Doc-in-a-Box

Marquel, TPVs NYTimes Doctor In A Box Section correspondent, was self-administering some recently-approved F.D.A. medication when he read In Ambitious Bid, Walmart Seeks Foothold in Primary Care Services. Wal-Mart is looking to grab a bigger share of the billions of health care dollars being spent in the United States and to benefit from the shifting delivery system that has resulted from the Affordable (Obama)Care Act. Everybody knows how Wal-Mart does business. All the associates sing the national anthem at the beginning of the day. The rest of the day they devote to selling items made by child labour in China with no governmental safety or health regulations to raise prices. It’s a successful strategy. Major mistakes might cause some returns of a one legged Barbie, perhaps, or a saw without teeth. But no big problem.

But Marquel wondered what people would do when medical procedures turned out to be sub standard. Everything at Wal-Mart is Chinese and cut rate. Surely Wal-Mart wasn’t planning on doing anything differently with a formula that had allowed it to shut out all competitors. So Marquel was left to worry. But not quietly. He went to Arkansas to talk with the Waltons, the owners.

I sat down with one of the Walton daughters. We discussed this plan to venture out into medicine.

“Our plans are long term,” she said. “Each Wal-Mart will be a complete medical facility, not one of those urgent care centers. Eventually, we will have one or more medical schools designed to supply us with our own physicians.”

“That’s planning on a big scale,” I remarked, “I wouldn’t expect less from Wal-Mart. Will the medical school be here in Arkansas? Will the average tuition be low enough that people on food stamps could afford it, as is true of all your products?”

“No the school will be in China where our other products come from.” She said.

“Do you mean in the same complex where those dust brushes are manufactured? And the hunting guns? And the bicycles with the sticky chains?” I questioned.

“Absolutely. Economies of scale. The ingredients go in, products packed in Styrofoam peanuts go out. It’s the Walton formula and it works. Students go in, three years later, they go out in boxes along with the other products to be distributed to our stores.”

“You’re going to ship doctors in boxes?” I asked.

“Beginning doctors. We’ve already perfected the boxes. You can remain safe inside for four days and saves geometrically over air fares.”

“What if something goes wrong?” I asked.

“All our merchandise is fully insured at cost value.” She smiled.

“What about the AMA?” I wondered, “have they voiced any concerns?”

“Not a peep. Not only will we have full medical facilities, but eventually every Wal-Mart will be a full hospital. And a Cancer Center. Other doctors will love to work with us.”

“Will they be associates?” I asked.

“If they are, they’ll get associate discounts, our people love that.” She said proudly.

“But these are doctors. They’re a high income demographic.” I said.

“No, not our doctors. They’ll earn what all our associates, our members, make.”

“How much is that?” I questioned.

“It varies by state. Minimum wage.”

“Do you really think that people will go to a minimum wage doctor?” I wondered.

“They go to a minimum wage department store. Do you know why?” She asked.

“Beats the hell out of me,” I said. “But if everything is so cut rate, even with your doctors in a box and famed efficiency, aren’t you afraid of your margins?”

“Not at all. They shop at Wal-Mart because they can’t afford anything else. That’s why they’ll check into our hospitals. And they’re on commission. If they refer a patient to a DVD or a stroller, or some tooth paste, they share in the sale.”

“The doctors are going to shill for Wal-Mart?” I asked.

“That’s part of the Wal-Mart philosophy, but we don’t call it shilling. It’s a referral, like to a surgeon, for instance.” She said.

“I still don’t understand why a doctor would work for so little.” I said.

“These are our doctors. They come from China. They’ve never made five dollars in their lives. They’ll be happy to boost Wal-Mart sales.” She said.

“But will they make qualified physicians?” I questioned.

“All our associates are qualified ” she said.

“But as doctors?” I asked.

“Well of course. And as sales associates from time to time.” She said.

“The doctors are going to sell stuff?” I asked.

“Of course. All our associates chip in. If someone is absent or we have a sudden rush, the associates come into the floor to help out.” She explained.

“But won’t a patient who just had a heart transplant be surprised to find her surgeon selling her a bathroom plunger?” I asked.

“We think it’ll be good for the physician patient relationship. In fact the whole store will be even more like a family. Imagine gramma having a cancer operation, you go into Wal-Mart to buy some toilet bowl blues, or some glass tumblers, or a new stereo. You turn to your kids and say, ‘why don’t we go up and see how gramma’s doing?’ “

“Yes that would be something,” I agreed.

“And if you tell the associate, he’ll save your place for a medical visit. You won’t find that at other medical centers.”

“No,” I said, “you won’t find fishing equipment, automotive supplies, tv’s, or hunting rifles at any other medical center.”

She was displeased. “I think” she said, “that you are being arbitrarily and unnecessarily cavalier about this. I know it seems like Brave New World right now, but I predict with great confidence that in twenty five years, the thought of going to the same location for a heart bypass, a hip replacement, chemotherapy, or dialysis, as for a box of cheerios, or a Disney toy, or a lawn umbrella, will seem as American as apple pie.”

I wasn’t worried about being unAmerican. I just think the future she treasured, mostly in her pocketbook, would be a sad day for a medical establishment that still takes first place in many areas. Wal-Mart will do nothing to maintain or improve that, even if they start the day with “The Star Spangled Banner.”

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BY MARQUEL: Doc-in-a-Box