Almost Sounds Like Saskatchewan
Most of these doctors were good men, and many had offered free clinics one day a month before the government changed the rules. They couldn't understand why these new clients, who clearly needed medical assistance, were coming in now when they hadn't appeared for the free clinic.
The answer was: pride.
These were people who refused to take anything for free, because they understood perfectly well that to take something from one person, you had to give something back - and they had nothing to give. They may have had land, and homes, and farms; but they didn't have cash. Their wealth was tied to where and how they lived, so they made do with what was there.
But they did understand taxes.
They understood perfectly well that provincial and federal revenues were collected from everyone - this was how infrastructure (which everyone used) was created. When everyone pays for something, everyone can use it. Only the most desperate of people begged, and gosh darned it, they weren't that hard up just yet. The popular phrase in England is "too poor to paint, too proud to whitewash".
Meet some people who are.