Kevin Carson at The Center for a Stateless Society has a long, fascinating paper, “The Health Care Crisis: A Crisis of Artificial Scarcity,”about different new initiatives in providing health services that bypass the high expenses of the current delivery system. One example he cites:

“A New York doctor is offering flat-rate health care for the uninsured for $79 a month, but he has run afoul of state insurance regulations in a case that challenges the established norms of the U.S. health system….
Dr. John Muney, president of AMG Medical Group, said he started the program in September after noticing that many of his patients were losing their jobs, and therefore, their health insurance coverage.

About 500 people have registered for Muney’s $79-a-month plan, accounting for 15 percent of patients at the practice, which has offices in each of New York’s five boroughs. The monthly $79 fee… covers unlimited preventive visits and onsite medical services such as minor surgery, physical therapy, lab work and gynecological care. Ilana Clay, a 28-year-old who works in marketing for a jewelry firm, said she signed up in March because she could not afford her employer’s health insurance, which would have cost around $300 a month. “I hadn’t been to a doctor in a couple of years at that point,” she told Reuters. She had a scar removed in a quick onsite procedure that was covered by the plan. Muney said another patient came in with a tumor on her finger: “Somebody else asked $3,000 to remove it. The first visit, we were able to remove it, 15 minutes it took us.”
So far the program has not turned a profit, but Muney said he estimates that it could be profitable with 4,000 patients. In the meantime, he said, his motive is to give something back and provide a model of how healthcare can be more efficient.

“Our healthcare system lends itself to abuse, fraud and waste,” he said, adding that bypassing insurers saved on administrative costs, which he said were about 25 percent of the price of care. “With this model, we’re bypassing all that.”

Muney said he received initial complaints from state insurance authorities in November. “The law says you can do preventive checkups unlimited, but if they come for sick visits you have to charge your overhead costs,” he told Reuters.

In February he received a letter instructing him that he must charge that minimum cost, which he calculates at $33 a visit—a price he says will deter people from signing up. Troy Oechsner, deputy superintendent of the state insurance department, said the rules were designed to protect consumers.

“Our concern is … making sure that consumers can rely on any promises made to them and that they will get the services they paid for when they need them,” he said. Protecting consumers by making them pay $33 per visit instead of $10. As Cool Hand Luke would say, “Wish you’d stop being so good to me, Cap’n.”

Muney’s comments on the savings from bypassing insurance, by the way, are suggestive of the
ways that reforms in delivery of service—say, by incorporating finance into the cooperative organization of service—may also be a solution to the insurance crisis. The provision of most primary care through such member-financed setups with no insurance paperwork cost, no incentive to pile on additional services, and strong incentives to minimize overhead given the inability to profit from 10,000% markups for supplies and drugs, may well be the future of medicine. Absent the perverse incentives and high overhead that prevail in bureaucratic hospitals, it’s really not surprising Muney can do it for $79.”