Do Americans want fee for service medicine?

There's an article on Salon.com about health kiosks in places like Walgreen's and Wal-Mart called "Wal-Mart can be good for your health!".

This is a hot topic in medicine as it gets into a number of hot topics

• Who will own these clinics? (doctors or industry)




• Who will staff & oversee these?




• What affect will this have on continuity of care?




• What affect will this have on the financial sustainability of medical practices when routine patient visits are siphoned off to these clinics?

One theme that jumps out at me, particularly when you read the reader comments section to the article, is that people are schizophrenic when they think about this (ie. Is medicine a business or nonprofit public utility?) and look at this from a completely different perspective than health care providers.

A number of complaints arise which basically boil down to that "the competition these clinics provide against doctor's office visits will be good and result in better service". This pretends that medicine is some true market economy rather then a corporate & federally-rigged game of Jenga. The winner of this "competition" gets the privledge of working much harder for much less money for much more aggrevation.

If you want to send a primary care doctor thru the roof, complain about having to pay a co-pay for and office visit and about not being able to be seen at a moment's notice. There's little understanding (or sympathy) for exactly how much our system is squeezing physicians to achieve savings in our health care system.

Particularly offensive to me is a Minnesota internet start up company I read about called CAROL, whose business model is essentially to try and turn medicine into Priceline.com

“We want to let consumers define value,” said Tony Miller, Carol’s founder and chief executive. “We don’t have care competition in the marketplace today.”The free site, which went live in January, generates revenue from health-care providers who become “tenants” on the site. When a consumer sets up an appointment with a clinic or doctor on Carol.com, the provider pays the site a fee.

Great! We were missing one more layer of capitalists strip mining the health care system.

Rob