Before 1965, medicine was not an especially lucrative profession. That changed when President Lyndon Johnson signed the Medicare bill. "This is not the first time money has entered into the doctor-patient relationship," Dr. Rothman says. "To hear some doctors talk about managed care, you'd think medicine had been a priestly duty before. Medicare brings money into medicine in a new way, because it created customary fees. Ultimately, every financial incentive in the system was to do more, which brought physicians additional income." Dr. Rothman also points to the rise in technologically complicated procedures that detach the compensation of care from time spent with the patient to the procedure itself