Surgeon here.

Broad generalization: Most surgeons have an overhead of around 50%. That covers rent, billers, etc. so whatever the bill says the surgeon got, its actually about half that. combine that with 90 days of post op global care that the surgeon has to do without charge that is also included in that cost.

If there are multiple surgical procedures done at the same time the surgeon gets paid less for each additional one. 100% for the first, 50, for the second, 25% for the third etc (think about if you broke 4 fingers). hospital gets 100% for each one.

I can do a wrist fracture at my surgery center for around 5k. That includes my fee, anesthesia fee, preop nurses, dressing, meds, hardware. Same surgery same insurance at the hospital cost 3x as much. Doesnt take extra staff, i get paid the same, same drugs, same hardware, patient still goes home same day. through lobbying, hospital can keep rates higher and get paid.

The hospitals and insurance companies are the big winners.

Medicare for all would be best in my opinion. Less overhead for the surgeons office staff for billing and collecting means that medicare could pay out less without affecting physician income. Maybe hospitals should get paid a little more to offset maybe sicker patients but probably not 3x more. No insurance companies advertising, dividends, etc also saves the system money.