There should be a good career ladder for nurses to become actual doctors if they perform well on the job. No need to gatekeep now that we have AI and internet.
It matters how much they add to the cost.
Typically, "margins" means the profit they make over and above expenses. For insurance companies, the salaries of all the people they employ, and the rent/mortgage/upkeep on their buildings & grounds, would all be classified as expenses that would not generally be included in their margins.
But in a single-payer system, none of that cost would even exist. We have to pay for all of that through our premiums, and we get nothing out of it.
2. Single-payer systems still have administrative costs. The administrative cost of running England's NHS is not zero. But, even if you created a perfect AI robot that had zero cost to operate (in magic fairytale land) to run your single-payer system, you still couldn't reduce premiums by more than 15%.
3. Realistically, switching to single-payer and doing nothing else would reduce costs by a single-digit percent.
This is only true if you assume that health insurance companies have no influence on the cost of care. That is, however, patently false.
Which means, of course, that their main option to increase profit is to increase overall spending on healthcare. Reducing cost is directly against their interests.
UnitedHealthcare buys up physician practices, and pays theirs higher rates. That's part of the 85% bucket, but they're profiting off it. https://www.statnews.com/2024/11/25/unitedhealth-higher-paym...
> Single-payer systems still have administrative costs.
https://www.healthaffairs.org/do/10.1377/forefront.20110920....
"According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue. Insurance industry-funded studies exclude private plans’ marketing costs and profits from their calculation of administrative costs. Even so, Medicare’s overhead is dramatically lower."
> Realistically, switching to single-payer and doing nothing else would reduce costs by a single-digit percent.
I mean, that's a start.
If you chart the US against the rest of the OECD, we're doing something bafflingly expensive versus everyone else. It is certain to be multi-factorial, but our insurance setup absolutely plays a role. https://commons.wikimedia.org/wiki/File:OECD_health_expendit...
The numbers don't back this up. https://www.cms.gov/files/document/nations-health-dollar-whe...
> There should be a good career ladder for nurses to become actual doctors if they perform well on the job.
Again, that's most frequently called becoming a nurse practitioner.
Look at the buckets: Things like Dental Services, Home Health Care, Nursing Care Facilities... This tells you about healthcare spending at the macro level, but doesn't explain why a particular doctor visit cost so much (I don't use any "nursing care facilities" or "dental services" when I visit the doctor for a sprained ankle, for example).
When you go to the doctor for a sprained ankle, where does that money go? By law, no more than 15% is going to the insurance company (which isn't just profit, that covers all the administrative costs of running the plan). Where does the other 85% go? Certainly some it is the cost of running a clinic (staff, rent, equipment, etc), but what about the rest?
Then look at doctor's income. Your basic family care provider living in Podunkville earns as much as a mid-career SWE in the Bay Area, and specialists earn way, way more. Where do you think that money comes from?
That's quite a bit to a middleman.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6179628/
"According to Reinhardt, “doctors’ net take-home pay (that is income minus expenses) amounts to only about 10% of overall health care spending."
It's also a big incentive for the insurer to increase prices. If they want more revenues, and more profits, they have to get overall spending to go up.
> Your basic family care provider living in Podunkville earns as much as a mid-career SWE in the Bay Area, and specialists earn way, way more.
Good. They should.
I'm aware of two huge exceptions that are large enough to make this basically not-true.
1) This doesn't apply when they're administering a self-funded plan, like most plans provided by large companies. This represents a giant chunk of US health insurance.
2) This doesn't apply to new plans (I believe in the first two years of operation). I admit I've not looked into it, but I'd be shocked if this isn't being gamed such that a fairly high proportion of plans that aren't excluded by #1, are always "new" and so not subject to those limits.
Personally, I would always rather see a physician due to how much more training/experience they have. A physician who's out of residency will have gotten at least 3 years of on the job training (after medical school). A nurse practitioner may have just gotten their BSN and then gone straight into an NP program without ever working a single day as a nurse.
But yes, you're right, this person is absolutely describing NPs.
There's a very good chance, if you're seeing a NP, that the NP has a lot more experience with that sort of condition than the docs. After all, the practice is sending those sorts of issues to the NP. My dad's a radiologist, but they haven't assessed a minor break in decades, because they're very subspecialized.
If it's unusual or complex, the NP is probably the first to say "we'll need to make an appt with Dr. So and So".
The first chart includes "private healthcare insurance" as an input, so I'm pretty sure you're wrong.
The $4.9 trillion detailed in this chart is "the official [estimate] of total health care spending in the United States". https://www.cms.gov/data-research/statistics-trends-and-repo...
Unfortunately, right now, it is difficult for doctors to do so much as move to and start practicing in a different state. But if you want medical costs to actually come down and to ensure availability, you need to multiply the number of doctors available to treat people.