In medicine, Medicare and Medicaid have made health care more inefficient and more expensive. Former ophthalmologist and Congressman Ron Paul tries to give the reader a sense of a time before such entitlement programs existed. Because Medicare and Medicaid were enacted in 1965, over fifty years ago, it is difficult for most Americans to remember a time without them: “the poor and elderly were admitted to hospitals at about the same rate they are now, and received good care […] every physician understood that he or she had a responsibility toward the less fortunate, and free medical care for the poor was the norm” (Paul). Without Medicaid and Medicare, physicians would act in a similar fashion today, since they did so without a government mandate