One important take-home point is that "direct pay" (sometimes known as "concierge medicine") isn't just for the wealthy. Rather, there are many options evolving in the marketplace suitable for middle-class and poorer patients.
BTW, I'll be talking about this topic in greater depth in my lecture tomorrow for SnowCon 2013 entitled, "Concierge Medicine: The Last Bastion of Health Care Freedom".
Here's the abstract of the talk:
As the ObamaCare health law is phased in, patients will be increasingly subjected to government controls dictating what care they can receive and when. Fortunately, many doctors are responding by moving into various type of "concierge medicine" and "direct pay" practices where they can still treat patients according to their own best judgment relatively free from such government constraints.
This talk will discuss the rapidly growing field of concierge medicine, the various concierge models, why many patients can benefit from it, how to evaluate a concierge practice, and how and why patients can help defend the morality of concierge medicine.