https://www.crainsdetroit.com/crains-content-studio/publishing-partner/cdb-mahp-mha-ideas-healthcare-affordable/

https://shvs.org/current-considerations-for-state-reinsurance-programs/

Free ideas to make healthcare affordable
By Dominick Pallone & Brian Peters - June 22, 2026

More Michiganders are taking a gamble by going without health insurance, jeopardizing their healthcare because they cannot afford the costs. While Michigan has historically maintained an uninsured rate below the national average, increases in health insurance premiums, the loss of federal healthcare tax credits and federal changes to Michigan’s Medicaid program will likely push another 200,000 Michiganders into the ranks of the uninsured, bringing the total to well over half a million.

To compound the uninsured spike, a troubling new trend among young professionals is to bet on their youth and decline employer-offered commercial health insurance. These bets can come at extremely high costs for all involved. The patient risks high out-of-pocket costs and plans suffer due to changes in the risk pool, while providers face higher rates of uncompensated care.

High costs are impacting Michiganders of all ages. Nearly 60% of older adults in Michigan are unable to afford essential prescription drug medications. Seniors with fixed incomes are now forced to choose between adhering to their treatments and other financial demands of life. This is not the American dream.

Increasing healthcare costs are forcing customers and patients to walk away from the healthcare table, feeling frustrated, annoyed and further in debt. It must stop. It is incumbent upon us to lead with solutions, rather than allowing finger-pointing.

Earlier this year, our associations brought together our teams to develop and share state-based policy ideas to lower healthcare costs in Michigan. Insurers and providers are in this crisis together and must find ways to help Michiganders stop rolling the dice with their health. We need to think creatively and focus on issues that can generate out-of-pocket savings for patients.

One such idea is reinsurance, which can be done at no cost to taxpayers. Seventeen states offer reinsurance programs to help pool costs for higher-cost medical claims. A state can establish a reinsurance program through cost savings by transitioning from a federal to a state exchange platform, at no cost to customers. States that have developed reinsurance programs have reduced premiums by an average of 16%, according to a Princeton University study.

Later this year, it is expected that Congress will pass several changes to allow small businesses and independent contractors to join broader Association Health Plans, which offer more affordable health insurance in a larger group setting. Michigan should be the first state in the nation to codify these changes into state law and preserve the expanded scope and accessibility of Association Health Plans. AHPs offer a more affordable health insurance option for small businesses, especially those in the gig economy. This is another idea that costs taxpayers nothing.

Michigan must also stop imposing taxes and mandates on health-related goods and services if it wants to prioritize healthy living. Government mandates on insurers to provide certain benefits or coverage, and regulations on hospitals to maintain mandated staffing ratios and meet various nuanced licensing requirements increase the costs of care.

One last creative idea is called a Medicaid Buy-In policy, which would allow uninsured Michiganders within a specific income threshold to purchase government-sponsored insurance that is cheaper than anything on the marketplace and could cost state taxpayers nothing. Such a policy requires federal approval but would create an important bridge for those most likely to find themselves underwater as a result of the upcoming Medicaid changes, or for those no longer able to afford individual marketplace insurance.

Overall, we need to continue to support solutions that protect access to care and help our communities. It’s time to stop Michiganders from further risking their pocketbooks and gambling on their health. It’s time to be bold and advance real reforms that will make healthcare affordable.

The CEA released their 11 page report Effects of Banning Hospitals Anti-Steering, Anti-Tiering, and All-or-Nothing Contracts on June 18th.  They find these three anticompetitive practices add about 5% to your healthcare bills.  Here is the Executive Summary and a link to the full report along with its substantial data set in pdf/zipped format:

https://www.whitehouse.gov/research/2026/06/effects-of-banning-anti-competitive-hospital-contracts/

https://www.whitehouse.gov/wp-content/uploads/2026/06/Effects-of-Banning-Hospitals-Anti-Steering-Anti-Tiering-and-All-or-Nothing-Contracts.pdf

Executive Summary

Anti-steering, anti-tiering, and all-or-nothing bundled contracting are mechanisms by which dominant hospital systems insulate themselves from price competition: anti-steering prohibits insurers from directing patients toward lower-cost providers; anti-tiering is one form of anti-steering that bars insurers from placing the dominant system in a less favorable benefit tier; and all-or-nothing contracting requires insurers to accept every hospital and affiliated physician in the system or none at all. The DOJ’s February 2026 complaint against OhioHealth and March 2026 complaint against New York-Presbyterian allege that anti-steering restrictions are anticompetitive. Both cases are pending.

This memo develops estimates of the hospital price and health insurance premium reductions that would follow a nationwide ban on all three mechanisms collectively. We estimate that a ban would reduce hospital and affiliated-physician prices by 18 percent (with a plausible range of 11 to 26 percent), averaging ~$4,100 per inpatient admission, in directly affected markets through three channels: restored insurer bargaining leverage, patient sorting to lower-cost providers, and over time, additional price concessions as removing the clauses allows competing systems to become more credible alternatives to insurers. After scaling by the hospital and affiliated-physician share of total employer-sponsored insurance (ESI) spending (approximately 57 percent) and applying a 70 percent pass-through rate, ESI premiums in directly affected markets would fall by an estimated 6.5 percent (ranging from 4 to 9 percent).

In directly affected markets, that premium reduction corresponds to savings of ~$1800 ($1,100 to $2,500) per family annually and ~$600 ($380 to $860) per individual (2025 dollars). Because the economic incidence of ESI premiums falls on workers, these savings flow to employees through some combination of lower out-of-pocket premium costs and higher take-home wages. Reduced hospital prices also raise payroll and employment at non-health-care employers and increase federal income tax receipts, with gains concentrated among lower- and middle-income workers. We estimate that 24 percent of Americans covered by ESI are in markets where these clauses are binding and consequential. Scaling our estimates to account for that indicates that nationwide ESI premium savings of 1.6 percent, amounting to ~$45 billion ($29 to $63 billion) per year.

The expected effects vary by market structure. In markets with a dominant system and competitive insurers, we expect premium reductions of 4 to 6 percent. Where both the hospital system and insurer have market power, the estimated reduction is 2 to 3 percent. In more competitive markets with lower clause prevalence, 1 to 2 percent.

For rural communities, multi-market systems may use anti-steering and all-or-nothing contracts to extend urban market power to rural hospitals, elevating prices in those communities. A ban could reduce premiums for rural workers and employers, improve the negotiating position of independent rural hospitals, and impose minimal pressure on system-owned rural hospitals.

https://sturgishospital.com/sturgis-hospital-closure/

Sturgis Hospital Closure
By D. Brown | June 16, 2026

Important Announcement from Sturgis Hospital

Sturgis Hospital today announced the difficult decision to cease operations pending closure. The hospital will stop seeing patients on June 19, 2026 at noon.

This decision follows many years of ongoing financial challenges facing rural healthcare providers, including declining reimbursement rates, rising operational costs, and a sustained decrease in patient utilization. Despite extensive efforts by hospital leadership and the Board of Directors to secure the hospital’s future, including pursuing potential acquisition opportunities and partnerships, a sustainable path forward could not be achieved. This decision was reached only after every reasonable option to continue operations was thoroughly explored.

The closure will affect all hospital departments and services, including the Emergency Department, Endoscopy, Surgery, Laboratory, Medical Imaging, Physical Therapy, Cardiac Rehabilitation, outpatient clinics, and supporting ancillary departments.

We thank you for partnering with the hospital, whether it was as a provider, a partner, or a supplier. We also thank you for your support and your patience while we have navigated this difficult journey.

Patient safety and continuity of care remain the hospital’s top priorities. Sturgis Hospital will proactively notify active patients with upcoming appointments so those appointments can be canceled, and arrangements made for care with other facilities.

Any patient who is experiencing an emergency should report to the closest Emergency Department, including Parkview LaGrange Hospital, Beacon Three Rivers Hospital, and Insight Hospital Coldwater.

Patients who wish to obtain copies of their medical records may do so by calling 269-651-7824 or by visiting sturgishospital.com to obtain the Patient Release of Information Form under Contact Us. This form is to be completed and brought to the hospital. This form can also be obtained at the hospital.

For a copy of this announcement, please click the link below.

https://sturgishospital.com/wp-content/uploads/2026/06/Announcement_Sturgis_Hospital-2.pdf

Their million square foot warehouse in Tracy, California was destroyed by a huge fire yesterday.  This will probably create regional shortages of various medical supplies and PPE price increases across the country.  Tracy is located in San Joaquin County, due east of San Francisco. 

Was this another anti-capitalist arson like the huge April 7th Ontario, California Kimberly-Clark toilet paper distribution center fire?

https://www.mdm.com/breaking-news-in-wholesale-distribution/medline-distribution-center-in-california-destroyed-by-massive-fire/

Medline Distribution Center in California Destroyed by Massive Fire
A fire that erupted June 11 at Medline Industries’ 1 million-square-foot distribution center in Tracy, CA completely engulfed the facility, with firefighting efforts expected to continue for several days. No injuries were reported and all employees were accounted for.
By MDM Staff - June 12, 2026

A massive fire that broke out June 11 at a Medline Industries distribution center in Tracy, CA destroyed the medical-surgical supply distributor’s approximately 1-million-square-foot facility, with firefighting operations expected to continue for days.

The fire began at about 1 p.m. local time at Medline’s warehouse at 5701 Promontory Parkway, according to the City of Tracy. Fire crews initially responded to reports of a fire on the roof of the facility and found a rapidly developing blaze involving the roof area of the structure. The city said early suppression efforts were hampered by a failure of the building’s private fire water system, which significantly affected initial firefighting operations. High winds, low humidity and elevated temperatures contributed to the fire spreading from the roof into the building’s interior and eventually throughout the facility.

The cause of the fire remains under investigation.

The city said wind-driven embers from the main fire ignited several spot fires in the surrounding area, including fires involving pallet storage areas and trailers near a FedEx facility. Additional spot fires occurred, with mutual aid resources deployed to contain them, and numerous local fire response teams supported fire suppression efforts .

No injuries have been reported, and Medline said all of its employees and other personnel at the site were accounted for. Nearby FedEx and Amazon distribution centers were evacuated as a precaution as firefighters worked to contain the incident and prevent further spread.

“The safety and well-being of our employees is our top priority. We are coordinating closely with local authorities and first responders as we assess the fire’s impact and will share more details as they become available,” the company said in a statement.

Northfield, IL-based Medline is the largest provider of medical-surgical products and supply chain solutions serving all points of care, according to the company. Medline reported full-year 2025 net sales of $28.4 billion, up 11.5% from 2024, and net income of $1.2 billion. The company employs more than 45,000 people worldwide and operates in more than 100 countries. Medline’s broader operating footprint includes more than 29 million square feet of warehousing globally.

The Tracy facility was one of Medline’s largest West Coast distribution operations and served as a major Northern California hub for medical products and supplies. AP noted that Medline supplies products including latex gloves, masks, surgical instruments and other medical supplies, and that the Tracy operation played a key role in distributing medical supplies during the COVID-19 pandemic.

The loss of the Medline facility follows another major distribution center fire earlier this year. On April 7, a six-alarm fire destroyed a 1.2-million-square-foot Kimberly-Clark toilet paper distribution center in Ontario, CA. Authorities later arrested an employee of a third-party logistics provider operating the facility on suspicion of arson.

https://www.justice.gov/opa/pr/justice-department-secures-resolution-cleveland-clinic-end-pediatric-gender-affirming-care

Justice Department Secures Resolution with Cleveland Clinic to End Pediatric “Gender-Affirming Care”
For Immediate Release - Friday, June 5, 2026
DoJ Office of Public Affairs

Cleveland Clinic Foundation follows Texas Children’s Hospital in reaching agreement with the Department of Justice to provide detransition care and not perform sex-rejecting procedures on minors

Today, the Department of Justice announced another resolution arising from its ongoing national investigation into violations of federal law in connection with sex-rejecting procedures on minors (often euphemistically referred to as “gender-affirming care”). The Cleveland Clinic Foundation (“Cleveland Clinic”) has entered into agreements with the Department and the Ohio Attorney General that include a decades-long commitment to not perform or offer sex-rejecting procedures—which includes the administration of puberty blockers and cross-sex hormones—for minors. Cleveland Clinic has also agreed to pay a monetary penalty and, in a landmark commitment, dedicate additional millions to help provide essential medical care for individuals living with the harmful consequences of such misguided medical interventions performed on them as children and adolescents (i.e., “detransitioners”).

“The Department of Justice is steadfastly committed to protecting America’s children,” said Associate Attorney General Stanley Woodward. “Just as the resolution with Texas Children’s, today’s resolution with Cleveland Clinic furthers that commitment and puts these providers on notice that this Department will vigorously enforce federal law where children are put at risk.”

According to the terms of the agreements, which the Department reached in coordination with Ohio Attorney General Dave Yost, Cleveland Clinic—a partner in other Administration priority initiatives—will pay $308,000 to resolve allegations regarding false billings submitted to public and private payors to secure insurance coverage for sex-rejecting procedures on minors. As part of the resolution, Cleveland Clinic has committed $2 million to provide restorative care for detransitioners—the very victims of these predatory and dangerous practices—regardless of their insured status or ability to pay.

The agreements come less than a month after the Justice Department announced its resolution with Texas Children’s Hospital (“Texas Children’s”), which the Department secured through a partnership with Texas Attorney General Ken Paxton. As previously announced, Texas Children’s agreed to pay a $10,000,000 penalty, and, much like Cleveland Clinic’s commitment today, create the first-of-its-kind clinic dedicated to treating detransitioners. Texas Children’s also agreed to permanently cease providing any sex-rejecting procedures to minors.

These historic commitments pair the cessation of these dangerous practices masquerading as medical treatment with substantial investments in remediating the destruction they cause and restoring the health of the victims.

In working towards this settlement, the United States acknowledged that Cleveland Clinic took significant steps entitling it to credit for cooperation with the Department in its investigation. At all times during the investigation, Cleveland Clinic remained cooperative, proactive, and solution-driven, as highlighted by its multi-million dollar commitment to providing care to the victims who most need it.

“I am grateful that institutions like Cleveland Clinic and Texas Children’s have decided to be part of the solution, not part of the problem,” said Brett Shumate, Assistant Attorney General for the Civil Division. “Cleveland Clinic’s commitment to providing millions of dollars towards care for detransitioners is emblematic of just that. I am grateful for this resolution with Cleveland Clinic, but our work is far from over, and our division will continue to work tirelessly to protect America’s children and hold accountable those that have preyed on vulnerable children, whether they be pharmaceutical companies or medical providers.”

These matters and the investigations into sex-rejecting procedures on minors are being led by the Justice Department’s Civil Division Enforcement and Affirmative Litigation Branch and Commercial Litigation Branch, Fraud Section.

The claims resolved by the United States in the settlements are allegations only, and there has been no determination of liability. Cleveland Clinic has denied all allegations.

https://medicalxpress.com/news/2026-06-nursing-home-staffing-declined-states.html

Nursing home staffing declined in states that protected facilities from COVID-19 malpractice lawsuits, study finds
By Gretchen McCartney, University of California, Los Angeles
June 2, 2026

Nursing homes across the country had less staffing in states where legislatures granted the facilities immunity from COVID-19-related lawsuits filed by patients and their families, according to findings from a new UCLA-led study.

Study links immunity laws to staffing

Researchers examined data from 13,205 skilled nursing facilities; those in states with litigation immunity reduced staffing by 2.5% compared to facilities in states that did not pass similar protections for nursing homes. That reduction translated to an average of almost eight hours per day of staff conducting clinical care and other duties per nursing home. The data were collected from 2018 to 2023.

"During the pandemic there was a lot of understaffing. It was even worse in these states with immunity from lawsuits," said Jill Horwitz, an Emerita Professor of Law at the UCLA School of Law, where she began the research published in the Journal of the American Medical Association.

She also is an expert on health policy and continued to work on the study at Northwestern University's law and medical schools, where she is now based.

Widespread adoption of tort immunity

Researchers were surprised by the numbers, they said. "These policy changes are not associated with a defined monetary reward or fixed staffing target," said Dr. David S. Zingmond, corresponding author and professor-in-residence at the UCLA David Geffen School of Medicine's Division of General Internal Medicine and Health Services Research. "So the robust magnitude of change was surprising."

Across the country, 86% of states enacted some kind of tort immunity for nursing homes during the pandemic. Some of the laws had an end date and others were indefinite; 23 states had retroactive immunity covering a period before the legislation was passed.

The scramble to pass legislation was sparked by an anticipated deluge of medical malpractice lawsuits alleging that negligent care caused patients to contract the virus or to die from it.

However, medical malpractice law also can help protect quality of care by deterring negligence, the authors wrote in the research.

Staffing cuts hit CNAs hardest

"Relaxing medical liability results in a worse staffing environment," Zingmond said. "Lower staffing negatively impacts care, and nursing home residents are among the most vulnerable patients."

The study found that certified nursing assistants (CNAs), who provide direct clinical care for patients, made up the primary group that saw reduced staffing. Hours worked by registered nurses (RNs), who often serve in administrative roles, stayed consistent in their staffing rates.

Researchers acknowledged the financial challenges and the general instability of health care staffing during COVID-19, which at nursing homes would have compromised the amount of time caregivers could devote to patients. But the numbers suggest that facilities with reduced tort exposure "may have been less likely to employ nursing staff or work to find replacements during shortages," the authors wrote.

Questions remain about care quality

The study did not chronicle the clinical effects of reduced staffing, and that kind of analysis could be the next step in painting a full picture of nursing home care during the pandemic, Zingmond said.

"Nursing home staffing is a predictor of quality of care that we could not directly measure with the data used in this study," he said. "We would like to see how these policies are related to measurable quality and clinical outcomes."

The information analyzed was from two data systems operated by the Centers for Medicare and Medicaid Services (CMS): the Nursing Home Compare (NHC) quality initiative and the Payroll Based Journal Daily Nurse Staffing dataset.

Publication details

Jill R. Horwitz et al, Tort Immunity and Nursing Home Staffing, JAMA Health Forum (2026). DOI: 10.1001/jamahealthforum.2026.1534

Journal information: Journal of the American Medical Association , JAMA Health Forum

https://michiganadvance.com/2026/05/26/class-action-lawsuit-in-federal-court-alleges-illegal-debt-collection-scheme-by-corewell-health/

Class-action lawsuit in federal court alleges illegal debt collection scheme by Corewell Health
By Katherine Dailey - May 26, 2026

Corewell Health, one of Michigan’s largest healthcare systems with 21 medical facilities statewide — encompassing more than 5,000 hospital beds and 60,000 employees — is being sued along with Delaware-based debt collection agency DCM Services, LLC in federal district court for allegedly trying to collect millions of dollars in medical bills that were already paid through insurance and government programs.

The lawsuit, a class-action suit filed Friday in U.S. District Court in Detroit, alleges that Corewell and DCM engaged in fraud and violated state debt collection and consumer protection laws, among other claims.

That practice, which the complaint calls “balance billing,” means that Corewell Health “submits claims for payment to insurers, group health plans, Medicare, or Medicaid and accepts reduced payments under negotiated agreements and governing law as payment in full for covered services.”

Legally, the complaint continues, after accepting those claims, Corewell “cannot bill, charge, collect from, seek compensation, remuneration or reimbursement from, or have any recourse against the patient for covered medical services.”

The complaint alleges balance billing is a “routine and systematic practice” of Corewell Health, listing 19 hospitals where the plaintiffs allege the practice is being used, ranging from Big Rapids in West Michigan to a number of hospitals in Wayne County.

Neither Corewell Health nor DCM Services, LLC responded to requests for comment by the time of publication.

The lawsuit was brought by Michelle Rzanca as a personal representative for the estate of Jordan Field, a Michigan resident who died after receiving emergency medical services at Corewell Health Butterworth Hospital in Grand Rapids in March 2024. Corewell billed over $61,600 for the medical services that he received before entering a payment contract with his insurer, Blue Cross Blue Shield PPO. Among the exhibits in the complaint is a copy of a billing statement from the hospital noting a payment of $19,448.92 listed as “Contractual Adjustment (Insurance).”

Despite that payment, the complaint states that Corewell Health claimed that the Field Estate still owed it a debt of $42,160.70 for the remaining unpaid balance, referring that debt to DCM Services for collection.

“The contract prohibited Defendant Corewell from holding a BCBS-insured patient liable for any payment or fees that were the legal obligation of BCBS. Defendant Corewell could not bill, charge, collect from, seek compensation, remuneration or reimbursement from, or have any recourse against an insured patient for a covered medical service,” the complaint states.

It should be noted that Michelle Rzanca, as a personal representative for the estate of Jordan Field, also has a case before the Michigan Court of Appeals against Oral and Maxillofacial Surgery Associates of Western Michigan PLC.

For instance, it can screen the notoriously long, fine-print insurance plans and spit out how well each might fit one's individual needs or susceptibilities.

And how about those statins??

https://www.beckershospitalreview.com/healthcare-information-technology/ai/vanderbilt-ai-tool-finds-statin-barriers-in-clinical-notes/

Vanderbilt AI tool finds statin barriers in clinical notes

Ella Jeffries    |     February 9th, 2026

An AI framework developed by Nashville, Tenn.-based Vanderbilt University identified statin intolerance, contraindications and patient deferrals documented in clinical notes for 10% of adult patients.

Researchers processed 197,761 clinical notes from 47,192 adult patients using a three-part framework that included a rule-based natural language processing filter with 100% sensitivity, a large language model refinement filter with 97.3% specificity and an LLM-based multicategory classifier, according to a Feb. 9 university news release.

The tool flagged statin intolerance in 6.4% of patients, contraindications in 0.7% and deferrals in 2.9%, according to the study published Jan. 1 in the International Journal of Medical Informatics. The AI tool was highly accurate in identifying statin intolerance and performed well in spotting contraindications and cases in which patients declined treatment.

At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.

https://thedailyeconomy.org/article/the-feudal-economics-of-modern-healthcare-how-regulation-turned-medicine-into-a-fiefdom/

The Feudal Economics of Modern Healthcare: How Regulation Turned Medicine into a Fiefdom
Government-created healthcare monopolies are forcing physicians into a kind of serfdom, gobbling up private practices to extract doctors’ labor.

By Richard Menger • May 19, 2026

High school history curricula often portray feudalism as a quaint medieval relic — a cautionary archetype of concentrated power, conditional rights, and extractive hierarchies that suppressed human flourishing for centuries. As ever, though, the deeper lesson of history is its recurring nature: when property rights erode and rent-seeking supplants open competition, societies reliably drift back toward feudal arrangements.

American medicine today offers a vivid illustration of this pattern, as government-created barriers sustain local monopolies, nonprofit hospital systems function as modern lords, and physicians relinquish professional autonomy in exchange for the illusory security of salaried fiefdoms. The result is contemporary serfs in white coats serving within tax-exempt citadels.

A Primer On Feudalism

In the medieval manor, a lord granted a vassal a fief — a plot of land — in exchange for loyalty, military service, and a share of the harvest. Serfs tilled the soil with little claim to its fruits. The system was rigid, hierarchical, and extractive. Today, a parallel structure has emerged in American healthcare, not through sword and oath but through certificates of need, Medicare payment rules, and tax-exempt status amidst the backdrop of massive mergers and acquisitions.

Non-profit hospital systems function as modern feudal lords. Physicians have become their vassals, granted small fiefdoms — department chairs, service-line leadership roles, or simply in employed practices — in return for allegiance to the system’s revenue machine. This is the neofeudalism of medicine, born out of crony capitalism and regulatory capture.

Feudalism’s formal titles — king, duke, baron, knight, vassal, serf — reflected a chain of reciprocal obligations rooted in land tenure. Lords owned the means of production; vassals administered justice and defense; serfs provided labor. The system endured for centuries because property rights were conditional and fragmented. Allodial title — true private ownership free of feudal dues — was rare. Markets were stifled. Innovation lagged. The decline of feudalism accelerated in the late Middle Ages and early modern period precisely because secure private property rights emerged. The rise of towns, the enclosure movement, and the commercialization of agriculture allowed individuals to own, improve, and trade land outright. Money economies replaced barter and service. The bourgeoisie accumulated capital. Centralized monarchies and later liberal states enforced contracts and reduced arbitrary exactions. As Douglass North and other institutional economists have shown, well-defined, transferable property rights unleashed entrepreneurship and growth. Serfdom withered not because of royal decree alone, but because free exchange proved more productive. Feudal ties dissolved when individuals could keep the full fruits of their labor.

Medicine’s Drift to Neo-Feudalism

Medicine once mirrored this liberalizing trend. Post-World War II, most physicians owned or partnered in independent practices. They controlled their schedules, negotiated directly with patients and insurers, and bore the risks and rewards of their craft. Private property in medical practice — autonomy over one’s office, staff, and patient relationships — fostered competition and innovation. That world is vanishing. Today, nearly 78 percent of US physicians are employees of hospitals, health systems, or corporate entities. Private practice has collapsed into a shrinking remnant.

The new lords are sprawling tax-exempt “non-profit” health systems. These entities enjoy at least $37 billion annually in federal and state tax breaks — property, income, and sales tax exemptions — while operating with margins and executive compensation packages that rival for-profit corporations. Many run massive investment portfolios and for-profit subsidiaries. Their community-benefit spending often falls short of the value of their exemptions when measured rigorously; some profitable systems deliver minimal charity care relative to their tax windfall.

Government policy supplies the moat around these castles. Rule after rule and regulation after regulation favors the big conglomerates. The regulatory reach adds to the lords’ dominion.

Certificate-of-need (CON) laws are still on the books in about 35 states plus DC, requiring regulatory approval before new hospitals, surgery centers, or even MRI machines can open. Incumbent systems predictably oppose competitors’ applications, turning state boards into tools of rent-seeking protection. Without CON, independent physicians and ambulatory centers could challenge hospital dominance. With it, local monopolies flourish.

Once entrenched, these systems wield two powerful economic weapons: the 340B Drug Pricing Program and site-of-service payment differentials. Enacted in 1992 to help safety-net providers serve low-income patients, 340B allows qualifying hospitals to purchase outpatient drugs at steep discounts — often 20-50 percent or more — then bill insurers or Medicare at full list price. In 2024, covered entities purchased $81.4 billion in 340B drugs. But studies and reports show the windfall frequently funds facility expansion, acquisitions, and executive pay rather than expanded charity care for the intended populations. Contract pharmacies amplify the arbitrage. The program has become a hidden tax on patients, employers, and manufacturers, with limited transparency on how savings reach the vulnerable.

Site-of-service differentials complete the trap. Medicare — and many commercial payers — reimburse the identical service at dramatically higher rates when performed in a hospital outpatient department (HOPD) instead of a physician’s independent office. A clinic visit, imaging study, or minor procedure in an HOPD can command 125 to 300 percent more reimbursement. Hospitals therefore acquire physician practices, rebrand them as HOPDs, and capture the facility-fee markup. Patients are sometimes seeing the same doctor in the same building but for twice as much.

Physicians are increasingly likely to be employed by these healthcare entities — not because they want to, but because the structure and rules are tilted that way.

The physician receives a salary or production bonus but loses ownership. The patient pays higher coinsurance. Independent practices cannot compete on price because the payment rules themselves favor the hospital flag. Vertical integration explodes. Horizontal mergers compound the effect. Markets once served by several competing hospitals see them consolidate into single dominant systems: one or two health systems control the entire market for inpatient care in half of American cities. Research consistently shows that such mergers raise prices five to 20 percent or more — with little or no improvement, and sometimes deterioration, in quality. Cross-market mergers demonstrate similar price effects after several years.

The physician-vassal’s daily reality reflects the bargain. A neurosurgeon or cardiologist may receive a competitive base salary, malpractice coverage, and administrative relief from his affiliation with a hospital. In return, the doctor must (directly or indirectly) refer patients only within the system, meet RVU targets that prioritize volume over value, and accept corporate dictates on electronic health records and formulary restrictions. They must accept care pathways optimized for margins, rather than patient outcomes. Dissent risks contract non-renewal, often triggering noncompete clauses.

True entrepreneurship — opening an ambulatory surgery center or cash-pay spine clinic — requires profound courage and near-inevitable litigation within the framework of CON. The independent doctor who once embodied the free professional has become a salaried cog in a revenue-extracting machine.

A Freer Alternative

Reversing neofeudalism in medicine demands restoring property rights and competition — the very forces that ended medieval feudalism. Policymakers should repeal CON laws nationwide, as several states already have with measurable price reductions and new market players. Implement full site-neutral Medicare payment for outpatient services, leveling the field so independent practices can survive. Reform 340B with transparency mandates, patient-definition tightening, and caps on windfall profits unrelated to charity care. Stop the unnecessary ban on physician-owned hospitals that provide better care at cheaper costs. Antitrust enforcement must scrutinize both horizontal and vertical mergers with renewed vigor. Tax-exempt status for hospitals should be performance-based, tied to verifiable charity care and community benefit exceeding the exemption’s dollar value.

Physicians are not serfs by nature; they are highly trained entrepreneurs stifled by regulation. Patients deserve choice, not tribute to the local castle. The same free market principles that dismantled feudalism can dismantle this one — if policymakers have the courage to let property rights and competition do their work. The alternative is a healthcare system where lords grow richer, vassals grow compliant, and everyone else pays the price.

Richard Menger MD MPA is an academic neurosurgeon and a graduate of the Harvard Kennedy School of Government. He focuses on complex spinal deformity and scoliosis surgery performing over 350 operations a year. He is a lead editor of the textbook Economics, Business, Policy of Neurosurgery. He is currently the Chief of Complex Spine Surgery at the University of South Alabama and is on the faculty of the neurosurgery and political science departments. He is a healthcare contributor to Forbes.

BLS did not separate out health care and social assistance violence, nor have they updated these numbers post COVID.  The social assistance sector has done little, but health care employers are taking measures to protect their employees.  We do know from BLS 2024 fatality data that health care workplace deaths have fallen by 25% while social services deaths have not changed significantly since COVID.  Fatalities in each employee category are less than 1% of overall workplace deaths, so the health care industry problem appears to be injuries, rather than homicides.  Most workplace deaths appear to be due to motor vehicle accidents, in any event.

The latest effort from Michigan Medical's Sparrow operation:

https://www.wilx.com/2026/05/14/university-michigan-health-sparrow-expands-panic-button-program-home-care-workers/

https://www.bls.gov/iif/factsheets/workplace-violence-2021-2022.htm

https://www.bls.gov/news.release/cfoi.t03.htm

University of Michigan Health-Sparrow expands panic button program to home care workers
Violence against healthcare workers is on the rise across the country and UM Health-Sparrow is among the hospitals scrambling to keep their staff safe.
By Bobby Cushing - May 13, 2026

LANSING, Mich. (WILX) - Violence against health care workers in the United States has seen a sharp increase in recent years, but at University of Michigan Health-Sparrow, something is being done about it.

The hospital system gives out wearable panic buttons for hospital staff to use when they feel unsafe. Now, that program is expanding to staff who work outside of the hospital’s walls.

The button sits behind a worker’s badge and can be tapped in seconds. Thousands of workers already have the button on them, and more than 250 have used it in the last 10 months. Now, members of the hospice and home care team are getting panic buttons of their own.

A hospital is already a high-intensity workplace, with workers spending long hours performing life-saving work. But there is a growing trend of violence against those workers.

A poll from the American College of Emergency Physicians found in 2024, 91% of emergency physicians said they or a coworker were threatened or attacked within the year.

“Some people just don’t call. They deal with it on a day-to-day basis. You know, our clinicians every day deal with things like this in the hospital,” said Chris Nemets, the Regional Chief Nursing Informatics Officer for Michigan Medicine.

To combat this trend, last year the hospital introduced panic buttons, giving workers an option to call for help if they feel unsafe or need assistance. Now those same buttons are being made available to hospice and home care teams.

“If there was a need within a home that they are in, because they go in and out of community homes, that they could call somebody and alert in an easy, discreet way,” Nemets said.

Nemets said the buttons stay out of the way until they are needed.

“And it’s a button that looks just like this that goes right behind your badge. It’s very discreet,” she said. “It’s silent, and it alerts our public safety department that there’s an incident going on.”

“They feel safer if they have a way to call somebody for help. If they get backed up into a corner, what are they going to do? Well, now, they have a duress button on their bodies,” Nemets said.

Nemets said even more workers at Michigan Health could soon get panic buttons of their own, but there is no time frame for that right now.

According to internal data from the University of Michigan Health-Sparrow, those panic buttons saw the highest rate of use in the emergency and behavioral health departments.