Appeal-Democrat (Marysville, CA)

Coming soon to your favorite neighborhood retail store: fast access to routine medical services at new health care clinics. It's a concept that not only fills a great demand, but should demand great attention from Gov. Arnold Schwarzenegger, who on Jan. 9 is expected to unveil his plan to cut health care costs and make medical services more available in California.

Unfortunately, the governor already has touted his plan to expand 147 existing health care clinics in public schools to 500 campuses throughout the state to provide physical and mental assessments, screenings, diagnosis and treatment of acute illnesses and chronic conditions, heath education, immunizations, counseling, physician referrals and follow-ups.

This is a good idea, very badly applied. Public schools already are charged with more than they should be doing, and considering the questionable job they do at their primary role of educating children, why would anyone think it's a good idea to add yet another unrelated responsibility to their workload?

Who would you rather send your child to for routine medical care, the public school or a health care clinic staffed by nurse practitioners? We recommend the governor scrap plans for adding more burdens to those many already foisted upon the public education system. Instead, we urge that he encourage private industry to bring routine medical care as close as the nearest CVS, Wal-Mart or Target store.

In-store health clinics, which are appearing across the nation already, can provide patients with fast access to services such as strep-throat tests, physical exams and flu shots. Clinics operate at reasonable fees of $25 to $60 per visit, often with no appointment required and with operating hours generally coinciding with regular pharmacy hours, even evenings and weekends. The clinics' nurse practitioners are legally permitted to treat patients and write prescriptions far less costly than provided by doctors.

The Wall Street Journal reports that the growing trend "is rapidly spreading in pharmacy chains as they look for ways to stem losses to mail-order pharmacies and big-box stores."

We like the entrepreneurial aspect of letting the market respond to needs, and apparently so do three large drug store chains, Rite Aid Corp., Brooks Eckerd Pharmacy and Osco Drug, which have announced plans to open clinics, according to the Journal. The drugstores are partnering with a Pennsylvania-based Take Care Health Systems LLC, which will lease space inside the pharmacies and operate the clinics. Take Care projects 1,300 clinics opened by the end of 2007.

Similar clinics already operate or are planned for Minneapolis, Baltimore and Nashville, as well as in Oklahoma, Arkansas, Florida and other states. California needs to join the party.

As might be expected, some doctor groups, which stand to lose business, criticize the idea, arguing that quality of care might suffer. But much of the routine care provided in doctors' offices doesn't require a licensed physician.

Insurers like the idea because of considerable potential savings. According to the Wall Street Journal, a typical doctor visit for a basic illness costs an insurer about $110. But a visit to a clinic costs less than $60. Moreover, clinic services are much less expensive than hospital emergency rooms, the popular alternative outside of regular business hours.

While the California Nurses Association concedes nurse practitioners are capable of administering such routine care, the association is concerned about communicable diseases being transmitted in such public venues and the possibility that appropriate follow-up will not occur. But Pacific Research Institute's health care analyst John Graham suggests that exposure to contagious persons would be no more likely than in any public setting. The greater problem, Graham contends, is that unlike in eastern states, the establishment of such clinics is greatly inhibited for people who currently are without medical care because California law requires for every four nurse practitioners, there must be one physician in a supervisory role.

Reportedly, some insurers already encourage patients to use such clinics by lowering or eliminating co-pay requirements. The market can be effective in reducing costs -- if allowed to be.

California should jump on this private-sector bandwagon, and Schwarzenegger, whose mentor was free-market sage Dr. Milton Friedman, is just the person to whip up popular appeal.