Walmart, Caterpillar and Medical Ethics

When I think about patient-centered collaboration in medicine I picture teams of physicians, nurses and social workers or primary care physicians working with specialists.

Now I'm thinking about Walmart and Caterpillar.

While Washington girds itself for a mega-debate about health care reform, companies that provide insurance for their employees are trying all sorts of innovations to make health care more affordable. This is what managed care programs did in the 1990s, but providers and patients turned against them for "intruding on the doctor-patient relationship" and challenging "physician autonomy." Insurers backed off. Costs skyrocketed.

An article in the Chicago Tribune describes how Caterpillar got fed up with its ever-rising health care costs. It decided that its pharmacy arrangements were "not adding value, but just higher prices." That led to a contract with Walmart to offer generic drugs to Caterpillar employees for free if obtained at Walmart or Sam's Club!

This is a straightforward business deal. Caterpillar, which is self-insured, lowers its drug costs. Walmart gets additional customers coming into its stores.

From the perspective of health system ethics the important thing here is that Caterpillar employees have an opportunity to understand health care in a more business-like manner. It's a system that can be influenced if we get tough with it. Maybe they will ask - "if my employer can get free generics for us by using its purchasing power why don't we do the same thing with the Medicare drug program, instead of forbidding Medicare from bargaining with drug companies? Look how much I'm saving as an employee? Why not do the same for us as taxpayers?"

We've allowed our health system to fragment the population into so many insurance pools that except in organizations like Kaiser Permanente it's next to impossible to think about the dynamics of cost for a population. Self insured businesses represent "populations" of people with something important in common - they work for the same company. If health care costs get out of hand the company can go down the tubes, as may happen in the auto industry. Thinking about value for money in health care becomes very personal.

In previous posts I've written about cost-containing innovations at Hannaford supermarkets, Foundation Coal and Peabody Energy, and Serigraph/Wellpoint. I hope we're seeing the start of a ground-up movement to treat containing health care costs as a moral and economic imperative.

If the business community gets business-like about the money it lays out for health care, maybe we'll make some progress with this issue nationally!