The hospital tells them what they will do and what care they will offer. There are maybe a half dozen doctors in my area who are not working in a "Care" (ie hospital) net work. And they are not accepting new patients because they are so busy.
And of course the lovely time they have when the insurance company wants them to fill out paperwork justifying keeping a patient on medicine for a chronic condition.
We had a top notch health care system.
And we let Obama kill it.
Obama didn't kill it.
Failure of one or the other side in the original Medicare debate (1955-1964) to prevail and impose a free-market system or a nationalized system killed it.
The compromise structure of the post-1965 hospital finance system was never sustainable. Reagan's band-aids (DRGs and EMTALA) let the hybrid system survive for a while, but it was never built for the long run.
"Obamacare" became inevitable, if only to keep the doors open for another 10-15 years, but it's just about done now.