstraps. After all, human lives ARE a market adjustment.

Ayn Rand would be proud.

 

[MaximusD]

HECK YES, FREE MARKET IN ACTION!

Strike another blow for UHC and a win for free market-based solutions in healthcare!

Pay attention, all you free market critics. That the white-collars and wealthy self-satisfyingly get the best in healthcare doesn't mean the parasitic lazy proletariats can't get a piece of that healthcare pie. These Walmart Triage's are the free market answer to the lower-ranks of society! Sure, the lack of doctors may mean a reduction in healthcare quality, but they get what they pay for. At any rate, if the parasites have a problem, all they need to do is just pull themselves up from their bootstraps. After all, human lives ARE a market adjustment.

Ayn Rand would be proud.

I'm not sure if you're being sarcastic or if you're an idiot.

 

[BME103]

Don't be so insecure! Nurses are taking over because frankly, the medical profession is screwing medical students over by requiring at least 7 years of training. Nurses can do the same thing with less pay and less whinning.

 

[asuhdds]

I'm not sure if you're being sarcastic or if you're an idiot.

Really now, was it that highbrow?

On second thought, considering the dominant presence of a certain philosophy on these forums, I guess I can't blame you.

 

[AwesomO]

HECK YES, FREE MARKET IN ACTION!

Strike another blow for UHC and a win for free market-based solutions in healthcare!

Pay attention, all you free market critics. That the white-collars and wealthy self-satisfyingly get the best in healthcare doesn't mean the parasitic lazy proletariats can't get a piece of that healthcare pie. These Walmart Triage's are the free market answer to the lower-ranks of society! Sure, the lack of doctors may mean a reduction in healthcare quality, but they get what they pay for. At any rate, if the parasites have a problem, all they need to do is just pull themselves up from their bootstraps. After all, human lives ARE a market adjustment.

Ayn Rand would be proud.

It actually cost less to see a physician by paying cash then it is to go to a wal mart clinic. Take for instance this innovative clinic in Tennessee http://www.patmosemergiclinic.com/Fees.html.
Pretty much anything seen in a Wal Mart clinic will be classified as a very simple visit which would cost $30. This is half the price of a Wal Mart visit. Even if you tack on say a strep test (cost of $10) the patient would still be saving $20. This with the added bonus of seeing a skilled physician.
His story is rather interesting. The majority of his patients are uninsured. He's able to keep his prices low because he does not accept medicare or other insurance so he doesn't have to pay for the overhead associated with it. He passes on the savings to his patients.
As Dr Berry puts it himself

[FONT=Verdana, Arial, Helvetica, sans-serif]we don't receive any taxpayers' funds either directly as subsidies or indirectly as a tax-exempt corporation. It is similar to boutique clinics such as Dr. Kaminetsky's in that it contracts directly with its patients – except that most of our patients don't have insurance..

[FONT=Verdana, Arial, Helvetica, sans-serif]The prices for medical services at our clinic are really quite reasonable. $35 for a sore throat. $95 for a simple laceration. I can keep my fees this low – and thus affordable to the uninsured and patients with high deductibles – because I avoid the crushing overhead and hassles of processing relatively small medical claims – a service from which they clearly do not benefit..

This is what we need in medicine people willing to adjust their practice models to benefit their patients. Unfortunately their achievements go largely unnoticed because it's not exciting. Uninsured getting treatments at affordable rates? Boring! But hey lady dies from PE on plain? Lets plaster that sucker all over the place!

[FONT=Verdana, Arial, Helvetica, sans-serif]In Canada, the median time from a mammogram to a mastectomy is 14 weeks. Personally, I don't think I could look a woman in the eye, inform her that her mammogram was suspicious for cancer, and then have to tell her that the cancer might have spread before she can receive treatment. Of course, in Canada, I wouldn't be put to that task because clinics such as mine are currently illegal there.

.[FONT=Verdana, Arial, Helvetica, sans-serif]The issue before you now, it appears, is very simple – "who will control healthcare dollars?"
.

[FONT=Verdana, Arial, Helvetica, sans-serif]The government? No – medical decisions are much to complex and personal to entrust to distant bureaucrats, many of whom lack basic medical knowledge.
.

[FONT=Verdana, Arial, Helvetica, sans-serif]How about patients, then? In my opinion, the most cost-effective and humane solution to many of our healthcare problems is to allow ordinary Americans to manage their own routine medical care by giving them control over healthcare dollars. They can do this now with pre-tax, tax-deferred personal and family medical accounts within consumer driven health plans and spend them at clinics like ours..

Nicely put by a man out there actually practicing solutions. If we can bring quality primary care to all we will be able to drive down costs by keeping people out of the hospital. For those who do wind up there obviously paying out of pocket is not going to work. As I've said in another thread Obama's plan would work nicely in such a case.

 

[tibor75]

this is great news.

The fact is that doctors are in short supply and are overworked. They are overworked in part from patients coming in complaining of stupid things like the common cold and back pain. Any average NP should be able to diagnose a cold.