Wal-Mart Can Be Our Surprise Salvation: A two-part discussion of the retail giant’s health care potential

In America, we have 43 million  Americans without health insurance.

Ultimately, the political infighting about our health care crisis isn’t the point. The possibility of solving it is. I am as surprised as you might be to be believing that the best hope lies with Wal-Mart.

First, a few facts:

1. All the plans being considered address the needs of the  43 million uninsured, many of whom cannot afford to buy decent insurance.
2. The goal of all the plans is to change that, while people who are currently insured would be able to keep their insurance.
3. Big insurance companies would no longer be allowed to deny coverage to anyone based on pre-existing conditions. If any one of these bills is passed, anyone in America can buy coverage they can afford. In most of the plans, everyone will be required to have insurance, in order to spread the risk and make it more affordable across the board.
4. And in several, a public plan — administered, like Medicare, by the government — would compete with private insurance.

Sounds good, but the fly in the ointment is the government.

It’s no secret that it takes more people and more time to get anything done when the government is involved. Any new agency to administer this expanded health care is bound to be more expensive than anyone can imagine, or at least and less efficient than we dream possible.

Medicare and Medicaid are entrenched. But we don’t have to depend on the government’s performance for the proposed new level of insurance for those without coverage. Who, then, can we trust?

Do I believe in the public option?

I do. But I would like to see it delivered by Wal-Mart.

Why do I say this?

At the start of the Clinton administration. a comprehensive health care proposal failed to pass. However, big business was watching, and saw this as a way to create “managed care systems.” They believed that doctors were wasting money making decisions based on personal relationships with patients. Any money their “new” model saved, they knew, would be a windfall for their management teams — and very soon their public stockholders. Soon doctors were signing with these HMO organizations, because they were afraid that they might have no patients otherwise.

Time passed. The savings promised by big insurance companies went into their own coffers, not to patients or to those trained in healing the sick or preventing illness. The HMO model has morphed into dozens of acronyms that gave patients less choice for more money. The percentage of our GDP spent on healthcare continued to increase, in spite of the promise of the Holy Grail of managed care.

Big business in the health insurance sector has thrived. CEOs of major health insurance companies have become millionaires many times over. Fewer people could afford insurance and others were uninsurable because of pre-existing conditions, and the crisis continued.

So we don’t want to leave this to Aetna, or Wellpoint, or United Healthcare. Neither do we want a new government bureaucracy. How can we get the job done?

I think there should indeed be a public option, one that builds on Wal-mart’s success, and uses it to give quality care. Here’s my dream: One day, I wake up and hear this from the radio news: “Today, Wal-Mart announced a plan for creating a “Wal-mart Insurance and Care Program” to provide low-cost insurance for basic health care to the uninsured.” Wal-Mart could do this with speed and efficiency.

Consider that…

• Wal-Mart is already in the business of providing pharmacies, health care screening and emergency care on a limited basis, along with screening for diabetes, heart disease, back to school physicals for children and immunizations to people of all ages. They do this in a timely and cost-effective manner.
• Wal-Mart stores are within driving distance of the great majority of the population. If asked to reach out to cities to provide care, Walmart would meet with far less opposition than they have in the past. (Who’d join a STOP HEALTHCARE campaign?)
• Each community, under the umbrella of my Wal-Mart Insurance and Care (TM), could create jobs, using Federal stimulus money to train now-unemployed people to become community health workers, who’d visit the sick at home and provide some care for the ever increasing geriatric population. These programs could be created in concert with national goals for control of obesity, and the prevention of diabetes, heart disease, mental illness and the health consequences of bad life choices that cost all other citizens money.

I imagine wellness programs: Wal-Mart Make Americans Healthier (TM) could offer community forums for health education. and provide local opportunities for change and hope. Social isolation increases with job loss and shame. Community support can prevent this unrecognized cause of  depression and emotional paralysis that can sap the will from the chronically unemployed and underemployed.

My imagined Make Americans Healthier (TM) programs could offer community forums for health education and provide local opportunities for change and hope. It could create support groups for smoking cessation, depression, alcohol and drug abuse, along with a plan for intervention and referrals to specialists.

Ideally, the health care providers partnering with my Wal-Mart Insurance and Care (TM) would know well the behavior of the patients whom they were caring for, increasing treatment compliance and documenting that risk reduction on the part of the patient ultimately will lower their insurance premiums, reducing insurance costs.

Wal-Mart has had a bad reputation because it has a history of employing low-cost labor. It has also been rightly accused of  unfair competition with local businesses, who could not afford to provide goods as inexpensively as Wal-Mart. Still. many of those who have been opposed to Wal-Mart don’t live on incomes or in places where money for basics was always tight.

Besides, Wal-Mart has steadily demonstrated an increased willingness to be a good citizen, a good employer and a leader in the march toward a sustainability.

Our government has enough to do — with wars in Iraq and Afghanistan; the support of an economy that is frail and in and out of the ICU; the search for ways to end each month’s rise in unemployment, and the disaster of foreclosures and increasing poverty and homelessness. Funding the insurance program for the increasing number of uninsured is an urgent matter—a crisis.

We can’t wait for, nor do we need to wait for, the creation of a government insurance bureaucracy that will provide the insurance for the 43 million-and-increasing uninsured.

The creation of a Wal-Mart outreach program, managed by citizens, would be a great way to begin. Wal-Mart screening and disease prevention with standard health care delivery provided by insurance from Wal-Mart is a sensible alternative to creating and funding yet another government agency.

Wal-Mart could become the most respected company in America — by extending its commitment to those who have less, and by providing the model for basic 21st-century health insurance and care to those who have none. The federal government can then focus on the business of taking care of those things that its citizens cannot do for themselves. Sam Walton would be proud.

(Tomorrow: How Wal-Mart can actually help make America healthier while helping to provide Health Care.)