The ink was barely dry on last Sunday's column when friend Tom Diffenbach sent me an article from the previous day's New York Times about primary care physicians who bill their patients directly and save a ton of money on administrative costs.

The number of so-called "patient-centered" practices is growing, the newspaper said, because doctors find they can spend twice as much time with patients and cut their overhead by as much as half by using new technologies and avoiding the red tape of filing insurance claims.

One Seattle physician charges her patients a monthly fee of $54 to $129, based on age, and encourages them to purchase a high-deductible insurance policy for serious illnesses. She spends 30 minutes to an hour with each patient.

The doctor who runs her clinic told The Times that patients can save 15 percent to 40 percent on health care, in large part because good primary care can obviate specialty care.

The clinic has two administrative employees, but it would need one or two for each of its seven doctors, he said, if they had to file claims with various insurance companies.

Direct billing for primary care is a throwback to the days when doctors made house calls, patients generally paid in cash at the time of service, and people bought insurance to cover hospitalization and extraordinary care.

But during the last half-century of medical progress, insurance plans have evolved to cover virtually every facet of care. And that appears unlikely to change as Democrats in Congress focus on reform plans that reportedly will require every American to have health insurance, purchased either by individuals, their employers or the government.

In Harrisburg, one key issue for the state budget for fiscal 2010 is a proposed expansion of government health insurance to "cover all Pennsylvanians."

This is not to suggest that insurance isn't a necessity, considering the price of modern medical technology.

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