It was interesting to see the response to free food offered by Oprah during her promotional stunt for Kentucky Fried Chicken (KFC). For those unfamiliar with the situation, KFC wanted to market their new grilled chicken offering and enlisted Oprah to plug a free 2-piece meal for a limited time. To participate, Americans could download a coupon, print it on their computer, then come by their local KFC to receive their meal.
Well, the response was overwhelming: over a million people rushed to download Oprah's coupon offered online. They then sped on over to their local KFC with the coupon in hand during their lunch hour, only to encounter huge lines. After all, there were only so many people behind the counter to take the coupons, validate them, cook the food, and distribute the grilled chicken chunks to the masses. People got impatient. Lots and lots of people. So many people, in fact, that in store owners thought everyone must be xeroxing their coupons and giving them to friends, so soon they would only take the coupons printed in color. Shoving and expletives broke out. Frustration ruled. In short, it was a public relations nightmare.
So what does this have to do with health care reform?
Well, a lot.
After all, we're working on making medicine into McDonalds.
Think about it. We're in the planning stages of trying to build low-cost, highly affordable medical care for everyone. Not that this is necessarily a bad thing. I mean, who doesn't want cheap, convenient food once in a while? There will still be a pretty good selection of offerings: from the nutritious (like salads and apple slices) to the not-so-nutritious (like an occasional soft-served cone).
One thing's for sure, McDonalds will be busy. Very busy. After all, they don't call it "fast food" for nothing. We'll have to get used to that. Costs, after all, are key: keep 'em low. For the clever businessmen and businesswomen out there, opportunities for significant profit will still exist at our McDonalds health care of the future, at least for senior management. And for the suppliers, well, they'll do just fine, too since the demand will still exist for their services.
Soon we'll be ordering Combo Meal #1 after you suffer a Big Mac attack and receive our Big Mac, fries, soft drink included with follow-up care for a year for one low, low price! And if you want a sundae, you might have to pay a bit extra.
But if we take the analogy a bit further, who's going to be flipping the burgers? Who will be greeting the patients to take their order? Will we offer drive through services and be open late on weeknights and weekends? Will we hire cheap labor to keep our costs down? After all, what's there to flipping burgers and taking orders? Just take the order, enters them in the register, get the boys in back make the sandwich, and another mouth will be fed, all in just a few short minutes.
Whether or not we just have McDonalds or be able to step up to a Chipotle or Outback Steakhouse remains to be seen. Certainly for most, these options will do. But there will probably be a modest number of people for whom none of these options will do. For them, there will be a selection of five-star restaurants, but they'll have to pay for it themselves. Whether the government will permit doctors to work at these establishments is the question right now, since the mass exodus of physicians from burger flippers to something more palatable is seriously in question.
It sure is going to be interesting.
But America has spoken: McDonalds, please. And that's okay.
We just have to know what we're getting...
... and what the Combo Meals will cost us.
I think this is an interesting (and amusing) post. While I don't think we would agree completely on issues of public health policy, I see your points as valid, and your concerns as serious, if not, in my opinion, insurmountable.
However, how does Johns Hopkins Bayview end up as Outback Steakhouse? I spent a month there as an externship student in the CICU and found the Cardiology attendings to be some of the most incredible clinicians and teachers I have ever met in my (brief) career so far. I guess you're placing Outback above Chipotle, but still... For the level of care they provide (including PCI for STEMI patients) they provide a great service in an academic, collegial, interdisciplinary and collaborative environment. Maybe you just like Outback Steakhouse more than I do. Perhaps I would suggest Houstons instead, with the downtown campus being Morton's.
My point was not to denigrate Johns Hopkin's Bayview, but rather to make the point there will probably be different establishments with different levels of health care amenities. The concern, of course, is that those amenities are likely to suffer in the name of cost savings. The challenge from a fiscal standpoint will be making as much as possible from the contraints imposed by the senior management.
Thanks for your response, Dr. Wes! I certainly see your point.
Wow! This was an excellent post on the new issues facing health care today. You did a superb job of juxtaposing the argument. And what happens to the "independently" owned McDonalds? When there is a rush of these coupons and free items, do these 'independent' programs not take the coupons?
In other words, when hospitals are fraught with rising medical costs and lower medicaid payments, or are required to cover everyone with very little, then will independent hospitals and clinics refuse medicaid/universal patients and only offer 'super-sized' coverage to a select few. Doesn't this increase the health disparity?
It's already happening but McDonalds will be Walgreens payasyougo clinic. Also Walmart.
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