Because anecdotally, among my friends, I’ve never known someone to not make it through the system to practicing medicine who wanted to, but I do know several who persevered despite being real idiots. I don’t see how opening the pool wider would lead to better care.
TLDR 1. Society is getting older demographically.
2. Physicians are getting older demographically and have stopped working.
3. Many rural areas and minorities are already underserved.
2. There are limited spots in certain residency programs due to how competitive they are. Ergo those specialties are artificially more lucrative. Dermatology is a good example.
3. Becoming a doctor is temporally arduous: 11 to 15 years! Why the hell do people need to spend four years of time and money on a bachelor's degree instead of entering a medical program directly?
4. Becoming a doctor is financially arduous. You will be in debt for four years of undergrad, then four years of medical school, and then you'll be paid garbage for 3-7 years of residency. High interest rates exacerbate this.
5. Residency is hell.
6. Working in a hospital is often hell. Burn out is very real.
7. There are many, many professions which provide a far better standard of living.
[0]: https://www.aamc.org/news/press-releases/new-aamc-report-sho...
https://students-residents.aamc.org/medical-school-admission...
We can also expand access to affordable primary care by shifting routine services to physician assistants and nurse practitioners. Physicians should be reserved for more complex or higher risk cases.
Because customer-insurer relationships are the only side of the healthcare system that most people see, they're oblivious to what are actually pass-through insurer-provider issues.
As you said, the reality is that insurers operate with pretty reasonable margins and incredibly meager per-claim overhead costs. They're stuck trying to make 2 + 1 = 2.
If the finger should be pointed at root causes in the US health system, it should be at: