There is a particular kind of audacity required for a health insurance company to show up at a medical school and say, in effect, “Let us explain how this system works.” That audacity curdles into something else when the system in question is the same one that will later deny care, delay payment, override clinical judgment, and quietly exhaust the people sitting in that room for the next three decades.

That’s why “The Unholy Matrimony of UnitedHealth with the University of Minnesota is Dangerous for the Future of Health Care” deserves close attention. Not because it is inflammatory, but because it is uncomfortably accurate.

The elective course described in the article — co-developed by UnitedHealth Group and the University of Minnesota Medical School — is framed as leadership education. It feels less like education and more like early insurance company tactic exposure that works against physicians and patients alike.

If we’re assigning grades, this one is straightforward: A for astonishing and appalling.

This is not education. It’s conditioning.

Medical education should prepare physicians to practice medicine. Of course, that includes understanding healthcare economics, incentives, and insurance company constraints. What matters is who is teaching those lessons and how they are framed.

UnitedHealth is not a neutral participant in the healthcare system. It is the largest healthcare corporation in the country, operating a vertically integrated model that benefits when care is constrained, delayed, or denied.

Inviting such an entity into the classroom to help define “value” subtly reshapes their expectations and clinical decision-making. It teaches them what questions are reasonable to ask and which ones are not.

When future physicians are encouraged to view care decisions through a “stakeholder” framework that includes shareholder interests, something is broken. Physicians do not have fiduciary duties to shareholders. They have professional and ethical duties to patients. Blurring that line before a student has even written their first order isn’t realism. It’s quiet surrender dressed up as pragmatism.

This is what makes it maddening

For those of us who spend our professional lives working alongside physicians and health systems in managed care environments, none of this is theoretical.

We see prior authorization deployed less as a clinical safeguard and more as a volume-control mechanism. We see denials issued at scale and reversed later, assuming clinical persistence will be the exception rather than the rule. We see clinical judgment displaced by algorithms that never meet patients and never bear responsibility for outcomes.

So learning that a payor is now teaching medical students to expect this environment — to treat it as normal, inevitable, and professionally appropriate is infuriating.

The problem isn’t knowledge. It’s normalization.

No one is arguing that new physicians should be shielded from reality of insurance interactions. But there is a meaningful difference between understanding a system and being trained to accept its worst behaviors as baseline.

The danger here isn’t information. It’s framing.

When young physicians later encounter denials, delays, and administrative interference, they won’t recognize them as out of balance. They’ll see them as routine friction. Resistance will feel naïve and advocacy will feel impractical. Accommodation will be mistaken for professionalism.

We should not also have to unwind expectations quietly set during medical education. We should not have to persuade physicians-in-training that what they are experiencing is not normal, not benign, and not ethically neutral. We should not have to point out, yet again, that the emperor has no clothes.

Teaching resignation is not leadership

If medical schools want to teach leadership, they should focus classes on how to:

• Retain professional authority in systems designed to erode it
• Identify misaligned incentives
• Advocate for patients without burning out or being isolated
• Understand power without internalizing its logic

That education does not come from the payor. When the entities most responsible for dysfunction are invited to frame the rules of engagement, the lesson is not leadership. It is compliance.

Why the grade stands

It’s disappointing that this course is shaped by a payor whose behavior physicians will later spend years struggling against.

That is not balance. It is asymmetry with academic cover.

And for those of us already in the trenches, the idea that this imbalance is being normalized for the next generation of doctors isn’t just concerning. It’s deeply dispiriting.

So yes, the grade stands.

A for astonishing.
A for appalling.

Not because physicians shouldn’t understand the system they’re entering — but because they deserve to enter it clear-eyed, not already resigned to it.