Before the mid-nineteenth century, the business relationship between a doctor and his patients was a simple one. The patient paid cash in exchange for the doctor's advice, skill, and service. If the patient did not have any money, they would utilize the bartering system as a way to pay for the services in lieu of a cash payment. It was a simple but effective method of reimbursement. However with time and advancements in science, medicine progressed beyond the small town doctor and reimbursement methods did as well. This progression included the advent of healthcare insurance. Originally it was promoted to the public as a way to receive better treatment and care than the average American. Since then private healthcare has become accessible to a larger portion of the population. This created managed care model as an effort to control costs while maintaining coverage for the plan users.
             Medicare is a Health Insurance Program which serves United States citizens 65 years of age and older, some disabled people under 65 years of age (Beginning in July 1973, Medicare was extended to persons under the age of 65 with certain disabling conditions. In 1988, Congress passed legislation to expand the program to cover health care costs of catastrophic illnesses, to be financed by a surtax on the incomes of taxpayers over the age of 65; this legislation, however, was repealed the following year. Medicare costs are met by social security contributions, monthly premiums from participants, and general revenues.
             Traditional private healthcare insurance allows members to choose the physician and facility. It then reimburses those providers the healthcare after it has been received. Managed care differs from this by contracting with the healthcare providers before the care is given and setting a pre-set payment plan. The enrollees in the plans can only chose providers who have agreed to these ter
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