The Nervous System Cost of the Healthcare System-When Healing Requires More Than a Payout: Privilege, Erasure

From Wisconsin’s Rural Bill to a National Wake-Up Call on the Cost of the Healthcare System

According to the Wisconsin Examiner, Gov. Tony Evers signed legislation on Aug. 8, 2025, enabling nurses with advanced credentials to practice independently in rural areas. Read the full article here. On paper, this is framed as a solution to provider shortages. In reality, it is a symptom of a deeper structural shift—one where the value of physician training, particularly in primary care, is being quietly downgraded in favor of cheaper labor models.

This is not an isolated incident. Twenty-seven states have now adopted similar measures, and once the precedent is set for rural areas, history tells us it rarely stays confined there. This is the same creeping transformation I saw two decades ago when MBAs started leading hospitals and residents became the go-to cheap labor force. We told ourselves it was “temporary.” Now, it’s the norm.

The Hidden Trauma of a Cost-First System

If the Mangione case with UnitedHealthcare taught us anything, it’s that the system doesn’t hesitate to place financial risk ahead of human well-being. That ordeal—where an insurer denied a surgeon’s request for a medically necessary breast procedure—made headlines because the harm was so visible.

But there’s another harm that’s harder to see: the nervous system cost of practicing medicine in a culture that continually erases your expertise, autonomy, and humanity.

For women physicians of color like me, that erasure is compounded by systemic inequities that mirror what BIPOC patients face. We are erased both as healers and as patients.

Privilege as Public Health

Public health is shaped not just by biology or behavior, but by who gets to hold power and resources. In the venture capital world, less than one percent of funding goes to women of color. The message is clear: your ideas, leadership, and innovations are not worth investing in.

The same bias plays out in healthcare workforce planning. Society will pay $300 million to retain a top-tier software engineer at Meta but balks at adequately funding a primary care physician—despite the irreplaceable depth of training and critical thinking that physicians bring. This is a “Tale of Two Cities” problem: one city rewards the architects of the digital economy, while the other city nickel-and-dimes the guardians of human health.

Why a Payout Is Not Healing

Financial compensation—whether through reparations, settlements, or higher salaries—cannot undo the physiological damage caused by chronic stress, discrimination, and systemic disenfranchisement. Trauma lives in the body. It shapes the nervous system. It disrupts sleep, immunity, and emotional regulation.

Cost of the Healthcare System

For physicians, especially those in marginalized groups, the constant microaggressions, policy betrayals, and market-driven decisions erode not just job satisfaction but our capacity to heal others. The polypharma model has not reduced chronic disease, improved outcomes, or lowered costs. And yet, cost-cutting measures keep targeting the very professionals best positioned to address root causes.

From Transaction to Transformation

If we want sustainable, equitable care, we need to stop treating physicians—and patients—like interchangeable line items.

That means:

• Investing in expertise rather than replacing it with the cheapest credential available.
• Embedding nervous system regulation and trauma-informed design into healthcare delivery models.
• Addressing privilege head-on by ensuring representation at every level of decision-making.

Without this, we are building a future where cost control masquerades as care improvement, and the human toll—on both sides of the stethoscope—will be catastrophic.

The Crossroads

This is our inflection point. The Wisconsin bill, the Mangione case, the national scope-of-practice shift—they’re not isolated events. They are connected threads in a system that has decided efficiency and volume matter more than precision and depth.

If we don’t address these shifts now, the next decade of American healthcare will look radically different—and not for the better. The solution requires more than watchdogging policy. It demands reclaiming the narrative, reframing the value of medical expertise, and dismantling the trauma baked into our structures.

Healing is not a payout. It’s the hard, continuous work of rebuilding systems so that they serve the people who depend on them—and the people who dedicate their lives to delivering care.