02/15/2026
"...Consider the wisdom and righteousness of that old-time custom—the paying of the physician by the year. Consider what a safeguard it was, for both the physician’s livelihood and self-respect, and the family’s health. The physician had a regular and assured income, and that was an advantage to him; the family were safe from his invasions when nothing was the matter, and goodness knows that was an advantage to the family.
Look at the difference in our day. What is the common, the universal, custom of the physician with a limited practice? It is this: to keep on coming and coming, long after the patient has ceased to need him—and charging for every visit. Almost as a rule—I might fairly leave that “almost” out—you are driven to the unpleasant compulsion of discharging him, in order to get rid of him. As a consequence you dread to call him again; and you put it off just as long as you can without peril..."
So, per Twain, the idea behind Direct Primary Care (DPC), simple membership payments instead of fee for service, dates back to well before 1842:
Thanks to the Mark Twain Project for researching and posting this: https://www.marktwainproject.org/about.html
https://www.marktwainproject.org/writings/autobiography3/autobio_supplements/prelims/something-about-doctors/
