Medical science’s individual servants are crushed under the weight of its promises, becoming commonplace and losing their authority; they are simple service providers who can be sued – often justifiably, moreover – if they commit an error. While the medical researcher, the scientist, and some surgeons whose skill amounts to genuine artistic genius retain immense prestige, in many cases the doctor is now seen only as a repairman who gets the machine running again until the next breakdown.

The real beauty of direct-pay primary care is not only that it’s attractive to patients. It can be a way for struggling primary care physicians to maintain a financially viable practice. The average patient pays $700 to $800 a year for membership. According to a report from Kaiser Health News, this is three times more than a doctor makes for each patient in an insurance-based practice. Not to mention the extra time and the absence of aggravation that comes when doctors eliminate insurance companies.

[T]he government and private insurers had begun a concerted effort to contain the escalating cost of health care by fiat. The kindly family doctor was diminished, downgraded, and de-professionalized to a “provider,” a bland descriptor on a clerk’s requisition form. Even worse, New York State’s Medicaid, insuring the indigent, classified me as a “vendor,” a term which sent me into orbit then, and which today still rankles. Hemmed in by profession-specific price controls, reams of restrictive regulations, heavy-handed threats of federal penalties and expulsion from Medicare participation for suspected infractions, I became disheartened.