The House is on Fire: A Call to Action for Orthopedic Surgeons

America’s health insurers have turned from middlemen to gatekeepers, deciding who gets care based on Wall Street. It’s time for doctors to blow the whistle.

Last week, I had the privilege of speaking at the OrthoForum’s 25th annual conference — a gathering of the nation’s leading physician-owned orthopedic practices. The conference organizers knew I had worked for two health insurance giants – Cigna and Humana – and became a whistleblower. They invited me to speak as a former executive of an industry that is kneecapping countless physician practices across the country.

These are doctors who’ve built their careers around helping people regain mobility, independence, and quality of life. And yet, in today’s health care system, they are now spending more time than ever fighting insurers to get “approval” to treat their patients, taking time away from providing the care those patients need. If you want to see a group of physicians who are absolutely fed up with how big health insurers’ prior authorization demands and other business practices (especially in their Medicare Advantage health plans) are strangling patient care, look no further than this room full of orthopedic surgeons.

I told them what I’ll tell you now: The house is on fire. And it’s burning because insurers—once simply the middlemen in our health care system—have positioned themselves as overlords, deciding who gets care and who doesn’t, based not on medical need, but on what’s best for their bottom lines. Prior authorization has become one of their most effective tools to avoid paying for medically necessary care. 

I heard story after story from these surgeons about patients forced to wait weeks or even months for necessary procedures, enduring pain while insurers drag their feet—sometimes denying care outright.

But this problem goes beyond just bureaucratic hurdles. The very business model of today’s health insurance industry is built on three barriers that make it harder and harder for patients to get the care they need: prior authorization, shrinking provider networks, and skyrocketing out-of-pocket costs. Medicare Advantage, which insurers have turned into a cash cow at the expense of patients and doctors alike, exemplifies this problem. Insurers market these plans as a more affordable, streamlined alternative to traditional Medicare, but the reality is they often delay and deny care, all while raking in billions from taxpayers. 

Just last month, Humana announced it would be kicking 10% of its Medicare Advantage enrollees off its plans because those people have been using more medical care than the company expected, hampering profits—proving once again that Wall Street, not patient well-being, drives these decisions.

We’re Reaching a Tipping Point

As I told the doctors, lawmakers, both state and federal, are starting to push back against insurers’ most abusive practices, including prior authorization and the unchecked power of pharmacy benefit managers (PBMs). Even Wall Street is waking up to the fact that insurers may have overplayed their hand, as reports of rising utilization in Medicare Advantage – and how insurers have gamed the program to capture more of our tax dollars – send stock prices tumbling. I see momentum building for real change—but it won’t happen unless more health care providers, like the ones I met at OrthoForum, start speaking out.

That’s why I ended my speech with a call to action: Physicians need to become whistleblowers, too. They see firsthand how insurers are blocking care, how administrative burdens are forcing practices to close, and how patient outcomes suffer because of it. They know that Medicare Advantage isn’t an advantage at all when insurers deny needed surgeries. They know that a lot of their patients—many of whom have insurance cards in their wallets—are functionally uninsured because of outrageously high out-of-pocket costs. I told them they need to tell those stories. I blew my whistle, literally and figuratively, to drive home the point. This fight isn’t just about exposing corporate greed—it’s about saving American health care before it’s too late.