Walmart announced Friday that it plans to provide “full primary care services” to consumers nationwide within five to seven years.

The retail giant made headlines in 2011 when it sent 14-page letters to health providers and companies requesting information to help it establish “the largest provider of primary health care services in the nation.” However, the company quickly clarified that it was “not building a national, integrated, low-cost primary health care platform.”

Speaking at the Foundation of Associated Industries of Florida’s 2013 Health Care Affordability Summit, Marcus Osborne—Walmart’s vice president of health and wellness payer relations—was asked whether the retailer plans to pursue retail clinics in rural areas.

He said, “That’s where we’re going now: full primary care services in five to seven years.”

Osborne added that Walmart’s clinics will be in underserved, urban areas because the chain has many stores in those areas. “One of the areas we’re highlighting is where there isn’t access to care,” he said. (So, if we were to get a Walmart in the old Grand Union space? Hmmm.)

Can Walmart provide us with primary care as efficiently as it provides us with unnecessary plastic objects and junk food? I think the answer is probably yes. It might not be the same kind of one-on-one doctor-patient relationship we long for, and it might involve more urgent care from midlevel providers and less preventive care or chronic disease management from physicians, but I think that a business like Walmart, that runs an efficient, national corporation, could find a way to disrupt things and deliver some level of care in a more efficient manner. For that matter, I bet the Cheesecake Factory could as well.

But here’s the catch. It can do so only if it does what other retail medical outlets are already doing: ignore the third-party payers. Almost everything that’s wrong with our health care system is the direct result of third-party payment. In response, there are a lot of people reinventing healthcare, in small corners around the country, and showing great improvements in efficiency, quality and patient satisfaction, by opting out of the third-party payer status quo. If Walmart were to negotiate directly with businesses and customers to provide care on its own terms, and not have to bow to health insurance companies like the rest of us do, I think they could indeed make a big impact. I just hope they do not skimp on quality. I don’t mind buying a plastic onion chopper that is going to break in 9 months, when I know I am getting it for ¢50, but I do not want discounted services when my child is sick and seeing their doctor.

I am not saying that our problems are being created by health insurance. There is nothing in principle wrong with insurance. The source of our problems is using insurance companies to pay medical bills. It’s insurance companies acting pro emptore — in place of the buyer. When this happens, a number of things begin to change, all of them bad:

• The provider becomes the agent of the insurance companies, rather than of the patient — and this changes the practice of medicine to the third-party’s view of how it should be practiced.
• The provider no longer has to compete for patients based on price.
• Absent price competition, the provider no longer competes for patients based on quality.
• Overall, the provider’s incentive is to maximize against reimbursement formulas rather than provide low-cost, high-quality care.
• The third-party payer further maximizes profits by adding levels of regulatory smokescreen, making it harder for providers to be reimbursed for what they’re owed in the first place.
• Causing the providers to work harder, see more, and further sacrifice quality.

Walmart has clearly been testing the waters for a couple of years, even prior to their bombshell announcement in November, 2011. A National Center for Policy Analysis Health Policy blog summed up their efforts almost two years ago:

This past weekend, Wal-Mart was offering health care screenings to male customers at no charge. Sam’s Clubs across the country gave any customer willing to take the time:

BMI Index measurements,

Blood pressure tests,

Cholesterol readings,

PSA (prostate cancer) tests, and

TSH (thyroid stimulating hormone) tests.

And that’s not all. Sam’s Clubs have more free screenings planned for the future. Here’s the schedule:

July: Kids Health Screenings

August: Vision Health Screenings

September: Diabetes Screenings

October: Women’s Health Screenings

November: Digestive Health Screenings

Further, at the store I visited there was no waiting. And if there happened to be a wait, I suspect it would be handled the way Wal-Mart handles prescription drugs. In order to reduce both the time cost and the money cost of care, Sam’s Club Pharmacy promises:

Hundreds of generic prescriptions for just $4,

Prescriptions filled in just 20 minutes, and

Text alerts to tell you when your prescription is ready, so you can shop while you wait.

So, is this a good thing or a bad thing? I don’t know. Instinct says that replacing a traditional doctor with a Walmart branded one is a bad thing. But on the other hand, the system is so broken that before long, the traditional doctors will be offering laser hair removal, weight loss clinics, Botox injections and Lasik eye surgery instead. We might need the Waltons to come along and bust things up a bit.