A new trend is emerging in the practice of medicine -- concierge services. Put simply, "concierge medicine" is an attempt by physicians to put sanity back into their practices by offering their patients better service.

They do this by charging a flat fee, not unlike other professionals. The fees range from a high end of $20,000 for jet-setters who want global 24-hour service to a more modest $1,500 a year for middle America (roughly the price of a latte each day).

The trend was first featured in 2001, when two popular Boston doctors decided to give managed care the send-off, cut their practices from 4,200 to 300, and charge patients a fee simply for the privilege of scheduling prompt appointments that are more thorough and personalized.

The movement was met then, and now, by the academy and prestige press as yet another sign that our health care system is failing both physically and morally. Not surprisingly, in 2002, a Harvard professor decried concierge medicine as "abhorrent," while the Tufts Health Care plan asked state regulators if directly charging patients for health care violated any state laws.

David Barton Smith, a health care professor at Temple University, argued that these practices are "totally unregulated with no oversight." "You're putting up a fairly large sum of money," he told The New York Times, "and there isn't really any assurance you are going to get your money's worth."

Another professor frets, "It creates an explicitly tiered medical system based on ability to pay."

All this rhetoric, of course, is nonsense.

Concierge medicine is a sign of an advancing market. All markets evolve with rich and varied forms of compensation and pricing arrangements to meet consumers' desires for the trade-off of price, convenience, and quality.

Why is it acceptable for Costco to charge people a fee to shop, but not for physicians to deliver better access to something as critical as health care? We don't have just one type of hotel to provide shelter -- a basic need -- when we find ourselves away from home. We have the choice to pay for the white-glove treatment of the Ritz-Carlton or the leave-the-light-on service of Motel 6.

For all of the commentary on how expensive health care in America is, the reality is that for most people it's surprisingly cheap-at least the portion that they directly pay for and that hits their pocketbook.

The average household in Los Angeles spends more money each year for entertainment ($2,386), than on health care ($2,196). The true cost of an item or service is not just the cash price that must be paid, but also the activity that must be forgone.

Time is money -- or at least its equivalent. Understanding this, the most expensive part of health care for many people -- especially those with above average incomes -- isn't the co-payments but the hour spent in the waiting room.

Smart money will gladly sign up and pay a flat fee to save time. And, if a patient feels he is not getting his money's worth, he is free to move to another doctor or plan.

Other than the "this-isn't-fair" whining from the experts and bureaucrats, the main charge against concierge medicine is that the fee-based pricing conflicts with HMO contracts. A woman who eagerly pays $1,500 for the service finds her employer's plan won't accommodate it. There's a three-word solution to this relatively minor problem: Health Savings Accounts. They are coming to an employer plan near you.