Healthcare Thought Experiment

Here is a thought experiment. You are a 55 year old vascular surgeon and you've been practicing medicine for 25 years. You went to medical school, did years of internships, studied and passed the boards. You have done hundreds if not thousands of carotid endarterectomies, bypass surgeries, and stent implantations. Over the years you've made alot of money as this is complex and critical stuff this vascular surgery (cardio-vascular disease is one of the five diseases that account for 75% of healthcare spending). You've raised kids and now have grandkids. For the near miracle of a carotid endarterectomy, which can add years onto someone's life, you used to get paid a couple thousand dollars. As Medicare has tried to put a lid on costs, that figure has gone down to less than a thousand bucks, say $900. The success rate of such surgery has gone up, so it should be more valuable, as should your own value since you've performed so many of them, but nonetheless you are earning less for this surgery. Now ObamaCare passes and in order to "bend the cost curve" reimbursement for carotid endarterectomies falls further - either through direct mandate Medicare lowers its reimbursement rate or the "comparative effectiveness" folks determine that this is a costly procedure based on some "quality of life adjusted years" formula. Let's say it falls to $600. What do you do? Here are some options:
1) Keep practicing this highly complex and special skill you have for the price a plumber would charge to install a sink (call this the "suck it up" or the "public spiritedness" option);
2) Retire to spend time with the grandkids, or do just about anything else given that you have more than enough money to retire (call this the "live your life" or "Go Galt" option;
3) Refuse any patients in need of a carotid endarterectomy that can't pay you in cash an amount more reflective of the free market price for the procedure, say $2500 (call this the "demand fair payment for your services" option);
4) Refuse to perform any carotid endarterectomies at any price and solely perform elective cosmetic vascular surgeries like repairing middle-aged women's vericose veins, where you make more money? (call this the "Half Galt" option)
5) Sue the government, maintaining that forcing you to perform carotid endarterectomies for $600 represents a "taking" of your private property, your expertise and training (call this the "fight City Hall" option).

Hmmm. Interesting thought experiment, no? Think option 2 isn't realistic? Watch this. Think option 4 is nuts? Read this. Think option 3 is crazy? Read this. Think option 5 is nuts? Read this. Might I suggest that the only nutty option here is option 1? So what will "bending the cost curve" do for our healthcare system if it is indeed achieved through lower reimbursements to doctors? Plenty to ponder there. Thanks for playing along.