With the coming advent of Accountable Care Organizations and the re-branding of capitation under the banner of "cost containment", the Surgeon realizes his days as an independently practicing general/trauma surgeon are probably limited. He understands that the only way to make the coming paradigm work (where health care spending is capped for specific inpatient admissions) is if all the doctors are employees. The idea is to eliminate the stake for physicians. If you are employed, then it doesn't matter to you if the employer stops getting reimbursed after a set spending limit during a long, complex admission. You get paid the same no matter what. A non-employed surgeon who gets asked to see a decrepit old ICU patient with free air at two in the morning when said patient has already gone past the reimbursement cap will be none too happy when he finds out he will get paid zilch for his troubles. The employed surgeon couldn't give less of a shit.
The Surgeon understands this "solution" as a quintessential deferral of responsibility. The main issue (performing unnecessary surgeries, providing futile care, ordering unnecessary tests) is kicked down the road. All that is addressed is the cost issue; to the extent that, mathematically, final hospital tallies will end up being reliably less than before. It is so much easier to declare, by fiat, that all this unnecessary medical care that occurs in the USA, especially in the last 6 months of life, will henceforth be written off, a victim of capitation, rather than to delve into the dark quagmires of rationed medicine and recognizing the limits of modern science. Much more difficult to catechize a generation of physicians who are not afraid of limits, of death, of the futility of efforts--- once a certain line has been crossed---- who are willing to see this calling as something far nobler than an income stream worked in shifts. And even more difficult to inculcate such complexity of thought in the mind of the general American populace.
It's pure cowardice.