Fed up with government health-care bureaucracies, and insurance and HMO constraints, two Seattle doctors have formed a cash-based practice that guarantees patients unlimited access to medical advice and treatment. Garrison Bliss and Mitchell Karton founded Seattle Medical Associates (SMA) to give greater attention and the best possible medical services to patients who were willing to spend a few dollars more.

• Patients over the age of 35 pay $65 a month for their service; those between 21 and 35, $35 a month; and children over 14 can be added for $10 a month.

• Patients are urged to buy health insurance that covers additional care -- such as surgery, specialists and hospitalization -- which the doctors, who maintain good connections within the health-care system, orchestrate as part of their service.

• There is no limit on the number of patient visits, the doctors can be reached 24 hours a day and the fees include an annual physical and X-rays as needed.

• The doctors don't bill third parties and do not take Medicare or Medicaid -- but maintain relationships with some insurance-related companies so they can refer patients to specialists affiliated with those plans.

That personal guide through mazes of specialists and health-care gatekeepers is what many SMA patients say they value most.

The two doctors have about 1,300 patients -- around one-third the number they used to have -- and they earn about $140,000 to $150,000 a year. The reduced workload allows them to keep up with medical journals and developments in medicine. Their billing department is a single personal computer.

The arrangement has its critics, though. There are always those who protest that it favors the wealthy -- even though its fees are aimed at middle-class families.