I recall a meeting of the private practice committee of the Manhattan District Branch of the American Psychiatric Association at the Payne-Whitney Clinic more than 25 years ago. I guess nobody was worried about the future of private practice back then. Only about three of us attended. We talked about psychiatrist Jay Reibel, MD at Four Winds psychiatric hospital and his attempts to cut costs for the State of New York by reviewing cases in what may have been the first "behavioral carve out."
We love to hate managed care in psychiatry as much as anywhere in medicine, but to help keep it all in perspective think back to the months long hospital stays and years of four sessions a week psychotherapy. Ask yourself whether we could ever be wealthy enough as a society to sustain such benefits for more than a privileged few. You can read more in this 1985 article from the New York Times: