It is so strong that even I, a libertarian, once had fantasies of a libertarian practice free of government payment and also free of a business transaction. My libertarian version of this fantasy was a clinic in which people just drop whatever donation they feel moved to drop in a sloted box in the waiting room.

Now, 20 years out of med school, I see how incredibly naive any fantasy that such could work really was. It isn’t that people don’t value medical care the way they value their church or other organizaitons they support, rather, at a gut level, they just resent paying anything for it just as they would resent paying their mother for her affections. People’s ability to overcome these primitive fantasies and feel comfortable with their physicians riightful desire for just compensation in and exchange of value with the patient is dependent on achieving a certain level of personal maturity that many people simply never reach.