David,
I vowed to stay out of this, but you drew me in.
Your dystopian view may come to pass. I think a simpler version is much more likely, and fits with many ideas that are floating around at very high levels in government now.
Step one: Congress passes a law that Medicare participation is a pre-requisite for a medical license. This has been bandied about on a state level, too, and really might happen.
Step two: A revision to the Medicare fee schedule: no more RBRVS, just a salary payment, with reductions or incentives based on your (perceived) quality of care. Payment is no longer based on volume, which is just what is being discussed now.

Jon
GI
Baltimore

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