As a physician, my first responsibility is to my patients. But today, caring for patients also means confronting the hard realities of a health care system under immense strain. Recent headlines about cuts to both Medicare and Medicaid aren’t just policy — they’re personal. They affect everyone, and they force all of us in health care to make difficult choices.

When Optum Medical Care announced changes to certain insurance networks in New York, some wondered what that meant for access to care. The truth is, these decisions are never easy, but as cuts to both Medicare and Medicaid deepen, they are necessary to keep care affordable and sustainable for the long term.

Consider the costs: In 2023, U.S. health care spending jumped 7.5% to $4.9 trillion. New York spends $14,000 per person, the

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