The box office hit Wicked is a modern retelling of the classic Wizard of Oz, where the Wizard labels Elphaba as “wicked” in his pursuit of control and greed. Much like the Wizard, who manipulates society by changing Elphaba’s name and orchestrating a movement to bring about her downfall, today’s health care insurance industry uses similar tactics to portray physicians—particularly anesthesiologists—as the villains. A recent article from Vox echoes this modern-day Wicked, misrepresenting anesthesiologists as “greedy” when, in reality, they are simply trying to care for and protect vulnerable patients.
This story begins with a recent policy change by Anthem Blue Cross Blue Shield (BCBS). In Connecticut, New York, and Missouri, Anthem BCBS unilaterally decided that insurance companies, rather than physicians, should determine the appropriate length of time for surgical procedures. This move prompted an outcry from anesthesiologists and other health care stakeholders, who warned of the dangers of allowing an insurance company to dictate the proper surgical treatment time—over the expertise of trained physicians. Unfortunately, this is just the latest example of the abusive practices commonly used by insurance companies, which include denying medications and treatments, imposing high out-of-pocket deductibles, and continuously manipulating the rules to avoid paying for necessary patient care.
The labeling of anesthesiologists and other physicians as “overcharging” patients is simply inaccurate. Payment for anesthesia services is based on several factors, including the precise time spent administering care—before, during, and after the surgery. Surgical time is typically determined by the patient’s needs and the surgeon’s judgment.
Moreover, physician reimbursement constitutes only a small portion of a patient’s total health care costs. A significant portion of patients’ health care expenses is related to the administrative burdens imposed by insurance companies. Recent data shows that 40 percent of hospital costs are tied to delays and roadblocks in processing insurance claims.
When we dig deeper into the data, we find that physicians’ salaries account for only 14.5 percent of total health care costs. According to the American Medical Association (AMA), physician salaries have declined by 30 percent over recent years and have not kept pace with inflation. Meanwhile, the profits of insurance companies, along with the salaries of their CEOs, have soared.
A recent article revealed that the top five health insurers have accumulated over $371 billion in profits since the passage of the Affordable Care Act. For example, Maurice Smith, CEO of Illinois BCBS, took home nearly $28 million in 2023 alone. When insurance companies profit, it is often at the expense of health care teams who work tirelessly to save lives or patients who are denied the care they need.
Physicians have long warned that the health care system has shifted from one centered on the patient-physician relationship to one driven by the profit motives of health care insurance corporations. Ultimately, the story’s true villain is not the anesthesiologists but the insurance companies with their insatiable drive for higher profits. They are, in fact, the “wicked” ones.
Lisa P. Solomon is a cardiac anesthesiologist.
