As a child, I loved games of strategy. Whether it was Monopoly, Stratego, or Risk, certain themes pervaded. One had to learn how to think multiple maneuvers into the future and form beneficial partnerships to survive the onslaught. The goal, of course, was total world domination. The game was over when one side was economically or physically manipulated into full capitulation.

I have carried these strategies with me on my long voyage through medical education and doctorhood. Disease, the great evil adversary, is wily and deft.  The ability to foresee her courageous moves, plan and prepare for the future, and meet her on the battlefield is a skill that every physician must obtain.

The political maneuvering and manipulating, however, was something that I was always grateful to be able to avoid in this laudable profession. Unlike my friends in the fields of business, law, and accounting, there were minimal office politics. My relationships were formed out of mutual respect and admiration, rarely out of a strategic need to protect myself. My naiveté, it turns out, was short lived.

Our current health care climate and legislation, unfortunately, is threatening to change everything. Whether intending to or not, Obamacare has heralded in an era of consolidation across the country. Expansions and mergers are creating large, too-big-to-fail health systems that are battling furiously against each other for market share. Alignment has become health care’s newest dirty word.  It’s the only thing that all participants are talking about.


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Doctors are aligning with hospitals, hospitals are aligning with insurance companies and nursing homes, and nursing homes are aligning with home health. Great divisions are forming based on strategic and economic lines drawn in the sand by each stakeholder who is greedily working to maximize profits.

Nowhere, in such discussions, is a consideration of what is best for the health and well-being of our community. As these large companies merge, they are demanding more from insurers, raising prices, and extorting the government for facility fees and other handouts.

Some systems will lose, and others will win. Nursing homes will either succeed or go bankrupt. Doctors will be bought by hospital systems and then spit back out when they no longer bolster the bottom line.

But our patients will continue to have no one to align with. Their futures will bounce back and forth at the whim of the economic necessities of these gigantic business interests.

They will be the unknowing losers, vanquished by an invisible game of strategy, for which they have no understanding of their own participation.