Financing health care fascinates me. So many folks who have private physicians resist changing to a health maintenance organization because they will lose the “personal touch”. I, who have advocated for the value of the physician/patient relationship, am always shocked by this choice. Sally, fifty-one, for example, spends $1500.00/month for her and her husband to maintain their physicians. This number represents their premiums, not their co-pays, or deductibles. The could spend half if they switched to an HMO, and finances are really tight for them. Plus, she and her husband are healthy, and rely on their physicians only for yearly check-ups. Still, the notion that they can call Dr. Lee, and Dr. Lee knows them, means so much to Sally, that she steadfastly refuses to change carriers. “What if the quality of health care was the same at an HMO, perhaps even better, would you still consider switching?” I ask, Sally, curious by what might be a sense of narcissistic pleasing, which comes with more personalized medicine, as is the difference between levels of service at three star versus five star hotels. “I don’t know. It just feels bad for me to switch, so I cannot think of it.” Sally says in a dismissive way, although I am also aware that her initial reaction to my comment is one of negativity, she often gives it deep thought. We, as a society, get used to a certain level of service, making it very difficult, even in the face of financial hardship, to go down to a system which meets the goal of good health care, without the special treatment of someone knowing your name and your family circumstances. Personalized care is often mistaken for better care. Automated care might not appeal to one’s narcissism, but it might get the job done. The rules of business prevail. Making people feel good sells. Outcome measures, or hard data, does not sell as well. Concierge medicine works on this principle. Business minded folks understand the rules. The public, unless mindful, are vulnerable to financial hardship as a result. The Affordable Care Act will bring these notions into the foreground. The change in level of service will be interesting to observe. The doctor/patient relationship will still be there, but it will be expensive. Service costs money.