Thanks to Kevin for this reference. Several groups California seem to be opting out of the third party payers hegemony.
Dr. Harold Sox in the Dec 4,2007 issue of the Annals of Internal medicine gives a brief history of the medical "guild" ending with this sentence:
"...by the mid-1960s the [medical] profession has become increasing subservient to the principal purchasers of health care;business and government."
In somewhat understated prose he nails it.
However, later he suggests that the third party payers have made an effort to make make medicine more lean and evidence based and he cajoles the internist readers of the Annals to meet "our partners"at least halfway. As expected he makes the obligatory genuflect to the concept of of the medical profession's obligation to work to conserve finite medical resources. For physicians to live up to the tenets of professionalism as defined by the ACP and the Annals folks private practice docs have to cooperate fully ( or at least halfway) with the altruistic efforts of third party payers to conserve resources and practice evidence based medicine.
The docs in California realize meeting them half way is worse than impossible it is probably suicidal.
"Well, he hands you a nickel ,he hands you a dime
he asks you with a grim if you're having a good time"
Many internists in private practice and their patients have long since stopped enjoying a good time.
Hats off to the physicians with the courage to say no.They have realized a simple fact.
The third party payers will not control medicine if the physicians do not contract with them.