In the health care business, as in other industries, there are marginalized and privileged payers. The number of patients covered determines which health care payers can sell at wholesale pricing, benefiting themselves while expecting providers and institutions to make up for lower reimbursements with patient volume. Uninsured patients typically pay retail prices unless they can secure rare waivers from providers or institutions. These waivers are uncommon due to the complex nature of health care economics, which even providers and institutions may not fully understand. As a result, self-funded patients seldom avoid entanglement in these complexities.
The responsibility falls on marginalized payers and their customers to bear the brunt of society’s health care costs. Health care providers seeking fair wages and institutions aiming to balance their books cannot rely solely on privileged payers’ low reimbursements or on waivers for uninsured patients. Privileged payers adopt a “take it or leave it” approach, while marginalized payers, conceding to this behavior, might think, “someone’s got to pay.” This is especially true for anesthesia providers, whose billed dollars are reimbursed at significantly lower rates by privileged payers, while marginalized payers compensate at much higher rates.
As the dynamics evolve, anesthesiologists face challenges. They must compete with non-physicians whose lower costs offer an alternative to increasingly expensive health care in a potentially unsustainable economic climate. Additionally, they must confront the existential threat posed by artificial intelligence (AI), which could render them irrelevant. To address this, humans may need to reconnect with others to counter AI’s non-human effects or collaborate with AI to develop emotional intelligence.
In the meantime, anesthesiologists may need to personally perform anesthesia services to compete with certified registered nurse anesthetists (CRNAs). Although CRNAs are generally exempt from overtime pay, some states and jobs may consider them non-exempt, making them eligible for overtime pay without losing their cost advantage. Anesthesiologists could negotiate higher overtime rates during physician shortages, especially as locum physicians. By mixing their schedules, they can prepare for a future in which AI and CRNAs force them to perform anesthesia services exclusively. Alternatively, they can pivot to administration, education, or innovation in anesthesiology or become consultants for emergent anesthesia consultations in-person or via telehealth.
In summary, history shows that diseases among the privileged become privileged themselves, as do the sufferings of the privileged. However, health care payers that cover large populations of marginalized individuals may inadvertently exacerbate marginalization if health care providers and institutions turn away from wholesale-priced health care, despite the ethical and legal implications of such decisions.
Deepak Gupta is an anesthesiologist.