There is a current movement called Direct Primary Care, where you sign up to a binding agreement to pay a continuing monthly subscription fee that covers your office visits, and your labs and prescriptions are also discounted. So it's possible. And it sounds absolutely fantastic upfront.

But the problem there is that places that do not accept insurance and/or Medicaid and Medicare are also not governed by HIPAA and other state and federal healthcare laws, something most people don't even know until they find out the hard way. I have a relative who thought DPC was the best thing since sliced bread until she found out that all the strange tests she kept being told she needed were not actually for her, and she was actually being submitted to various clinical trials without her knowledge and against her directly expressed wishes, for symptoms and diseases she's never even had.

So now she's paying for a monthly DPC subscription she can't use because she's afraid of them and refuses to go back. They won't even give her her medical records (not surprising, because that practice is all a clinical trial fraud scam so they'd be a work of fiction anyway). And she doesn't have a lot of money to start with; she can go to an urgent care place if she needs something immediate, I suppose.

But if you break a DPC agreement, you have to pay full value for every office visit you ever had, every non-billable service under the agreement, and it gets added up against the monthly subscription fees you've been paying. These agreements are written so as to be difficult to break (pick one and look for the following "Termination" language):

If this agreement is terminated or held to be invalid or unenforceable for any reason, you agree to pay practice an amount equal to the fair market value of the services actually rendered to you during the period of time for which the fees were paid commensurate with prevailing rates in the practice area . . .

So yeah, DPC is great in theory, as long as in practice it's not just a front end for some other medical scam, because they lack oversight and are exempt from all the consumer protections built into insurance-oriented laws like HIPAA. There is no recourse with these non-insurance places, because insurance laws are also pretty much the only consumer protection laws with teeth that exist in the doctor-patient relationship, and very few states have any legislative experience with, much less written law, in regard to Direct Primary Care. We're trying to find an attorney that knows enough about it to be able to assist, but even that's a challenge.

I don't know if fraud was the primary intention of Direct Primary Care, but because of the way it is structured it absolutely attracts the bottom feeders of medical practice who want to pull in otherwise underserved (uninsured, poor, undocumented) patients for some kind of economic exploitation.

Probably a justice system where you can't be sued for 150 bajilion for every time someone slips on wet floor. And where health insurance does not expect you to give them 95% discount because every other hospital does. Among other things.

I don't know. How would you get around malpractice insurance and deal with the competition that has economy of scale?

• set* up* a low-cost health-care clinic
• covering its* marginal costs

do what everyone else is doing

vote biden he promises to fix it