> Can you speak to the narrative of administrative bloat in US hospitals?
Admin bloat is a consequence of having too few doctors, and also legal requirements on how visits have to be handled in the US. For each medical visit you get at least 10~15m of recording the visit. A doctor without any help would spend around half the time talking to a patient, and half the time filling out charts for insurance and legal requirements.
Thus to make money you need to delegate all those tasks as much as possible, and you get to a point where some hospitals even offer a full medical assistant per provider. To solve this you need to have way more doctors, and a lot less medical liability from a legal standpoint. For example, you cant have paper charts in the US, which is standard in many other first world countries.
Billing is also a very expensive source of admin work. You have to have a perfect pipeline for billing to have high collections, then you have issues collecting the money months after that is settled, etc etc.
Many ways to solve this one, but partially solved by moving a lot of expenditures to cash-based payment. You can save all of this in a cash-based system. Alternatively you could have competition in the insurance market, but although that could improve things, in the end, you still need to write medical and administrative work to get paid. This problem also exists in many other countries.
> Are doctors paid relatively less in other countries?
The Gross income of physicians in the US is surely the highest in the world. But gross is gross. At those levels taxation approaches 50%, and medical education can cost half a million dollars. Its a perverse system where you pay a lot to a ticket to earn a lot, but you get collected all the way to the bank. And if you dont make it, you fail really hard. Primary care physicians are the lowest paid in the us and have an abnormally high suicide rate.
> And is there any chance that the high pay is needed to counter-act overly stressful working conditions in the US (vs., say, the UK's NHS?)
High pay is a simple result of too few physicians. But what goes to physicians directly is a smaller part of spending: only about 10% of spending goes directly to physicians. You can make it better, but I think its likely they want better working conditions over money, its just not an option in this market structure. You cant operate part time, or with 30min appointments, without charging patients above insurance levels. (example, OneMedical, Concierge medicine, parsley, etc).
> I'm also curious about doctors' personal expenses. If most of their salary is going towards rent or homeownership, short of situating a hospital on something like a kibbutz... maybe there is some sort of rent subsidy -- or tax break for landlords that give a 10% rent discount / for banks that give a medical professionals low interest home loans -- that could be enacted. It could allow doctor's effective salaries to stay the same, but medical prices to drop?
This market structure needs less rules, not more rules. I have NEVER seen a market so captured as this one, and its captured by everyone in some way. Every single actor in this market is using government to get something from someone else, including patients, insurance takers, physicians, admin, pharma, gov. Literally everyone.
> I'm afraid you are going to say that doctor's biggest personal expense is student loans for medical school! If medical-school-debt were to be wiped out, do you know how much salaries could drop in terms of objective price without changing doctor's effective income?
Causal relationship is backwards here. Salaries are not high because medical debt is high. Salaries are high because there are too few doctors, because it is too expensive to get an education for it. If you wipe out medical debt, you are assisting the ones that made it over, but not all the ones that could not make it in the first place.
To reduce the cost of education you need to do a few things:
1- eliminate federal funding for education, that makes it only "approved" universities be able to provide limited slots.
2- Eliminate or reduce the cost of licensing. In the us you need a license per state to practice medicine, and it is very stringent. If it were handled like a legal bar exam instead, you would put significant pressure in the college system while also allowing for independent education to ocurr.
3- Allow medical degrees from other countries to practice in the US. This would leave the option for doctors to study abroad for nearly free and come back and practice.