1. Good post.

    I’m part of a project in Madison, WI that is addressing this issue right now. It’s called Our Lady of Hope Clinic, and it will offer free basic healthcare to the uninsured.

    How will this be paid for? We are currently recruiting and signing up benefactors. These benefactors will pay a single annual fee to receive all of their primary care from the clinic. What’s in it for them?

    1. Their contribution serves the poor.
    2. They get high-end concierge-style care. In other words, instead of the average six-minute appointment, they are guaranteed 30-minute office visits so the provider gets a complete picture of their health and their needs. There is 24/7 access to a personal physician. This also allows for a focus on preventative medicine so health care doesn’t turn into “sick care.”
    3. Only 300 benefactors per physician–about 10% of the typical practice. This allows for the long appointment times and individualized attention. It also allows the doctors to spend slightly over half of their time treating the poor.
    4. 100% pro-life. Parents don’t have to worry about doctors pushing birth control pills on their teens.
    5. No billing or claims. The annual fee covers everything.
    6. There are tons of tax deduction opportunities, depending on one’s situation.
    7. Depending on their current coverage, many people can actually save money by becoming benefactors and switching to a high-deductable secondary coverage for their advanced care.

    Certainly the solution to American health care is not singular, but I believe this model will make some serious inroads. It’s a win-win for the poor and the benefactors.

    Additionally, it eases the burden on the system. When the uninsured can treat, for example, their diabetes early, it cuts down on ER visits that will never be paid for. This reduces the sunken costs of our hospitals and benefits the consumer.

  2. Sounds like a pretty good idea. It kind of reminds me of the stuff Wal-Mart is doing with its health clinics. My main concern is that if these sorts of things become too popular, the AMA will try to shut them down, ostensibly on grounds of safety but really as a form of protectionism for doctors.

  3. When I was fairly young our family got most of our care from a local clinic which worked on something like this model — it was I believe open to anyone who was a city, state or federal employee (my dad worked at a city college) and it was the local clinic at which young doctors did their internships.

    And yes, one of the major obstacles to this kind of thing is the AMA, which wants to make sure that the value of doctors (and thus cost of health care) remains high.

  4. Diagnosing standard diseases and infections, and treating them with anti-biotics. Standard inoculations. Basic screening tests. Treating basic injuries. X-rays. Standard ultrasounds and pre-natal care. Delivery in cases without complications. Well-child care.

    It is an interesting idea, although it may be difficult to distinguish in practice between ‘basic’ and advanced health care. To cite one example, during both of my wife’s pregnancies, either she or the child required more than ‘basic’ care; it is hard to assess pregnancy risks ex ante.

    I have had a couple acquaintances (both in their twenties) in the past five years who went to the doctor with fairly minor complaints (a persistent cold, a sore knee) that turned out to be cancerous, requiring prolonged medical treatment. It is possible that a regular nurse or less skilled personnel would have made the proper referrals for a timely diagnosis; but health care is a field where incremental differences in education can matter a great deal. At least, so it appears from the outside.

    Given the large number of people who cannot (or will not) pay for basic insurance now, the balance of harms may weigh heavily in favor of relaxed licensing requirements. Any change will have trade-offs, and this is an interesting suggestion. How feasible it is politically is another question entirely…..