That's why there's the complex business of 'partners', which buy into the "business".
IIRC GPs refused to be NHS employees, so the government compromised and agreed to pay existing private GPs to treat NHS patients.
Now increasingly as older GPs who are partners in prentice's retire they sell their practice to privet equity backed groups. GPs don't want to buy into a practice anymore.
The result of this is significantly worse care and service as the PE backed groups try to extract profits from the system. It's an attractive deal for PE, guaranteed income based on patent list size, and an opportunity to cut costs to make a profit.
Why is that?
NHS dentistry is a lot more .. honest about "we don't have any NHS appointments, but you can have the same service from the same person at a higher price, in which case we do have an appointment".
The number of doctors per capita in the US increased a lot for decades[0], but stalled over the past 10 years. I wonder if the blame lies at the AMA's feet.
For what it's worth, my personal experience with routine medical care hasn't been too bad in three (very different) states, though it's unclear to me what my expectations should be. It seems like the US is worse than average for primary care wait times and better than average for specialist wait times among developed countries[2].
[0]: https://www.cdc.gov/nchs/data/hus/2020-2021/DocSt.pdf
[1]: https://www.statista.com/statistics/186092/active-physicians...
[2]: https://www.oecd-ilibrary.org/sites/242e3c8c-en/1/3/2/index....
The prevailing opinion in government is that services are better when they are organised locally.
This is obviously wasteful and results in duplication and hundreds of organisations (e.g. councils) all doing the same thing in a different way.
The disadvantage of the opposite is that if everything is nationalised into one giant org, it could become too big and become an unmanageable and slow monolith (which is why it was decentralised back in the 90s).