Defending Direct Pay Practitioners

I enjoyed this "doctors' Galt speech", though the ending paragraph is a bit weak.  I also think that the whole idea of a two-tiered system criticism should be challenged, it exists in every market, i.e. Ferrari drivers have objectively better cars than do most of us, so what?  (The rest of his analysis is true, regarding disruptive processes and first adopters paving the way for mass marketing of most goods.)