The majority of the blame here lies with the thousands of politicians, bureaucrats, and administrators who haven't reformed the system in *sixty years*. Not the people who were doing their best with much less information than their successors have had.
There are a lot of first actions that need to be reexamined in the 21st century.
With the inflation numbers this year I have no idea what we are going to do, since we are already 6-7% in the hole from the 2021 cuts and now inflation is 8-9% ( assuming the economic numbers are correct... )
there's bound to be at least a third option and the fact that you ignored it is part of the problem.
Im not sure where you are getting the ‘you ignored it’ comment, when the new rates were announced we adjusted pay according to the decrease in rates.
Insurance is a scam on patients and providers.
5. Pay cuts - Most of the critical doctor specialties (ER, ICU, primary) that were the backbone of the pandemic got "raises" that were less than inflation (hers was 1.5%) while profitable elective specialties got big raises. The root cause is the billing system where elective surgeries bill pay out more than critical roles. Still, it's extremely demoralizing to be called a "pandemic hero" and have your pay get cut.
6. Criminal and Financial Liablity - Healthcare is delivered by a team yet the financial and criminal penalties for mistakes are assessed at the individual level. Recently a nurse was given a criminal sentence for a drug mistake which many believe was systematic failure (bad UI / IT systems, bad hospital practices, AND negligence on the nurse). Imagine getting sued or jail time as an engineer for dropping a production database. The few malpractice cases my partner has been involved in, it was very clear that the issues were systematic and perpetuated by hospital practices. However, if they had gone to trial, an arbitrary worked would d have been sued and the hospital wouldn't change its crappy practices. Institutions have effectively dodged liability in many cases.
7. Chronic understaffing and burnout - most ICUs have been understaffed throughout the pandemic. From an economics POV it seems crazy that their is a labor shortage but salaries are effectively dropping.