You can still get good health care without an act of Congress, but Dr. Rodney Malisos, a local family-care physician, said that is becoming more difficult.

Like most physicians in private practice, Malisos, 36, said his goal is to treat his patients and keep them healthy, not to become embroiled in Washington politics and bureaucratic health insurance snarls.

“With Medicare’s recent 21 percent cut on physician reimbursement, the final nail may have been driven into primary care’s coffin,” Malisos said. “Perhaps the last stand for physicians will be to offer cash-only options for patients at competitive prices.”

Malisos said as families grapple with the loss of jobs and lack of health insurance or high deductibles, primary care physicians are finding themselves competing with the corner pharmacy or discount chain stores for patients.

“Medicine in the United States is changing,” Malisos said. “Primary care is rapidly becoming a nursing profession with the explosion of Take Care, Redi Clinic and Minute Clinics.”

While he welcomes patients with insurance coverage and is still providing care for his Medicare patients, Malisos is also offering a cash-only option for those without insurance or with very high deductibles or for those who are self-employed.

“Our fees are less and you get more comprehensive care than you would get at a nurse-only clinic,” Malisos said.

A basic office visit is $59 and sports or camp physical fees are $30, for example. Same-day appointments are available and with an in-house laboratory and equipment, many medical procedures can be done in his office.

Malisos said that 95 to 99 percent of those with medical concerns do not need to go to the hospital although he does believe people should have some type of hospital insurance coverage in case of a catastrophic illness or accident that requires major surgery.

In addition to all the usual services provided by a family-health practice, Malisos and his staff also offer more comprehensive care like EKGs, casting and fracture care, echocardiograms, laser and botox procedures, bone density screenings, suturing, blood tests, weight management, hearing tests, skin cancer excisions and injections for arthritic and painful joints and much more.

“We’re a one-stop care center,” Malisos said.

To a more limited extent, Malisos also practices what is known as “concierge medicine,” for which patients pay an upfront annual membership fee and in return get 24-hour, seven-days a week access, including his private cell phone number and same-day and no-waiting appointments. How much the fee is depends on the patient’s age. For example, someone under the age of 29 would pay an annual fee of $1,750, which includes an extensive physical exam, wellness and lifestyle consultation, screenings and tests, some vaccinations, house calls and treatment as needed.

Malisos said he was considering offering a concierge family plan. Though only a small percentage of physicians are practicing concierge medicine now, it is a growing trend, according to the Physicians’ Foundation and other medical organizations’ Web sites.