The U.S. health care system is like a gigantic, top-heavy Rube Goldberg machine that should be handed over to the people who run Taco Bell. At least they know how to think outside the bun.

Instead, layer upon layer of complex gadgetry keep getting added to the health care machinery. Because it’s such a big money maker, nobody wants to eliminate one function or another to make it simpler. The end result is that the doctor walking into the examination room and investigating your problem is only one itsy-bitsy, teeny-weeny portion of the health care pie.

Here’s an idea that strips a lot of that away.

A Seattle based medical practice called Qliance, which runs three clinics, charges $65 per month for unlimited access to one of its doctors or nurse practitioners. Patients still have to pay for lab work, but the average person pays the clinic system about $800 per year for primary care coverage.

But can you see a doctor at night and on weekends? And can you drop the doc an email for a question or two later?

Yes you can, to paraphrase a famous politician.

According to a description on the Qliance website, the clinic “is like a health club membership, but for health care. Your membership gives you unrestricted access to your Qliance clinician and services for one monthly fee.

“Traditionally, over 40¢ of every $1 you spend on health care goes toward insurance billing and overhead. This means your clinician must work harder and faster, seeing more patients each day just to make ends meet.

“As a patient, you experience longer wait times, shorter appointments and higher costs. Instead of dealing with costly overhead, we reinvest that 40¢ in our clinics, in electronic medical records and in patient services. You experience shorter wait times, longer appointments and lower costs.”

A recent article by Kaiser Health News describes the case of a 63-year-old man who joined Qliance when it opened in 2007. He pays $79 a month for primary care and couples that with a catastrophic medical plan with a $10,000 deductible, which costs him $225 a month.

“The doctors will sit there with you as long as you need them to,” said the patient, who has high blood pressure and Type 2 diabetes. “They don’t rush in and out.” He set up the plan in the nick of time – after he joined he was laid off and lost his health benefits.

I could envision a health care system in which primary care clinics like this one pop up all over the country, many of them staffed by physicians assistants or nurse practitioners, overseen by a physician. Clinics might even compete for who can offer the lowest prices.

Coupled with that, the federal government could offer one basic, simple catastrophic medical plan with a very high deductible – maybe $10,000 like the case cited in the example, or perhaps even higher, $20,000. This way, people’s primary care needs are covered at a reasonable price and you’re covered in a worst case scenario.

Digging out of a $20,000 hole after an illness isn’t pleasant, but it’s a lot better than worrying that you can’t get the surgery or procedures you need because it’s way out of your price range.

It may not be the ultimate answer to the U.S. health care’s Rube Goldberg machine. It might still price some people out of the market. But it has something going for it that’s pure gold: simplicity.

Photo: Rube Goldberg machine made of Legos from http://www.flickr.com/photos/xt0ph3r/3591236086/

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