Wal-Mart announced Thursday that it will begin rolling out a generic drugs discount strategy for its pharmacies, whose revenues have stagnated in recent years. This development merits close scrutiny. Last year, the retail giant began offering clinic services for routine health care at selected stores.
Is this the coming face of health care for millions of un- and under-insured Americans? Drugs as a loss-leader to attract "customers" to second class care?
The employer-based health care system is unraveling. Virtually all Americans (all but the very well-to-do) are experienced higher co-pays, higher out-of-check premiums to make up for what their employers no longer cover, and higher deductibles when large bills (like a hospital stay) hit. Within a few years, if current trends continue, a large fraction of the American people will have nothing but a catastrophic health care plan from their employers.
This, of course, is where the Bush administration and economic conservatives would like to see health care go. In their view, making people pay for first-dollar coverage will create "market discipline." Once health care consumers (don't use the word patients; that's so 20th century) have skin in the game, their informed choices as to what they "really" need will finally bring health care spending and prices under control.
This will be a disaster for public health. For low- and moderate-income people living under already constrained household budgets, the first things eliminated would be routine check-ups and preventive care. The long-term effect would be a further downward slide in the health of the American people, which already ranks in the second tier of OECD nations.
Wal-Mart sees a market opportunity in this evolving mess. There's good money to be made from the bottom half of the population's mad scramble to gain access to health care.
People who want to create a decent health care system for all in this country will be faced with a conundrum if they oppose, because of its inequities and its impact on overall national health, these entrepreneurial efforts to deliver routine health care services to people at affordable prices. It will be a repeat of the argument over Wal-Mart's low wages and benefits for its employees, where conservatives point out ad nauseum that the lower prices enjoyed by Wal-Mart shoppers are a far greater benefit for low- and moderate-income people than the higher wages that might go to its workers.
In health care, the same line of logic will argue that low-priced and easily accessible health care -- no matter what the quality -- is better than no health care at all. In a world where many people have no other options, Democrats need to offer more than platitudes about universal coverage if they're going to successfully counter their arguments.