The government reduces Medicare payouts by a fixed percentage, starting at 1% in 2014 going up until it reaches 9% in 2022, to any participant who doesn't meet meaningful use requirements. The only way to opt out of the requirement is to completely opt out of medicare. That rather sounds like a nonvoluntary penalty carrying program to me.
IMHO, that's a feature, not a bug. Though it is unfortunate that some doctors have to be dragged kicking and screaming into the 21st century; I'd be really suprised if such doctors were better, by any reasonable metric, than one that had needed no prodding for EHR.
