Contact Points

In 1844, Ralph Waldo Emerson picked up a French word: croisements. Crossings. It's pronounced roughly krwahz-MAHN. I had to look it up too.

He got it from the French philosopher Charles Fourier, who wrote that nature loves cross-breedings. Emerson noticed his best ideas came from contact points: an old book reread with new eyes, two metals touching, a friend arriving or leaving. So he tried to arrange his life to present, in his words, "as much transitional surface as possible."

I came across that in a Daily Stoic email, which pulled it from Robert D. Richardson's Emerson biography, The Mind on Fire. My first thought was that this is exactly what the insurance model took out of medicine.

Count the contact points in a normal primary care relationship. There's a visit you booked weeks out and a short appointment with a screen between you. There's a phone tree, a message relayed through staff, a portal, and a billing office in the middle of every conversation. Each layer was added for a reason, and each one shrinks the surface where a doctor and a patient actually meet.

That matters because medicine works like Emerson's crossings. The useful stuff happens at the point of contact. A mom texts a photo of a rash on Saturday morning instead of sitting in urgent care. A patient mentions the chest tightness on the way out the door because the visit wasn't rushed. A follow-up question gets asked because asking doesn't cost anything.

Insurance doesn't pay for contact. It pays for codes. So contact gets rationed.

Direct care does the opposite. There's one monthly membership and no copay for asking a question. Our doctors answer their own phones, take their own texts, and manage their own email. There's no phone tree and no message relayed through staff, and visits last as long as they need to. That's more transitional surface, on purpose.

It's also a reread. Direct care isn't new. It's the old family doctor relationship, read again with modern tools: texting, wholesale medications, and a posted price. When you return to a book that shaped you, you find something new in it. That's not nostalgia. It's a crossing between an old relationship and new tools.

I am not anti-insurance. Keep a policy for the wreck. But you shouldn't need a claim form to ask your doctor a question.

Croisements is a hard word. More time with your doctor is an easy one.