The main obstacle to reducing Medicare and Medicaid spending is the fact that physicians have a choice about whether to participate in the programs. In the long run, the fact that physicians have a choice about whom they see and where they practice is the most significant challenge to the full implementation of Obamacare. The logical thing — politically and economically — is to eliminate that choice. You don’t have to formally nationalize the health-care industry; you just nationalize 40 percent of each physician’s practice and call it his “fair share.”Doctors, like all licensed professionals, are utterly at the mercy of the state. Obamacare effectively has put the federal government and the states in the insurance business (for the healthy, young, and middle class for the first time), which means that the powers that control physicians’ licensing now have economic interests that are adverse to those of the doctors themselves. It is easy to imagine yet another episode of “fair share” rhetoric being deployed to conscript doctors in trying to make this unworkable mess work. Senator Warren’s totalitarian analysis — that the government has a claim on your property in the present and future because it exerted a claim on the property of others in the past — is entirely applicable here: Ambulances move on public roads, the government supports medical research, etc. You didn’t build that. So here’s your federally mandated portion of money-losing Medicare and Medicaid patients. They won’t call it conscription; they’ll call it shared sacrifice.
Which will lead to another wave of physicians saying "the hell with it," and leaving the profession.