People who don't want expert medical advice go to the counter clinic, we don't have to serve resentful patients, and we can spend our time thinking about medicine with patients who appreciate our service.

Further, patients sometimes visit a counter clinic, but they have issues beyond what the counter clinic can handle. So, the counter clinic will refer the patient to us ---the medical doctors. One of our most regular patient referrals is corner CVS because the local medical doctors introduced themselves respectfully to the CVS clinic staff.

However, don't be fooled by the "cost cutting" nonsense. My estimation is that counter clinics increase total medical spending in the same way that shopping at Wal-Mart increases total consumer spending. Yes, each individual purchase of "health care" is moderately cheaper. However, given the lower prices, omnipresent availability, and cross-marketing of other products in the store, people do not simply buy the same things at a lower cost, they impulsively buy many smaller purchases of dubious value.

So, rather than visit an outpatient medical doctor for an hour for $500 (that is what we bill, though we usually only collect about $300 of that from insurance), one visits the Wal-Mart counter clinic for $70. That's a savings of $430, right? Maybe. Assume the counter clinic treated your sore throat, but you also had another issue, and later visited the medical doctor. Both issues could have been treated by the medical doctor for $500 now rather than $570 over several weeks. Oh, and you also bought "health supplements." Add another $30 recurring cost. Well, actually, you don't go to the doctor at all because you only have $500 for health care, and the doctor costs $500, but you only have $400 because you've already spend $100 on the counter clinic and supplements ---oops, actually, that $400 is already spent by your employer for health insurance.

So, you still pay, but you never visit a doctor, chronic heath conditions continue to exasperate, and in addition to suffering from chronic health problems, you eventually get very sick, progressively lose your ability to function, and are hospitalized sooner at a much higher cost.

Even a single day of missed work at $5 minimum wage due to illness not addressed by a counter clinic is quantitatively worth more than the $37 best case savings at the counter clinic. Primary and preventative care alternatives are almost never "cost savings" unless you know precisely otherwise.

By the way: there is some ludicrous cultural myth that exasperated health problems can be "fixed," or if you can just avoid "having a a serious problem" and "keep natural," you will be OK ---or at least, you can "fix" health "issues" "later."

No, you don't. You die.

Also, jeez, you spend so much time and money making your face and buying clothes, but when you have a disease, you're thinking about saving a few dozen dollars? Bleh.

The basic care that you receive will come from a physician assistant/nurse practitioner. This dramatically cuts down on cost while mantaining an adequate level of care. Physicians are going to continue to become more and more specialized. Which leads to physicians only providing specialized/unique treatments.

Instead of talking to people, you'll stick your arm in one machine socket and spit into another and it will take your blood and analyze your fluids for the flu, a dozen diseases and genetic defects. Then it will print out a prescription with a credit for the store it's located in.

You'll be force-fed advertising while the process happens and then they will sell the results to various other corporations which will then market you cures. They'll be able to do this because they will flash an EULA on the screen waving all your rights, which you have to agree to so you can get help.

Then the medical vending machine corporations will have a massive lobby for their rights in Congress which cannot be defeated because they will get the loons on their side to defend their massive profits as "American Values".

If you have 45 minutes to kill, you can listen here (http://dpcare.org/wa_health_underwriters) to a Seattle doctor talk about the issues, his company's approach, and why direct primary care is such a good thing. He advocates concierge care as opposed to the Walmart care discussed in the article, and I find the approach to be more sound. His approach is like Performace Based Logistics for medicine--the doctor that keeps you healthier makes more money, and I like that incentive. Nonetheless, both his solution and the Walmart solution are attempts at taking advantage of the same idea: paying directly for primary care can both lower costs and improve quality because the time and money required to pay for routine things with insurance is so terribly high.

I am convinced we are witnessing the birth of a revolution in medical care. I pay out of pocket for primary care, even though my insurance would cover everything if I went to a traditional provider. The new way is that much better than the old way -- and that cheap.

I wonder if having a small number of doctors available to these nurses could improve treatment by allowing more patients to get a doctors opinion (somewhat in the same way e-mail and IM tech support allows each technician to server more people than phone support). Could they treat even more conditions that way?

It seems a setup like this with some technology checks and balances (to make sure the right questions get asked) could make health care a lot more efficient.