I'll take a swing... I believe that the most correct answer is "who the **** knows" as the variables in play are far too unpredictable -- the largest one being the federal government.
If forced to speculate, I would have to side with significant painful changes for all involved. If MC/MA continues to operate as it currently does, their non-negotiable fee schedules will have the same effect as any fixed-income annuity -- the returns will be decimated in an inflationary environment. As these payments continue to lag the costs of providing the services, marginal services will continue to suffer and ultimately disappear. We are already experiencing this with the latest round of L&D closures and hospital system acquisitions of healthcare providers just to mention two examples. Rural areas will be particularly hard hit; their low population densities and unfavorable payer mixes will continue to place pressures on already constrained budgets. Services that cannot stand on their own financially (due to volume constraints) will be concentrated into population centers -- and those that cannot be sustained due to the fiat pricing structure will be relegated to subsidized entities. Providers will increasingly display a herd mentality, forced into seeking a false protection from an association with regional power brokers; this is a false protection because they are trading their autonomy and decision driving authority in for becoming a line item cost -- a burden to be managed and directed -- by a corporate structure. In the end, providers will lose....
The huge "demand destruction" is a form of rationing and will ultimately be required. This is largely why I argue that the physician shortage is a farce; you cannot, on the one hand, claim that we do not have enough providers to service the needs -- while decrying the volume and aggregate cost of these services being provided by the existing workforce (unless you want more providers, each providing significantly less... and at a higher cost and lower efficiency).
A hyperinflationary event will only unduly impact providers if their payments remain cardinally fixed; if the pricing mechanism becomes more elastic we will likely still experience declines (b/c the general populace believes that the current prices are inappropriate), but they will not be nearly as painful as they would likely be under a purely free market approach.
