Everyone should read Dilbert -- it is the most intelligent current commentary on the state of bureaucratic affairs, and while not as thoroughly terrifying as Kafka, it is insightful and helps maintain a sense of humor about all this. Which for me, is the only way to adapt and survive.
Going outside of Medicare is not possible in most areas of the country -- most everyone out here is on Medicare, and even the ones who have the means would never pay out of pocket. The rich feel just as "entitled" as the poor, they just see it differently (unlike the undeserving poor, they earned their right to Medicare, etc.)
Bureaucracies are in business to stay in business. Not to make good decisions. Doesn't matter if it is Unkle Sam or IBM or Lockheed or United Health Care. A bureaucracy is a bureaucracy. I would take my chances any day with Medicare over United Health Care or Blue Cross. Medicare is just dense. United Health Care is devious and vicious. I also suspect they are sadistic, and are fully aware of and enjoy discomfiting physicians.
They invite us to play cat and mouse games with them. It's frustrating. Some days I want to quit, but then, tell me a better job!
