Maybe you’ve picked up a prescription medication or been fitted for a pair of eyeglasses at Wal-Mart. But would you trust Wal-Mart with your larger medical care?
The retailer is trying to figure that out, opening up clinics in a handful of stores in South Carolina, Georgia and Texas.
At a recently opened clinic in North Augusta, South Carolina, a steady stream of patients came through on a recent morning. The clinic is located near the front of the store, with opaque windows for privacy. It’s small, with just three exam rooms.
For $40 you can get a medical checkup with a nurse practitioner. For Wal-Mart employees on the company health plan, it’s only $4.
Roger Beahm, the executive director of Wake Forest University’s Center for Retail Innovation, says the move is a natural step for Wal-Mart. He says growing companies are always looking for the next big thing.
“So how do you that? How do you get more customers into the store? How do you increase the size of the shopping basket when they are in store?” Beahm says. “The answer to that lies in getting more products, more services that customers are willing to buy when they come into the store.”
Wal-Mart has done that before by offering in-store banking and food service. Some locations already host walk-in clinics in space leased to local healthcare providers. But now, Wal-Mart is opening its own on-site primary care clinics.
By owning the clinics, Wal-Mart can control costs and the services offered, says the company’s senior health and wellness director, Jennifer LaPerre. She says the company has a track record of pushing other retailers to provide health services at a lower cost. She cites the $4 generic prescription drug program the company rolled out in 2006.
“That became branded in the community. It caused numerous other pharmacies to follow suit,” LaPerre says.
The company is piloting the concept in areas with high rates of chronic disease and a shortage of healthcare providers. So far, that means smaller cities in the South, in states that aren’t expanding Medicaid under the Affordable Care Act.
It’s an obvious place to start, says Dr. Harris Berman, the dean of Tufts University School of Medicine. Berman says he would have been skeptical of the idea a decade ago. But he says technology is making it easier for nurse practitioners to stay in touch with doctors who will supervise them remotely and help ensure better care. He says rural areas have an especially critical need for primary care providers.
“I don’t think patients in Boston would go for this concept, or in metropolitan areas,” he says. “But Wal-Mart is very much into rural areas. And I think there, there really is an acute shortage and this would be seen as better than no care.”
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Stock markets around the world are having a downbeat day so far, in part because that's what tends to happen in September, but also because of a new signs of trouble for Europe's economy. A survey of business activity in the 18 countries that use the Euro suggests recovery there is stalling. Plus, there's news today the Obama Administration is cracking down on what are called "inversions," the controversial maneuver of acquiring foreign companies to save U.S. tax. Targeted are the special loans that make these acquisitions possible. President Obama and republicans and democrats in congress agree that what's need in the longer run is tax reform. Yet that's a process that doesn't seem to be moving forward any time soon. That got federal budget watcher Stan Collender doing the math on an unconventional solution. And among the many announcements coming out of Climate Week in New York comes this news of strange bedfellows: A partnership between some leading environmental non-profits, including the Environmental Defense Fund, and five oil companies.
The Obama Administration has announced a crack down on what are called "inversions": the controversial maneuver of acquiring foreign companies to save U.S. tax. Targeted are the special loans that make these acquisitions possible; seen as a stopgap approach.
President Obama and republicans and democrats in congress agree that what's need in the longer run is tax reform. But that's a process that doesn't seem to be moving forward any time soon.
That got federal budget watcher Stan Collender doing the math. Collender—who use to work for both the House and Senate budget committees and tweets at theBudgetGuy—has written a column entitled "How to Abolish the Federal Corporate Income Tax without Increasing the Deficit," and stopped by to talk about an unconventional solution.
Click the media player above to hear Stan Collender in conversation with Marketplace Morning Report host David Brancaccio.
You heard all about the largest initial public offering (ever) last week. That is, the debut of the Chinese e-commerce company Alibaba. Now, investors are awaiting the second-biggest U.S. IPO of the year.
Shares of Citizens Financial Group are expected to price later Tuesday. It could be the largest bank IPO since Goldman Sachs in 1999.
Citizens Financial Group is one of the largest regional banks in the U.S., but it’s owned by the Royal Bank of Scotland. During the financial crisis, RBS was bailed out by British taxpayers. Now, the UK government wants out, says banking analyst Richard Bove with Rafferty Capital Markets.
“They’re saying, 'Hey look, we don’t want to be in the banking business,'” Bove says. “'You forced us to bail you out. Now give us the money back, and if that means selling off assets, sell them.'”
Kathleen Smith manages a fund that invests in newly public companies at Renaissance Capital. She says this year has been the strongest for IPOs since 2000, but financial companies haven’t fared so well.
With the Citizens offering just days after the biggest IPO ever, “it will be a test of the market capacity to add additional new product to portfolios,” she says.
Smith says investors may also look askance at the $9 million in bonuses Citizens executives are expected to get from the IPO.
Among the many announcements at Climate Week in New York comes this news of strange bedfellows: A partnership between some leading environmental non-profits, including the Environmental Defense Fund, and five oil companies. The companies agree to work at cutting emissions of methane—a potent greenhouse gas—in the process of exploration and drilling.
These oil companies aren’t household names in the United States, but they’re big, like the national oil companies of Mexico and Norway. The absence of “super-majors” like BP and Exxon isn’t the potential weakness that concerns Stanford geophysicist Mark Zoback, who served on an Energy Department panel on shale gas safety.
"You have to understand, it’s not the companies you know," he says with a laugh.
Rather, big problems may come from small-timers, who operate under a variety of state regulations and ethical constraints. The U.S. Energy Information Agency estimates there are as many as 15,000 oil and gas drillers, most of them relatively small time. An agency report showed almost half a million active natural gas wells in 2012.
"There’s so many wells being drilled, and there’s so many companies in the process," says Zoback. "It only takes a few bad actors to cause problems."
Nathaniel Keohane, vice president of international climate at the Environmental Defense Fund, agrees that there are limits to what this particular initiative can achieve. "We think that by starting with this group and expanding it over time, we can start to make progress and demonstrate what’s possible," he says.
You can’t buy a lot for $4—maybe a cup of coffee or muffin. But at about a dozen Walmart stores across the South, $4 will get employees a visit to a nurse practitioner at an in-store clinic. It’s part of a new primary care program that Walmart is testing in three states.
Eric Klein leads the healthcare team at the national law firm Sheppard Mullin Richter and Hampton. He says Walmart could actually come out ahead in the big picture.
“You have to look at the entire cost,” he says. “It’s not just the $4 copay, it’s the entire cost.”
Klein says if employees go to an on-site clinic owned by Walmart, the company could save money on doctor visits and insurance premiums. Cutting out the middle men could bring down the cost of Walmart’s insurance plans.
Dr. Harris Berman, the dean of the medical school at Tufts University, agrees.
“If the employees are getting it done here for $4, it won’t show up in their insurance bill,” he says.
With more than a million employees and their dependents on the Walmart health plan, the program could help shape the primary care market if it goes nationwide.
Jennifer LaPerre, Walmart’s senior director of health and wellness, says the company has a “unique opportunity” to help provide lower-cost care. LaPerre says the $4 figure is also part of Walmart’s branding strategy, in keeping with the $4 generic drug program that it launched in 2006.
Klein says Walmart also wins by having clinics just steps away from the checkout lines.
“By taking better care of their employees they actually get better results economically,” Klein says. “Less absenteeism, and that’s a real cost savings over time.”
Walmart is piloting the idea for now; planning to open about a dozen clinics by the end of the year in Georgia, Texas, and South Carolina. LaPerre says Walmart is choosing stores in areas with high rates of chronic disease and a shortage of primary care doctors.
If the concept works, Walmart may take it nationwide.
The U.S. Treasury has taken steps to stop tax inversions, the process by which a U.S. company acquires a foreign firm and moves abroad in order to reduce its tax bills. In recent weeks, large companies including Burger King and Medtronic have revealed that they are pursuing inversions, drawing the ire of the Obama administration and Congress.
The Treasury’s new rules, announced late Monday, make inversions harder, and eliminate some of the financial benefits associated with the process. The Treasury moved to close a loophole that facilitates “hopscotch loans,” which allow corporations to gain access to their accumulated foreign earnings without paying U.S. taxes for that access, as is typically legally required.
“The Treasury notice, almost entirely, is directed toward preventing that from happening,” said Robert Willens, president of Robert Willens LLC, a tax accounting and consulting firm.
Treasury Secretary Jacob Lew has admitted that the new rules won’t end inversions altogether, and called on congress to take action. Congress has made unsuccessful attempts in the past to limit inversions.
“The problem is, every time Congress does something, firms find a new way to take advantage of becoming a foreign firm and reducing their U.S. taxes,” said Roberton Williams, a Senior Fellow at the Urban Institute’s Tax Policy Center.
When I first figured out that the most popular car in the U.S. costs the same now as it did 25 years ago when Marketplace first went on the air, I was as astonished as I assume you are.
We have been looking at the weird, wonderful but sometimes destructive ways that prices have moved in the last quarter century. When it comes to cars, it has been an article of faith that 2014 cars have so much more sophisticated stuff bolted to them that they must be more expensive.
The 1989 Honda Accord for instance had no airbags at all. ABS braking? Forgettaboutit. The entry level DX sedan didn't come standard with air conditioning. You had to roll down the windows. Its engine generated just 98 little horses. It did come with doors and a steering wheel, however, and luxurious power steering.
The sticker price for that base Honda Accord in 1989 was $11,700. These days, the cheapest Accord has airbags galore, AC standard, Bluetooth, power windows. Its got 185 horses, its fuel economy is much better, and it's even just about a foot longer. But it lists for $21,955. The price of the extras that accumulated over the years.
Or is it?
Adjust for inflation and the 2014 Honda Accord is like $11,445 back in 1989. In other words, the fancy new Accord is selling for a few hundred dollars cheaper than its more Spartan predecessor back when the first President Bush was in the Oval Office.
Since we didn't just fall off the turnip truck however, we know that the cost of a car is not just the cost of a car. What happens to the total cost of driving a mid-sized sedan like the Accord over the last 25 years? The results of that analysis were also a surprise and they're here. Not to ruin the suspense, but while gas, maintenance insurance, taxes/title are more expensive now, the cost of borrowing money to buy a car is much, much lower now. Depreciation is also less as cars get better and last longer.
But I haven't forgotten I mentioned the Japanese Prime Minister in the headline. What does Mr. Shinzo Abe have to do with any of this? Maybe nothing, maybe a lot. One veteran economist I talked to about how the 1989 and 2014 Honda Accord cost the same reminded me that Honda is based in Japan. Prime Minister Abe's economic stimulus program known as Abenomics has had the effect of weakening the Japanese currency. Even though the modern Honda Accord is assembled in Ohio, the low yen/high dollar means that Honda can keep the Accord's price low, in part because the same amount of dollars generates more yen when the profits are sent back to Japan. This economist told me that Honda's competitor Ford grumbles about this and estimates the low yen these days lets Honda sells the Accord for a few thousand dollars less than a U.S.-based car company.
The thing is, Mr. Abe has only been running things since very late 2012 and his Abenomics have held sway since last year. And those Accords have been awfully competitive contenders in the U.S. car market for decades.
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