About 30 percent of Americans are enrolled in Medicaid or have no health insurance.

In addressing this problem, the Affordable Care Act of 2010 follows a path that is very indirect, expensive and possibly unconstitutional.

The law provides low-income individuals with nearly cost-free access to traditional health insurance, balancing the books by raising the premiums for other patients and requiring that all Americans have qualifying insurance.

A decision on the constitutionality of this law is expected any day by the Supreme Court.

A far better approach would be to create a system of free health clinics, operated under contract to the federal government. Such a system could be called the Public Access Health Service.

As I picture it, this service would operate under guidelines set by a medical board of governors.

Treatment guidelines The cost of health care in other industrialized countries is only 40 to 50 percent of U.S. costs with outcomes that are as good as ours.

Accordingly, the board of governors would be required by law to set treatment guidelines so as to limit the cost per patient to 50 percent of the cost of mainstream medical treatment.

Such savings are possible. First, the Public Access Health Service would not be an insurance program and would avoid the 20 to 30 percent overhead costs of insurance companies.

Also, the large scale of operations would facilitate cost-saving innovations such as centralized electronic record keeping and remote diagnosis.

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A fresh start for health care reform