In November, the American Society of Anesthesiologists (ASA) issued a stern warning: One of America’s largest insurance companies — Anthem Blue Cross and Blue Shield — just “unilaterally announced that it will no longer pay for anesthesia care, regardless of how long the surgical procedure takes, if the surgery or procedure is arbitrarily delayed.” The decision applies to Anthem’s plans in Connecticut, New York and Missouri.
The announcement gained national attention later Wednesday The fatal shooting of UnitedHealthcare CEO Brian Thompson Widespread discussion of controversial insurance industry practices on social media. A A populist rage against the music arose. People imagined patients waking up from surgery owing thousands of dollars because their procedure was 15 minutes long.
The anger spread to the insurance company X user To government officials, with Connecticut Sen. Chris Murphy and New York Gov. Kathy Hochul Both condemned the insurer’s decision, with the former tweeting, “This is appalling. Saddling patients with thousands of dollars in additional medical debt. And for what? Just to increase corporate profits? By Thursday, Anthem withdrew the policy.
Yet this whole mess was badly misguided.
Americans have many legitimate complaints with insurance companies, which often refuse to cover essential care.
But this particular fight wasn’t really about pitting patients’ interests against predatory corporations. Music’s policy will not increase costs for their enrollees. Rather, it will reduce payments for some America’s highest paid doctor. And when millionaire doctors push back on cost controls — as they have here — patients pay the price through higher premiums.
Anthem’s policy will cover costs for anesthesiologists, not their enrollees
Anesthesia services are billed partially on a case-by-case basis How long does a procedure take?. This creates an incentive for anesthesiologists to err on the side of exaggerating how long their services are needed during an operation. and have evidence Any anesthesiologist may engage in overbilling by exaggerating the length of a procedure or the amount of risk a patient may be exposed to while administering anesthesia.
Starting in February, Anthem planned to discourage overbilling by adopting a set of maximum deadlines for the Centers for Medicare and Medicaid Services’ data-driven approach. If an operation is prolonged for medically necessary reasons, anesthesiologists may apply for higher payments. But the reimbursement process will be more difficult.
Critically, Sen. Contrary to Murphy’s claims, the policy won’t saddle patients with surprise bills if their operations run out of time. The burden of controlling these costs will fall on participating anesthesiologists, not patients. Christopher Garmonis an associate professor of health administration at the Henry W. Bloch School of Management in Missouri-Kansas City.
“Say there’s a contract between an insurance company like Anthem and an anesthesiologist,” Garmon told Vox. “What’s always in that contract is a clause that says, ‘You, the provider, agree to abide by the full payment terms in this contract.’ This means the provider cannot then turn around and ask [the patient] for money.”
Providers — not insurance companies — are the primary drivers of high health care costs
Private insurance companies have gained public trust. They regularly keep the well-being of their policyholders high. And there is also provision of private health insurance Higher administrative costs than single-payer systemsSo that the government is the only insurer.
But the greed and inefficiency of private insurers is not the only — or even the primary — reason why essential medical services are often unaffordable and inaccessible in the United States. The big problem is America’s health care providers—hospitals, physicians, and Drug companies — charge much higher rates than their peers in other rich countries.
In 2021, the United States spent approx Double per capita In terms of healthcare compared to other developed countries. According to Kaiser Family FoundationThis gap is mostly explained by higher payments to hospitals and physicians. Americans spend $7,500 per person on inpatient and outpatient care, while other wealthy countries spend an average of $2,969. This is not because Americans are receiving more medical care than their peers abroad; In contrast, we have fewer doctor visits per capita and fewer average hospital stays. We just pay too much.
In 2023, the Average physician salary In the US it was $352,000. In Germany, this figure was $160,000; In the UK, it was $122,000; In France, it was $93,000.
This disparity is partly explained by the fact that European countries have more socialized healthcare systems, where governments impose more cost controls on medical providers. In the past, progressives have insisted that a Medicare-for-all system would lower overall health care costs by forcing providers to accept lower payments.
With its new policy, Anthem was trying to do exactly that: force anesthesiologists to accept lower reimbursement rates.
And particularly strong in reducing payment rates for anesthesiologists. According to Medscape 2024 Anesthesiologist Salary ReportAverage Salary for an American Anesthesiologists made $472,000 in 2023. This represents a $70,000 increase over the field’s average salary in 2022. This ranks anesthesiologists among the top five highest-paid specialists in the United States.
If we want America’s health care system to treat more patients — while charging less for all of our coverage — forcing countless specialists to accept lower payment rates is not an option. Ideally, we would do this through a comprehensive system of public expenditure controls and insurance provision. Failing that, we need private insurers to drive a hard bargain with the most expensive doctors and hospitals. When we demonize insurers for doing it right, we’re not standing up against the profiteers of our health care sector—we’re standing up for them.
