In a recent article, the writer describes a twist in medical fees. A specialist, in this case a cardiologist, is charging a premium retainer fee for accessibility. That’s access, not treatment! The levels of service created by the cardiologist are $7,500 per year for “concierge” service, $1,800 for “premier” status, and $500 for “select” status. The differences among the levels range from priority to get an appointment to 24/7 access by phone or email. Medicare or private insurance still pays (or doesn’t) for the actual service. But this doctor says that Medicare reduces his billing rate and this is a way to earn the money he can and wants. This is brutally frank. But, as in other areas, economics control.