A growing number of Democratic physicians are running for public office, driven by frustration with rising healthcare costs, declining access, and policy decisions that often feel disconnected from clinical reality. The instinct is right, no matter which party. Few professionals experience the consequences of healthcare dysfunction as directly as doctors do. But if physicians truly want to transform U.S. healthcare rather than remain constrained by it, we must confront a harder truth that clinical expertise alone is not enough.
Through my experiences over the past three decades, I have come to understand the nuances of how healthcare is financed and how power is exercised through data, contracts, and incentives. That understanding has shaped my belief that meaningful reform depends as much on who delivers care as on who controls the economics, data, and the negotiations that govern.
This is ever more apparent in issues related to United Healthcare and Medicare Advantage as the tip of the iceberg of who controls the levers in healthcare. I have repeatedly said that no matter what reforms are put in place, one dynamic will remain constant (for the time being) that insurance companies will never go bankrupt. No matter the changes in laws or policy, they will find a way to beat the system. There is no better evidence than the unintended consequences of where we are 16 years later with the Affordable Care Act.
READ: Upside-down food pyramid: When nutrition advice ignores economic reality (January 8, 2026)
Healthcare today is not primarily a clinical system. It is a financial and administrative one. Employers purchase coverage and insurers design benefit structures. Pharmacy benefit managers shape drug pricing. Hospital systems consolidate leverage. And increasingly, algorithms determine access, authorization, and payment. Physicians operate inside this machinery, but rarely control it. Insurers control the financial float — not doctors or employers.
This imbalance is becoming more visible and more consequential. In Maryland, recent disputes between UnitedHealthcare and major health systems brought this reality home when tens of thousands of patients were suddenly pushed out of network, not because of medical judgment, but because of failed contract negotiations. These standoffs are not about quality of care. They are about data ownership, pricing power, and who gets to dictate terms. Insurers hold enormous leverage because they control claims data, utilization metrics, and increasingly the algorithms that drive reimbursement and authorization.
This is why the medical profession has struggled to “move the needle” on reform. Most physicians, even highly engaged ones, cannot fully trace how money flows from employers to insurers, through PBMs, into hospital systems, and finally to providers. Insurers, hospitals, and lobbyists, by contrast, understand this ecosystem in granular detail. They know where the margin lives. They know how contracts are structured, negotiate relentlessly and hold the cards.
That gap is widening rapidly with the rise of artificial intelligence. AI will not only transform clinical care diagnostics, imaging, and decision support but also the administrative backbone of healthcare: billing, utilization management, prior authorization, risk adjustment, and workforce allocation. Without a working understanding of how AI reshapes incentives and bargaining power, physicians risk falling further behind. The danger is not missing a technological trend but is losing influence over how care is organized, paid for, and accessed as algorithms will increasingly mediate those as evidenced by the announcement of ChatGPT Health this week decisions.
There is also a cultural challenge within medicine itself. We as physicians are trained to value certainty, authority, and individual decision-making. Public leadership demands humility, coalition-building, and compromise. Doctors who assume their credentials alone entitle them to lead often struggle. Those who succeed are willing to learn quickly, listen carefully, and engage power without being consumed by it. This is a very difficult transition for doctors who are used to being in control and I know this firsthand.
If doctors want to transform U.S. healthcare — and stop being beholden to insurers and administrative machinery, we must broaden out training beyond medicine. We must understand finance as well as physiology, algorithms as well as anatomy, and negotiation as well as diagnosis. We must engage technology, especially AI, before it defines the rules without us.
America does need more doctors in public life. But it needs physicians who recognize that healthcare is not only a moral or clinical enterprise. It is also an economic, technological, and political system. Only when we learn to operate confidently in all three will we be able to reshape a system that, for too long, has been steered by everyone except those who care for patients.