[Enlightened1]

How is the federal government the customer in Medicare/Medicaid?

[Alberta's Child]

The Federal government pays the bills under the terms of contracts signed between the government and the health care provider.

That's one of the things that has destroyed medical care in the U.S. (and most of the world).

A doctor may have patients, but he really works for his customers (i.e., the ones who pay the bills).