In July of this year, UPMC got rid of more than half of its board of directors. The explanation was plausible enough: The board had grown unwieldy over time as UPMC took over new hospitals. A consultant advised that a smaller group would be more practical. Twenty-nine board members were invited out. Shortly before this happened, UPMC announced a unilateral divorce from the region's largest insurer, insisting that Highmark's rescue of a much smaller hospital system made it a direct competitor. Without a new contract, many Highmarkers will find UPMC services too expensive. They will have to pay substantially higher out-of-network rates, change insurance companies (as if that were as easy as changing their minds) or seek care elsewhere, and to hell with doctor-patient relationships. Is it a coincidence that the board was so dramatically downsized just as UPMC went to the mattresses? It's not unusual to reduce a board, but then again, if you're going to war, you only want your most trusted lieutenants in the tent.