I mean arguably they’re being broken now, in the sense that insurers and medical provision systems have climbed upstream of them and command the medical economy

America’s unique health economy has a lot to do with midcentury professionals acting through the Republican party to preserve their petit-bougie autonomy rather than becoming employees or even public servants like with the NHS. That’s the resistance to public healthcare and also to plans for industrial employers or unions to employ doctors for their workforce directly, leaving us with the employer-tied insurance system.

Then by the ‘90s costs were going up (also since the Golden Age of Surgery ended in the 70s, pharmaceutical companies and medical device manufacturers were gaining on doctors in terms of share of medical value provided) and you saw the big HMO (”Health Maintenance Organization”) wars, where health insurance companies tried to cut rising costs by essentially becoming in-house health providers

There was a sense at the time that outrage stories about denied treatment and reduced provider choice (amplified by professional-funded organizations) knocked this back, but we basically have all of this now through “PPO” (Preferred Provider Organization) plans. Meanwhile consolidated insurers are grinding down independent practices through control of rate-setting through dominant market position, effectively subordinating autonomy to systematic coordination.

Meanwhile you’re starting to see things like primary care clinic chains where doctors are explicitly salaried employees, and proposals to break guild gatekeeping by expanding the authority of nurses and physician assistants