By Dennis Quick

– Medical moxie. Small business owners shopping for affordable health care—and groaning throughout the process—might find some relief in pay-as-you-go medical services.

Consider Nason Medical Center, which opened last month in Mount Pleasant. The urgent care facility treats just about everything from scratches to chest pains and performs physicals, checkups, drug tests and other medical examinations in addition to urgent care services. It doesn’t matter whether you have health insurance. The center will treat you as long as you can pay and will even customize a payment plan for you.

That’s a big help to small businesses that can’t afford health insurance for their employees. And frees aspiring entrepreneurs, deterred by concerns over the high cost of health care benefits, to go ahead and take that entrepreneurial plunge.

I’m hardly reactionary, but in tackling our national health care crisis, maybe it’s time to return to the old days when doctor-patient relationships were as simple as the relationship between you and your neighborhood grocer. Once upon a time you paid for the checkup, or the lamb chop, then and there. End of story. The transaction involved no one else.

That’s what a doctor in Renton, Wash., had in mind when he started SimpleCare in 1998. SimpleCare is a pay-as-you-go health care program that enables participating doctors to charge as much as 50% less than what they would normally charge patients. That’s because the doctors charge strictly for medical care, not for insurance administration fees. Insurance companies aren’t involved in SimpleCare, only the doctors and their self-pay patients.

With no insurance companies to hassle with, SimpleCare doctors claim they’re no longer losing money. And by paying reduced fees on customized payment plans, patients, including the uninsured, have access to affordable health care.

The old Chinese saying about seeing opportunity in a crisis is more than a mere cliché. What we have in our national, highly expensive health care mess is a perfect opportunity for doctors and business-savvy folks to team up and create pay-as-you-go health care programs.

Whereas pay-as-you-go policies dispense health care fairly, most health insurance plans do not. They tend to slam healthy people, those who keep fit and rarely frequent the doctor, by forcing them to pay for the unhealthy and the uninsured. That’s what drives health care costs.

Although it’s shameful that some 43 million Americans do not have health insurance, I’m hesitant to embrace socialized medicine. Imagine waiting in line for rationed, government-controlled health care. The headache from such bureaucracy would dwarf the combined experience of the ER and the motor vehicles department.

That’s why the answer to our health care crisis lies in capitalistic ingenuity. Pay-as-you-go programs alone won’t solve the problem. But for small businesses, at least, they’re a good start.

– Building boom. Long-time Johns Island residents look sourly on all the subdivisions sprouting up on their island. They don’t want Johns Island to get built up to a Mount Pleasant-like density. I understand their concern and sympathize with them. But there is little they can do to stop the build-up. As long as people continue moving here, Lowcountry real estate will be in hot demand, and Johns Island is the Charleston area’s last frontier for real estate development.

However, Johns Islanders needn’t despair too much. Yes, increased traffic is on the way, but the island won’t resemble Mount Pleasant, James Island or West Ashley in population density. I doubt you’ll see strip malls every other block. The bulk of Johns Island development is concentrated along Maybank Highway between River and Main roads. Most likely the rest of the island will retain much of its rural character, thanks largely to density ordinances. Johns Island might not be as rural as it used to be, but it’s not about to become a Mount Pleasant, either.

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