Problem is, Walmart basically invented the idea of making a product substantially worse in order to sell it at a lower price. Items in Walmart often aren't "the same product but cheaper" but many times are "a substantially reduced quality version of an item, sold at a cheaper price than the original". So you might get cheaper health plans... but it's likely going to come at a reduced quality, too.
This is actually fine for something like healthcare.
We get into this sacred idea that you _must_ have the best healthcare and treatment. Once you declare something as a _must have_, it becomes extremely expensive. Think education, healthcare, automobiles.
In reality, you don't need the best treatment, just very low cost "pretty good" treatment. Taking an IV shouldn't cost $900 using some advanced equipment. It should cost $50 with a cheap plastic bag hanging from a wall hanger.
We also need to scale medical malpractice lawsuits wayyyyy down. IMO doctors aren't out to get or harm you. Most of them want to help. It's impossible not to make mistakes as human beings. You should be able to take that risk, give that you're ok with driving on the road which is one of the riskiest things you have accepted
Yeah, the 'best' care is needed mostly for critical life threatening situations and for emergency situations such as accidents/fire etc. If one were to see the relief camps or first aid offered during war, it becomes pretty evident that a well sterilized plastic bag should suffice for IV. Probably not even costing 50$.
I'm not sure you've personally used "'pretty good'" treatment. There's a reason why generics and off-branded items are so cheap, and it's not because they don't do marketing. If you don't know: they're shit and the FDA will not prosecute large equivalency discrepancies.
I'm also not sure you've visited small town/rural doctors. While perhaps in the city (and under private coverage), doctors have natural competition with other professionals to provide the best service. Whereas doctors under relatively "public" coverage and in small areas without competition/alternatives, they really don't need to offer good, or even ethical service. It may not even be hugely unethical, like pulling wisdom teeth, when they're not causing issue or doing unneeded surgeries for "preventative" measure, or liberally prescribing medication under the guise of "quality of life improvement."
This post gives off a very strong sense of disassociation from the reality of things for the not-so well-off, i.e more than 90% of the population.
> There's a reason why generics and off-branded items are so cheap, and it's not because they don't do marketing. If you don't know: they're shit and the FDA will not prosecute large equivalency discrepancies.
I think the OP is overstating by calling generic drug "shit". However, generic drugs do not have to be identical to the branded versions. As measured by pharmacokinetics, they need to fall within 80% to 125% of the branded version. So there is some variation. This webpage does a nice job explaining.[1]
The generic drugs also do not have to have the same excipients (inactive materials used to make the final drug product like a pill or capsule). Normally this doesn't matter, but if you have an allergy to an excipient, the branded might be the only one you can take.
Finally, there have been issues with some generic drugs, namely generic Wellbutrin. The FDA asked for bioequivalence data on some dosage forms, but not the 300 mg pill. That pill released drug much faster than the branded and patients had some nasty side effects as a result. I've also heard the same with some generic anti-epileptics. Epilepsy is a disease where drug levels need to be very tightly controlled.
Sure, do you want evidence that generic manufacturers don't follow strict quality control and equivalency testing? I can dig those up from the FDA's database.
Do you want evidence that generics manufacturers fake their equivalency tests? This is going to be harder, because the FDA doesn't publish the private sector data. I can try to see what I have on hand.
Do you want evidence that the FDA doesn't prosecute these huge problems? I can only point to the routine handing out of the equivalent of "yellow cards," i.e warnings of misconduct, but still allowing repeat-offenders to sell in the U.S.
Considering the large degree to which your claims contradict the conventional wisdom of "generics are just as good as name brand drugs," it would be good if you actually gathered and presented some of this evidence (and demonstrated that these issues are prevalent/damaging enough to matter) instead of just threatening to do so.
On the other hand, they do have some good stuff, too.
For example, their "Great Value" brand LED light bulbs have been excellent for me. They would be great at their normal $2 price for 8.5 Watt 800 lumens with a claimed 18 year life bulbs. I happened to get them when there was some sort of instant rebate going on (sponsored by my power company, I think) where they were $0.17 per bulb. I got something like 30 and replaced pretty much every incandescent I had.
Only about 12 of these are in places where I use them heavily. Of those, I've had no failures [1], and no noticeable apparent dimming over the first year. I also have some Cree bulbs with similar specs that are a year older and cost an order of magnitude more than the $2 Walmart bulbs when I bought them (but now are only about 4x as much). The Crees lost a lot of brightness over the first year, and 2 of my 4 died within a couple months.
[1] I'm not counting one that I dropped onto concrete in my garage when trying to screw it into a fixture in the ceiling. The bulb is plastic and was not damaged, but it broke something on the circuit board inside.
Their LEDs have been great for me, but their CFLs were terrible. I have CFLs from Home Depot that are still going after 10 years. My Walmart versions often died in less than a year. Clothing is another thing -- I've gotten really good at supergluing their shoes back.
That said, I still buy from Walmart, but I'm much more careful about what I get. I've gotten good use out of kitchen ware, household goods, LEDs, etc.
I agree with you. Walmart already revolutionized pharma once by offering a huge list of drugs for $4/30-day and $10/-90 day. Even if no one reading this buys those drugs from Wal-Mart, you get them cheaply because Wal-Mart forced everyone else to drop prices to compete. I wonder if it could be calculated how many lives have been saved by doing this. Anecdotally I know a lot of people whose lives have been improved by being able to take those cheap options. And I know a couple of doctors who say they point their patients in that direction to help them save money.
>But I’d never buy non-consumables from them.
I'm curious, would you get a Wal-Mart xray or MRI? Depending on the issue, I think I might.
> Walmart already revolutionized pharma once by offering a huge list of drugs for $4/30-day and $10/-90 day
I was shocked to find that some of my prescriptions that were costing me $20 out of pocket withinsurance at Rite Aid where $4 cash price at Walmart. I've moved everything I can to cash at Walmart, even in some cases where the Walmart cash price is a little higher than my with-insurance price elsewhere, just on the general principle that I don't want my insurance company to know what drugs I take [1].
[1] This stems from a time once when a condition I had improved to the point that I could stop taking drugs for it. A few months later it returned, and I asked my doctor to renew my prescription. He did so...and the insurance company rejected it. They were treating it like I was a brand new patient, and they no longer allowed that drug unless you had first tried a couple other newer drugs and they were not acceptable. I'd never had those drugs, but I'd had others in their families and they were either not very effective or had annoying side effects. I was willing to try the new drugs eventually, if this relapse turned out to not be temporary, but in the short term I wanted what we already knew worked well.
You might look up the company IMS and the states with mandatory prescription surveillance. When I was in the “biz” we could get prescription data at least by county, in some places by pharmacy and/or prescriber and, of course, for some drugs the patient.
Wait, you thought that info was confidential? Ha, this is the USA!
I saw the same thing at Costco. The thyroid pills my cat needed were $60 at a CVS or the supermarket, but only $15 at the Costco pharmacy. People just don't shop around enough.
I'm pretty sure that you signed something with your insurance company that allows them to get a list of your active prescriptions even if you don't file a claim...
Well, prescription drugs are one thing Walmart can't pressure the manufacturer to make worse. It has to be exactly what's printed on the label, nothing else. Many things aren't that way, including health plans.
There are minimum requirements in the United States for health insurance plans. Pretty much every insurance provider already offers a barebones plan, and if Walmart/Humana could beat that on price, that would be a good thing.
Mostly agreed but be careful.. There have been incidents of generics that don't have as much active ingredient in them -- or have other quality control problems.
The other factor is packaging and longevity. Generics e.g. tend to have bits of foil that are too easy to detach and swallow.
And shelf life -- a quality of packaging and ingredients issue -- is less certain.
> Bausch + Lomb began recalling 850,000 tubes of Muro 128 ointment--plus 35,000 tubes of an unbranded sodium chloride product sold by Major Pharmaceuticals--after users complained of a "gritty, sandlike feeling" in the eye, The Wall Street Journal reports. The Valeant Pharmaceuticals ($VRX)-owned ophthalmic specialist was unable to find the source of the problem at the manufacturing plant, leading it to conclude that the extreme cold experienced over the winter may have caused crystals to form in the product during shipping.
Do you really trust the logistical capabilities of Walmart's supply chain to properly control for temperature?
Couldn't agree more. Ultra cheap options is exactly what healthcare needs. 95% of medical issues don't require expensive equipment or highly trained practitioners to treat. Your broken bone doesn't require the very latest X-ray machine - the one from 20 years ago will do fine. The nurse practitioner can handle your UTI. You don't need someone who went through residency for that.
There is so much cost to be saved all over the system if we could break some of these anti-competitive thickets. Walmart is an excellent choice for doing that sort of thing.
I agree, cheaper health care is what we need, and hospitals can cut back on some unneeded expenses to make that happen... but my fear is we'll just see more low-cost low-benefit healthcare plans instead. I'd work with an older x-ray machine if it meant a little cheaper price. I wouldn't, however, buy a healthcare plan than didn't include x-rays just because it was cheaper.
Well, the hope is your plan would cover what is required to treat a given condition. I.e. if you have a simple broken bone, you get the cheap x-ray. If you have a complex fracture that requires fine resolution, they cover the brand new fancy x-ray. The problem right now is: Your doctor prescribes the fancy x-ray as a catch-all, for everything that requires an x-ray. The insurance company then gets billed for "x-ray", which the doctor said was necessary. There is no incentive pressure for you to choose the cheap one, because you're not paying. The doctor doesn't care because they're not paying. And the insurance company gets screwed - but they're a business, so what do they do? Raise rates for everyone, and pass it on down the line.
Someone commented but was downvoted (apparently because they work for an insurance company?), and they deleted their comment. I think it's informative enough to quote here for history:
> Actually, in many cases, we slap an authorization requirement on the fancy imagining or deny the claim for a lack of medical necessity. (Source: I work for an insurance company)
You want to improve healthcare? Fix drug prices, fix the adversarial model between insurers and providers and do whatever you have to to get patients more facetime with clinicians. Connect and coordinate care - especially post discharge. Worry about things outside of medicine like food or social isolation or financial health.
I think that's true when they can tell the difference. But a lot of times, the doctor is just "go get an MRI, and hey, why don't you go to the place in our building". The price will be 3x higher than the place down the street, but the patient doesn't know that or care. Now, some insurers do indeed have strict in-network requirements, where they approve each place and how it provides care, and that can be a reasonable solution to this problem, but patients hate it, so many of them don't do it, and instead absorb this cost.
> You want to improve healthcare? Fix drug prices, fix the adversarial model between insurers and providers
What does 'fix drug prices' mean though? And why would 'fixing the adversarial model between insurers and providers' help things? In every other setting, adversarial models push costs down. These seem more like aspirations than solutions.
This may be more my emotional/irrational reaction than anything, and if so please correct me. Seeing how WalMart treats it’s own poeple, and the lack of concern they’ve ever shown to the impacts of their stores on communities, I kind of doubt their commitment to my health in this scenario. I wouldn’t trust them to deliver what’s best for me, just what’s profitable for them.
Have you ever worked retail? Retail is just kind of a bad industry that sucks to work in. It’s generally unskilled with high turnover. So while Walmart sucks compared to desk jobs, it’s pretty good for retail.
I think they are great for communities. I lived in a rural community as a kid for many years without Walmart. We had no book store, no music store. Small under 1k people and one stoplight. They literally had only one science fiction book in the library (broken lands from empire of the east by saberhagen, super awesome book. Weird that that was the one)
Walmart opened close-by and all of a sudden I could buy books. They had so many more options. We didn’t have to drive 40 minutes for groceries. About 1/3 of the Main Street stores closed but they really sucked. Interestingly their employees had zero benefits and zero sexual harassment protections.
It was a small town where if you worked for the dime store you got no vacation, no benefits, got paid 50% if you were black. Lots of lame stuff. At least wal mart paid you some benefits.
Walmart isn’t some all positive entity, there are negatives. But they aren’t horrible and are a huge positive force for the poor by lowering prices.
It’s very frustrating to hear a rich person complain about Walmart when they haven’t had to need their groceries being 20% cheaper than Kroger or 50% less than Whole Foods.
I think you're missing the market effects of having a Wal-Mart. If Walmart moves in and offers MRIs at half the price of everyone else, then everyone else will have to offer better prices to compete. Someone who might not have been able to get an MRI at all will now have the Walmart option, and you'll still benefit from lower prices at your "premium" option.
Until you buy a box of crackers and realize the price per gram is higher than equivalents at the grocery store that just come in larger boxes. The more you investigate walmart, the more you find you're not actually saving much. It's not worth the sub par customer service, deceptive product offering and questionable quality to me.
How is it going to be worse? Are they going to save on sterilization and wash them in a kitchen sink ? Unless you have a very specific condition like a specific type of heart disease or rare cancer, you will be fine even without paying $50k for childbirth. Not to mention that for healthy people a nurse can tell you what you have and prescribe an anti-biotic.
Maybe. I have bought hunting gear from them and it’s substantially superior to the crap from, say, bass pro shops. WM are clearly selling to folks who plan to, or need to, eat what they catch so the gear has too be inexpensive and practical.
They have also been a major player in getting dairies etc to become organic.
https://www.fastcompany.com/54763/man-who-said-no-wal-mart