Robert W. Morrow, M.D.
Are you ready for industrial medicine? Profit-driven chains looking to sell candy, cosmetics, and your personal healthcare?
Ready or not, the transformation of US healthcare is underway. Retail chains are ready to make policy and provide our health services. And they know the best legislators and regulators that money can buy.
Vaccine in the 21st Century
(The subtitle above is a nod to Thomas Piketty’s, “Capital in the 21st Century,” a long, but important book about the ongoing uneven distribution of income and wealth that I strongly recommend.)
A patient came to my office recently and asked for the new shingles vaccine. I reply, ‘well, the data is rather thin on it compared to two doses of the older vaccine without an adjuvant. The adjuvant—an extra chemical to amplify the immune response-has little track record, in spite of the fact that they’ve started a mass immunization advertising campaign with it.’
Effective or not, proven safe or not, I cannot get the “new shingles vaccine” stock to my office. But you can get the vaccine at a chain drug store. Seems it has only been shipped to the chains, and that’s the same way influenza vaccine is shipped—to the big chains first.
No surprise there. We live in a competitive market for pharmaceutical products these days in the US.
Although I have argued in previous posts that the weight of debt undertaken by the healthcare systems in the US would soon become insupportable, I seem to have underestimated that the world finance markets are awash in cash, That’s due to the growth of the financial sector at the detriment of the sector of those of us that work for a pay check. (Hence the reference to Piketty’s book.)
Who will buy the (discounted?) debt/bonds from the struggling health systems and commercial insurers? Yes, you heard about this… CVS, Walmart, JP Morgan Chase, Apple, Berkshire Hathaway, Google, and so on.
The creative disruption of health care in the near future involves pharmaceutical chains, IT, and finance capital. And yes, this has started.
The list of direct financial partnerships is plenty wild and presumptively is the tip of the finance capital iceberg. Current talk in this community is that commercial health insurers have no business justification or necessity in “value-based” health care services.
That includes sundry commercial sellers of governmental programs — think the privatization of Medicare Advantage plans and the Veterans’ Administration.
This crowd defines ‘value’ as cheaper and systematic, and big data driven. As an artisanal physician, this is chilling. Of course, as an independent family doc of 38 years, I cannot compete with venture/finance capital. And industrial-style health care has no tested proof of excellence, and does not have room for continuity care and real prevention, or professionalism and trust.
Big Data* – Big Money
We do have data, and the real world example of urgent care centers, the model for the future of US primary care.
Rotating providers, frequently in retail stores and themselves of unknown provenance, evaluate you, and then make referrals to telemedicine for specialists. No one has shown a benefit of this model of primary care. Research mostly shows higher costs, more amputations of diabetic feet [from the lack of continuity care), more expensive “shotgun tests,” and high bills that are unexpected, such as high facility fees.
Someone ultimately does pay for this low-cost, low-value ‘value.’ And for the shingles vaccine monopolized by CVS, Rite Aid, or whoever comes next.
But the vaccine is not available at my office. Even though I now use a big consignment company, which buys and bills for the vaccine.
Guess you now understand this snapshot of the future…commercial pharmacy chains and IT firms and telemedicine – all competing in the race for the bottom, and the capture of ‘attributed’ lives.
Dr. Bob gets the vaccine last if ever.
* Speaking of data, big data tends to be highly suspicious as a way to make individual decisions, largely because the data at the source needs to be curated before the math is applied. (May I recommend a spectacular book by a data academic Big Data, Little Data, No Data-Scholarship in the Networked World, by Christine L. Borgman.)