ONE OF THE DOCTORS you’ll meet in conjunction with our annual survey of top physicians “specializes” in an area that seems out of fashion in this era of increasingly refined subspecialties: family practice. As a doctor in training Martin Cahn eschewed more narrow (and more lucrative) fields, and as a young physician he left the world of HMOs in order to form a solo practice where he could serve as primary watchdog over his patients’ health. He wanted to do it all, treating people, not just bodies, over the course of his patients’ lifetimes.

Cahn looks like something of an industry anachronism, but maybe, just maybe, he’s a bellwether. Congress has spent the better part of the summer hashing out the future of health care, but for much longer than that Seattle has been pioneering ways to provide the best care. Well before managed care came into vogue, there was Group Health, founded in 1947 to provide affordable one-stop medical care. And just a few weeks ago, it was extolled by the Obama administration for the way its electronic medical records lower health care costs. The same year Group Health was born the UW medical school admitted its first class of students; it is now regularly recognized as one of the nation’s leading primary care medical schools (among many other distinctions). Then, in 1996, Seattle spawned the nation’s first concierge service, letting patients pay annual fees to have as much access to their doctors as they need, without battling insurance companies to do so. The latest iteration of this “direct practice” approach may be Qliance, a start-up that has also drawn national attention for bypassing insurance companies and affordably providing the kind of one-on-one care so valued by Dr. Cahn and his patients.

All these solutions may sound like luxuries if you’re worried about having a job and insurance. So turn to the Meltdown Survival Handbook for advice on making yourself valuable to your employer, living well while saving money, and making the best of tough times.

Or, you could just bury your head in the sand. It’s balmy August, so go ahead, escape to the best of our nearby beaches and splash, paddle, hike, or hunt for treasure in the waning days of summer.

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