“Some health policymakers are encouraged by this trend. They think an increase of direct-pay doctors—especially affordable ones—could lead to better health care in the U.S., which has the highest costs and some of the worst outcomes of any wealthy nation. “I think it’s great,” says Kevin Schulman, a professor of medicine and business administration at Duke University. “We’re rediscovering that if we just ask people to pay for services, we could provide them with better value. Primary care is affordable.”