The Luxury of Being Heard

Concierge medicine used to be a rich person thing. Twenty-five thousand dollars a year so some hedge fund guy could have his doctor’s cell phone number and skip the waiting room. Fine. That was the usual have-and-have-not nonsense we have all learned to roll our eyes at and move on from.

But something shifted.

Now it is teachers. Small business owners. Retirees on fixed incomes. People who are not shopping for luxury. They are shopping for survival.

They are paying out of pocket for what their insurance premiums were supposed to guarantee in the first place: a doctor who has time to listen without making them wait three months for an appointment, an actual human being who calls or texts back, someone who will fight the prior authorization instead of shrugging and saying, “Insurance denied it.”

That is the part I cannot stop thinking about. The American healthcare system has created an entire secondary market for buying back what we already paid for. Patient advocates. Care navigators. Billing specialists. Concierge memberships. Direct primary care. Whole industries now exist because the primary system failed so completely that people have to hire a second set of professionals just to access the care they were promised the first time.

When “being heard by your doctor” becomes a premium feature instead of a baseline expectation, something is deeply wrong.

And to be clear, I am not taking a shot at patient advocates or care navigators or anyone trying to help people survive this mess. Quite the opposite. Some of the best people in healthcare are doing that work because they know exactly how impossible the system has become for ordinary patients. The problem is not that these services exist. The problem is that they have become necessary. The problem is that we have normalized paying twice: once for coverage and once for access.

That is a hell of a sentence to write, but here we are.

This is also why I wrote We the Patients: Understanding, Navigating, and Surviving America’s Healthcare Nightmare. I wrote it because nobody should have to fight cancer, decode insurance fine print, hire a side hustle of advocates, and become their own case manager just to get the care they already paid for. I wrote it for the moment the system decides you are on your own and you realize surviving the disease is only half the job. The other half is surviving the paperwork, the phone trees, the denials, the delays, and the bureaucratic shrugging that somehow passes for modern healthcare.

I do not have a tidy policy solution to hand you at the bottom of this post. Outside of my usual line that the system is not broken, it was built this way, I mostly have the same question I keep hearing from patients and families all over the country: why do we now have to pay twice? Once for coverage. Once for access.

If this has happened to you, I want to hear about it. Have you ever paid out of pocket for a patient advocate, billing specialist, concierge physician, or any other service just to get the care your insurance was supposed to provide? Drop your story in the comments. These stories are not edge cases anymore. They are becoming the business model.

Welcome to 2026: the Year of the Patient, where the sick shall inherit the ballot.