You raise an excellent point in my opinion. One that is certainly debatable, and ought to be. But it seems an exaggeration to say that the capitalist way of medical care ended with medicare because the entire medical care delivery system including patients on medicare is highly capitalistic today -- though in the form of a government protected cartel -- which is not the form of capitalism that we can be very enthusiastic about. So yes, there is heavy government involvement, yet it is thoroughly capitalistic. An enigma if you like. My dad, four uncles, and my grandfather were all physicians. My dad observed that when medicare first came in fees jumped rapidly to whatever had been the norm plus what medicare would pay on top of that. Certainly if we go back before medicare, there were many without medical insurance and fees were, if not low, still affordable by the middle class without insurance. Physicians reduced their fees for the less well off and treated the poor gratis. During the depression it was not terribly unusual for a physician to be paid for delivering a baby with a chicken, or equivalent. Physicians, nevertheless, even going back into the late nineteenth century, did well financially. It was, however, long after medicare came in that they begin getting rich. Whether that was caused by medicare, or some other factor, or a combination of factors, I don't know, but I suspect the growth of third party payers in general had something to do with it, and almost certainly much heavier government involvement and regulation as well. Also, it is clear that the ratio of physicians to patients must have been significantly greater earlier in the twentieth century because the level of personal attention and time spent with each patient was far greater then than now. Physicians, almost all in private practice, spent early mornings at the hospital, late mornings and afternoons at their offices, and spent evenings making house calls and/or hospital rounds. Patients stayed far longer in the hospital and were visited twice a day, morning and evening, by their physician.