The Wal-Martization of Health Care

Document Type

Article

Publication Date

12-2007

Journal Title

Journal of Legal Medicine

ISSN

0194-7648

DOI

10.1080/01947640701732155

Abstract

I am delighted to discuss retail medical clinics here at the Southern Illinois University School of Medicine. Ted LeBlang is a legendary figure in law and medicine, and I am honored to be the inaugural LeBlang lecturer.

It may not be obvious from my title, but I am here to talk about national health care reform. For several months, I have been having—as Yogi Berra might say—“feelings of déjà vu all over again.” I cut my teeth on health policy in the Clinton Administration in 1993, spending half a year in the thick of that health reform effort. We seem now to be back where we were in the early 1990s, for reasons I can understand but with fewer novel approaches to expanding health care access being discussed than I might like to see.

For example, this morning's USA Today contained an article entitled “States Consider Tobacco Tax Hikes.”Footnote1Why are states considering tobacco tax hikes? To fund universal health coverage, much as they (and the Clinton Administration) proposed in the early 1990s. It strikes me as challenging to fund major health insurance expansions from tobacco revenue, even if smoking generates health care costs. I teach my regulation and public policy students that, in general, you can only get one of two things from a tax. You can either get money or you can get behavior change. If you tax tobacco, you can either get people to stop smoking or you can get them to pay you money for the privilege of continuing to smoke. And the higher the tax, the less revenue it generates.

I have also noticed many articles in recent weeks about large employers supporting comprehensive approaches to national health coverage. That reminds me again of the early 1990s, when large employers championed a combination of HMO-based care and cooperative public purchasing called “managed competition.” Remembering the health reform debacle 15 years ago, the fact that current conditions seem oddly familiar does not bode particularly well. Are there things that are different? That might make health reform more achievable? To begin to answer this question, I chose retail medical clinics—what, for lack of a better term, one can call the “Wal-Martization of health care”—as my subject for a lecture on health law and public policy.

First Page

503

Last Page

519

Num Pages

17

Volume Number

28

Issue Number

4

Publisher

Taylor & Francis

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