 He recalls that in the early 1960s, patients typically paid for basic medical services with cash, as there was almost no government payment for care, and as those Americans who had private insurance were typically only covered for hospitalization and emergency care.In that setting, he says, providers almost always charged minimal fees for services in order to improve the chance of being paid.He argues that the emergence of government as a payer for healthcare services in the form of Medicare and Medicaid, along with government policies of the 1970s that led to the expansion of private insurance to cover routine medical services in addition to hospitalization and emergency care, and which required most employers to provide health insurance for their employees, interfered with the traditional physician-patient relationship.