So, there is at least one light in the darkness of organized medicine’s frantic attacks on convenient clinics – those storefront operations, often staffed by nurse practitioners and paid directly by patients, that offer some diagnoses and treatments, .....umm..... conveniently.

The Wall Street Journal’s Dr. Benjamin Brewer is rebelling against colleagues in his rural Illinois town by opening up his own clinic, and hiring nurse practitioners to staff it. “Beat the clinics or join them,” writes the good doctor.

Dr. Brewer realizes how ridiculous it is for his patients with earaches to go to the hospital ER at $600 a pop because they have no other option after hours. Imagine his patients knowing that if his office is closed, they can go to a clinic run by their own family doctor, where the nurse practitioners will have access to the medical records, and even a professional relationship with Dr. Brewer himself! And if the situation requires follow-up treatment by the doctor during regular hours, he’ll be able to pick up the case right where the nurse practitioner left off.

One of the tests of whether you’re on the side of the angels in public policy is how you address competition. Will our friends at the Convenient Care Association lobby the state to prevent Dr. Brewer from opening up his own clinic? I don’t think so.

So, convenient clinics are already prompting innovation in primary care practice. What’s next? Somewhere down the line I think we’ll see the end of $600 earaches in ERs, or $1,400 colds (as reported in the Atlanta Journal-Constitution).

People talk about the ER as the most expensive place to treat minor ailments, but that’s not quite right. Hospitals have high fixed costs relative to marginal costs, and they have to allocate their overheads.  The marginal cost of treating these ailments is not so high. However, the Medicare Prospective Payment System and other government regulations demand an esoteric and Byzantine approach to pricing and billing for procedures and supplies. Once the $600 earaches disappear from the ERs, the hospitals lose an input to their algorithms for determining the prices they charge everyone else. So, they might become a little more creative (a.k.a. free-market oriented) with their public policy goals.

Of course, if I held my breath waiting for hospitals to break free of their government dependency I’d turn blue and pass out first – in which case I’m sure I’d get great treatment at Dr. Brewer’s new clinic!