well said imo. the fact that most jobs in health care are administrative (never see a single patient) is telling that the incentives aren't good: we aren't increasing physicians per capita, we're just ... adding admins, very similar to what's going on in US universities.
however there's a huge parasitic class of administrative jobs that exist due to this, so it's gonna be painful to excise. that pain will increase every day it's not done, unfortunately.
Administration on both the provider and payer side of this system accounts for, depending on the estimates I've seen, 12-17% of total health care costs. You can't in reality zero those costs out (even Medicare's much-vaunted 2% administration cost would shoot up if it had to deal with every patient in the country), but even if you could, you wouldn't have made health care in the US affordable.
why estimate? i linked a study you must not have read that says:
> After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States, as compared with 16.7 percent of health care expenditures in Canada.
or did you have a problem with that study or something?
Sure. For starters, that paper is using 1999 numbers, and there has been a sea change in health costs since then --- we pay almost 3 times as much in total health costs today as we did in 1999.
Intelligence Squared hosted a debate last week on M4A vs. private health insurance, and had two extremely motivated and well qualified debaters on the pro-M4A side, including Adam Gaffney, president of Physicians for a National Health System; their central argument was that Medicare has a lower administrative cost than private insurance, and their estimates were Medicare at 2%, private insurance in the teens. Not 30%.
for example, we know most growth in medical "jobs" are administrative in nature, and thus not helping per-capita physician rate or anything like that: https://hbr.org/2013/09/the-downside-of-health-care-job-grow...
it adds up, e.g. https://www.nejm.org/doi/full/10.1056/NEJMsa022033 where it's 3x cost of canada.
however there's a huge parasitic class of administrative jobs that exist due to this, so it's gonna be painful to excise. that pain will increase every day it's not done, unfortunately.