When people look at the US healthcare system, they imagine that private healthcare has to be hugely expensive. But the reason it's expensive is because it's hugely over-regulated. Tax and regulatory rules promote insurance through employers – reducing individual choice and meaning you lose your insurance when you change jobs. You can't buy insurance across state lines – live in New York and you have to have a Rolls-Royce insurance plan of the kind New York specifies: you can't buy a SmartCar plan, even if that suits you better.
And of course a rising part of the US healthcare system is the federal Medicare and Medicaid plans - bigger than the UK National Health Service, and growing fast:, according to the CBO, Medicaid and Medicare alone will absorb 20% of GDP in 70 years' time.
There are some proposals to open up the insurance market: a standard personal tax deduction rather than favouring employer-based plans, allowing choice across state lines, and so on. But there are promising new alternatives too. Pioneered by drugstore chains CVS, Target and Walgreens, more than 1500 retail health clinics are now in operation, up from 800 last year. Wal-Mart plans to open another 400 by 2010.
Wal-Mart will lease space in their supermarkets for drop-in clinics run by local hospital and other providers. Nurse practitioners will staff them, and they will be open seven days and evenings each week. They will provide basic services and will refer more serious cases to doctors and hospitals. Prices will be typically in the $40-$65 region.
People will be able to get quick, cheap, convenient diagnostics, even if uninsured (about half of Wal-Mart clinics' patients are uninsured). That will break the physicians' monopoly, which will have very positive effects on driving down US healthcare costs more generally. I only hope that the Wal-Mart clinics come quickly – before the doctors lobby to outlaw them and restore the regulatory sclerosis that they naturally favour.