In November, the American Society of Anesthesiologists (ASA) issued a dire warning: One of America’s largest insurance companies – Anthem Blue Cross and Blue Shield – had just “unilaterally declared that it will no longer pay for anesthesia care if the surgery or procedure “exceeds” an arbitrary deadline, regardless of how long the surgical procedure takes.” The decision applied to Anthem’s plans in Connecticut, New York and Missouri.

The announcement drew national attention Wednesday after the fatal shooting of UnitedHealthcare CEO Brian Thompson sparked widespread discussion on social media about controversial insurance industry practices. There was a populist uproar against Anthem. It was imagined that patients would wake up after surgery and discover that they owed thousands of dollars because their procedure took 15 minutes.

Anger at the insurer spread from X users to government officials, with Connecticut Senator Chris Murphy and New York Governor Kathy Hochul both condemning the insurer’s decision, with the former tweeting: “This is appalling. “ Burdening patients with thousands of dollars in surprising additional medical debt. And for what? Just to increase corporate profits?” On Thursday, Anthem revoked the policy.

But this whole commotion was completely misguided.

Americans have many legitimate complaints about insurance companies that often refuse to cover necessary care.

But this particular fight wasn’t really about pitting the interests of patients against those of predatory corporations. Anthem’s policy would not have increased costs for participants. Rather, payments would have been cut for some of the most overpaid doctors in America. And when millionaire doctors push back on cost controls — as they did here — patients pay the price in higher premiums.

Anthem’s policy would have cost anesthesiologists, not their students

Anesthesia services are sometimes billed based on the duration of the procedure. This creates an incentive for anesthesiologists to exaggerate how long their services were used during an operation. And there is evidence that some anesthesiologists overcharge by overestimating the length of a procedure or the level of risk a patient faces during anesthesia.

Starting in February, Anthem had planned to prevent overbills by implementing a set of maximum deadlines for procedures based on data from the Centers for Medicare and Medicaid Services. If an operation took too long for medically necessary reasons, anesthesiologists could demand higher compensation. However, the refund process would be more complicated.

Contrary to Senator Murphy’s claims, this policy would not have saddled patients with surprise bills if their surgeries dragged on for an extended period of time. Christopher Garmon, associate professor of health care administration at the Henry W. Bloch School of Management at the University of Missouri-Kansas City, said the burden of this cost control would fall on participating anesthesiologists, not patients.

“Suppose there is a contract between an insurance company like Anthem and an anesthesiologist,” Garmon told Vox. “This contract will always contain a clause that states, ‘You, the provider, agree to accept the refund rules in this contract as payment in full.’ That means the provider can’t then turn around and ask (the patient) for money.”

Providers – not insurance companies – are the main contributors to high healthcare costs

Private insurance companies have gained the public’s distrust. They routinely prioritize profitability over the well-being of their policyholders. And a private health insurance system also incurs higher administrative costs than a single-payer system in which the government is the sole insurer.

But the greed and inefficiency of private insurers are not the only – or even the primary – reasons why vital medical services are often unaffordable and inaccessible in the United States. The bigger problem is that American health care providers — hospitals, doctors and pharmaceutical companies — charge much higher rates than their competitors in other wealthy countries.

In 2021, the U.S. spent nearly twice as much per capita on health care as other developed countries. According to the Kaiser Family Foundation, this gap is largely due to higher payments to hospitals and doctors. Americans spend $7,500 per person on inpatient and outpatient care, while other wealthy nations spend an average of $2,969 per person. This is not because Americans receive more medical care than their counterparts abroad; On the contrary, we make fewer doctor visits per capita and have shorter hospital stays on average. We simply pay much higher prices.

In 2023, the average doctor salary in the United States was $352,000. In Germany it was $160,000; in the United Kingdom it was $122,000; in France it was $93,000.

This discrepancy can be partly explained by the fact that these European countries have more socialized healthcare systems in which the government imposes greater cost controls on medical providers. In the past, progressives have emphasized that a Medicare for All system would lower overall health care costs by forcing providers to accept lower payments.

With its new policy, Anthem tried to do just that: force anesthesiologists to accept lower reimbursement rates.

And there are particularly strong arguments for enforcing down payment rates for anesthesiologists. According to Medscape’s 2024 Anesthesiologist Salary Report, the average salary for an American anesthesiologist was $472,000 in 2023. This represented an increase of $70,000 over the industry’s average salary in 2022, making anesthesiologists among the top five highest-earning specialists in the United States.

If we want the American health care system to treat more patients — while charging us all less for health insurance — then there is no alternative but to force countless specialists to accept lower reimbursement rates. Ideally we would achieve this through a comprehensive system of controlling public costs and providing insurance. If that doesn’t work, we need private insurers to negotiate harder with the most expensive doctors and hospitals. When we demonize insurers for doing just that, we are not standing up to those profiting from our healthcare sector – we are standing up for them.