The shell game he’s describing begins and ends with government. Medicare’s government-administered reimbursement system allows hospitals to collect separate facility payments for outpatient services while reimbursing independent physician practices at lower rates for many of the same services. Hospitals and other savvy corporations can acquire or establish outpatient practices and, through hospital affiliation and qualifying facility designations, become eligible for additional payments unavailable to independent practices. These government-created financial incentives reward consolidation, favor large hospital systems, and undermine smaller independent practices. Yet it’s so much sexier to blame the greedy doctor while the benevolent government bureaucrats and their corporate cronies get off scot-free, bonuses in hand, for supposedly making the world a better place. The problem isn’t your typical small private practice. It’s the government-designed system and the corporations that profit from it.