These are tough times for Wal-Mart, America’s biggest retailer. Long accused of wrecking small-town America and condemned for the stinginess of its pay, the company has lately come under fire for its meanness over employees’ health-care benefits. The charge is arguably unfair: the finn’s health coverage, while admittedly less extensive than the average for big companies, is on a par with other retailers’. But bad publicity, coupled with rising costs, has stirred the Bentonville giant to action. Wal-Mart is making changes that should shift the ground in America’s health-care debate.
One strategy is to slash the prices of many generic, or out-of-patent, prescription drugs. Wal-Mart recently announced that its Florida stores would sell a list of some 300 generic drugs at $4 for a month’s supply; other states will follow. That is above cost but far less than the prices charged by many pharmacy chains, which get profits from fat margins on generics.
Wal-Mart’s critics dismiss the move as a publicity stunt. The list of drugs includes only 143 different medicines and excludes many popular generics. True, hut short-sighted. Wal-Mart has transformed retailing by using its size to squeeze suppliers and passing the gains on to consumers. It could do the same with drugs. Target, another big retailer, has already announced that it will match the new pricing. A"Wal-Mart effect" in drugs will not solve America’s health-costs problem: generics account for only a small share of drug costs, which in turn make up only 10% of overall health spending. But it would help.
The firm’s other initiative is more controversial. Wal-Mart is joining the small but fast-growing group of employers who are controlling costs by shifting to health insurance with high deductibles.
From January 1st new Wal-Mart employees will only be offered insurance with very low premiums (as little as $11 a month for an individual) but rather high deductibles (excesses): an individual must pay at least the first $1,000 of annual health-care expenses, and on a family plan, the first $3,000. Unusually, Wal-Mart’s plan includes three doctor visits and three prescription drugs before the big deductible kicks in. Since most employees go to the doctor less often than that, the company argues, they will be better off because of the lower premiums. That may be true for the healthy, say critics; sicker workers will see their health costs soar.
This debate, writ large, is the biggest controversy in American health care today. The Bush administration has been pushing high-deductible plans as the best route to controlling health costs and has encouraged them, with tax-breaks for health-saving accounts. The logic is appealing. Higher deductibles encourage consumers to become price-conscious for routine care, while insurance kicks in for catastrophic expenses.
Early evidence suggests these plans do help firms control the cost of health insurance. But critics say that the savings are misleading. They argue that the plans shift costs to sicker workers, discourage preventative care and will anyway do little to control overall health spending, since most of the $2 trillion (a sixth of its entire GDP) that America spends on health care each year goes to people with multiple chronic diseases.
For the moment, relatively few Americans are covered bv these" consumer-directed"plans. But they are becoming increasingly popular, especially among firms employing low-skilled workers. And now America’s biggest employer has joined the high-deductible trend. That is bound to have an impact.
As to the health-care issue, Wal-Mart is trying to