As we move towards Wal-Medicine, will the providers follow?
Yes of course – the providers will follow, and something will be rendered to the customer. By all accounts, American Retail Public Medicine will approach the American Public School System by the end of the decade in quality, reliability and desirability of product. Whether or not that is the goal, that is most certainly the outcome.
If you look at the history of American Public Healthcare over the last dozen years, there has been an increasing fragmentation and bureaucratization – which coincided with soaring costs, and may have caused the soaring costs. The mess that we have now is a consequence of ignorant and misdirected “reform,” not the starting point. This mess has largely been made by committee.
The difference between customers and patients is that many patients are not savvy customers. About half the population are children; many persons are elderly; only a small percentage are able to aggressively seek “client care.” Most of the discussions presume that these are the target demographic; the others are invisible. In that case, straight fee-for-service serves the vocal niche consumers; the others fall by the wayside. That’s hardly progress.
In many Third-World countries, the target consumer market is VERY well serviced by their concierge physicians and clinics; and if the problem is more serious, they fly off to an international medical center. The target market is always going to do well, thanks.
Look at the story of the VA’s. It’s merely evolutionary pressure in favor of the savvy. The with-it veteran knows how to make the bureaucracy jump and perform; the one who has dementia or other limitations, doesn’t.
The regulatory hand, in demanding equitable service, will increase the density and complexity of rules until there is No Patient Left Behind. It was decided perhaps a dozen years ago that the Personal Physician model was not cost-effective, except for those for whom money is no object. Ask your personal physician if (s)he agrees – do you have one? Now that retail public medicine is booming, physicians will become like bespoke tailors, yes, they are out there, but not for you. If you want a gorgeous $25,000 suit, you can still get one handmade in the US. You still have choices.
People who play with systems not understanding their complexity get bit. It is hubris – a common human condition. The builders of the unsinkable Titanic caught the butt end of the whip on this one. The Titanic was massive – the iceberg, even more so. We can laugh at icebergs all we want; they are not easily offended.

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