This article investigates the ways in which the relationships between patient, provider and hospital have evolved in the past fifty years, while paying special attention to the influence of modern health care reform on all parties involved. Using Medicare as the primary standard, the nation's health care system is examined both historically and in light of recent changes that seek to transition its structure from one that is cost based to an approach that emphasizes performance. It is only through understanding the roots of our health care program that we can make informed decisions designed to improve its future impact and benefit both the system and the people it seeks to serve.