Physicians were in individual or small group practices, practiced medicine independently, and ran their own business. When the government's attempt to nationalize health care failed in the 1960s the void was filled by big business. The economics of medicine is now controlled by these big insurance companies. No longer is a physician a true individual entrepreneur. Medicine has become a unique industry in which almost all of the economic might and economic control are on one side.
Insurance companies are exempt from antitrust laws.
Although considered natural competitors of each other, they often conspire and lobby to achieve their goals. Physicians on the other hand cannot even discuss economic issues such as fees and contracts together or they are in violation of antitrust laws, and as has been shown many times, will be vigorously prosecuted for this by the federal government. With these changes, medicine is now following the rules of the economic marketplace that it had long been exempt from. This has not occurred simultaneously throughout the country. Areas such as California, Minnesota and Florida have been most affected.