The magic of the marketplace, the invisible hand of the market, and the intrinsic joy of capitalism, are all in disrepute for a moment or two, while we flush all those toxic assets into a government river, far, far away.
But if there is one market segment, one important piece of the pie, that still revels in the notion that we all wake up in the morning, consumed by greed and prepared to make our fortune (while inadvertently helping each other), it is health care.
Yes, yes, it is (to use the formal economic language) “icky” to categorize health care as just another consumer service, just another product on the shelves, but we really can’t help ourselves.
Even with Medicare and Medicaid propping up and distorting the health care marketplace; even with hospitals bludgeoned into caring for the uninsured; even with community health centers that beg for government money and then sort of, kind of, usually provide health care when you walk in the door; at the end of the day, those docs and medical facilities and all of us sickly consumers are in a marvelous market mess.
Where better to find the medical market at work than in metro Boston, with one out of every three big buildings devoted to internationally known palaces devoted to health care treatment and research?
What has popped up, in a money-mad, convenient, nutty Boston market sort of way? Those in-store medical clinics at CVS or Walgreens. While the major medical practices got a bit huffy about the clinics, the market screamed out for them. Got a rash that requires, oh, a little tube of stuff to rub on it to make it go away? Don’t go to your expensive doctor; don’t sit around a big-hospital emergency room for three hours. Pop into CVS and see the nice MinuteClinic boy and girls.
And while you’re there, roam the CVS aisles buying paper plates and tooth brushes and stuff. Go, you marketplace! Cure the ill and make money and all that good stuff.
To the medical grumps, the public criticism of these kinds of clinics is that the unsuspecting patients will get “fragmented” care, rather than the loving, precise, coherent care they would get if they went to their very own private doctor.
The whispered criticism is that maybe, just maybe, triage will be performed on you by a nurse practitioner, who will miss the diagnosis of Rocky Mountain Spotted Fever and send you to the line for adolescent earaches.
Good Enough
That’s a good research question for the academic docs and the medical journals and the health insurers and, of course the trial lawyers to hash out. But as a matter of philosophy, the question does get to the very heart of the debate about what constitutes a medical marketplace.
Are we comfortable with such a thing as mediocre health care, or, are we still in that dreamy place where every American is entitled to the very best health care that money can provide?
If it is truly a marketplace, then mediocre health care and mediocre health insurance are right there fighting for consumers, along side the mediocre cars and mediocre houses and all-you-can-eat Chinese buffets.
Last year, when Massachusetts hospitals were scolded for turning away ambulances when the emergency rooms were “overcrowded,” we were all quite proud of our compassionate selves – but at the heart of the matter, there are only two ways to (dare we say the word out loud?) ration health care: charge so much that some people can’t afford it; or make people stand in long lines to get a mediocre version of it.
The allure of the drugstore clinic is that, for modest ailments, at a modest price, it mimics what would happen to you if you walked into Mass. General, clutching your gold-plated insurance card to your bosom.
Early in February, a deer walked into a PetSmart pet shop in Rossford, Ohio, with an injured hind leg. This pet store had a clinic. The staff held the deer down, fixed the wound, and sent it back out the door. Now, all the deer know. You don’t have to go to Cleveland Clinic when times are tough.â–
