The NYT has a great piece about direct primary care: doctors who have stopped taking insurance and instead work for cash. Like a normal business. Surprise! It works pretty well.

Lee Spangler, vice president of medical economics with the medical association, said Texas was seeing an increase in practices like these because they gave doctors more flexibility to determine the services they provide and to cut costs for their practices.

"A physician has very little ability to negotiate all policies and procedures that come with insurance contracts," Mr. Spangler said, adding that some insurance companies can even dictate the business hours during which doctors can be paid. "Basically you get rid of all those shackles in terms of having a carrier dictate to the practice how to deliver medical services."

It is the direct primary care business model that proves most attractive, Mr. Spangler said, adding that doctors "want to get out from under what has been stacked up on them."

Bizarrely, "some people" seem to be more worried about health insurance than actual health care. Could it be that these "some people" make their livings as middlemen who don't want patients to go straight to doctors?

Some health care specialists worry that if too many practitioners choose this path, the state could be left struggling to find doctors to accommodate patients with insurance as the federal health care overhaul is making such coverage mandatory for most Texans. So far, efforts to enroll Texans in the federal insurance marketplace -- crucial to the success of the Affordable Care Act -- have made a small dent in the state's uninsured population, which has reached 6 million, according to United States Census Bureau data. The federal Department of Health and Human Services reported that 295,000 Texans had signed up for insurance coverage in the federal marketplace as of March 1.

"We have to find ways of stretching the current number of primary care doctors to meet that demand," said Dr. Clare Hawkins, president of the Texas Academy of Family Physicians. "Direct primary care goes in the other direction."

What if you passed a law mandating insurance, but no doctors showed up?

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