Comment by threethirtytwo

>Where will all those students rotate for their clinical years? There aren’t enough hospital slots.

This is a policy fiction. Residency slots are capped by federal law, not by hospital capacity. The Balanced Budget Act of 1997 froze Medicare-funded residency positions, and despite modest expansions decades later, the cap remains largely intact. Teaching hospitals routinely report excess clinical volume relative to trainee supply. The bottleneck is artificial and regulatory, not logistical.

>Stop taking aim at people who sacrifice so much to help you. The real cost driver is administrative bloat.

This framing collapses under scrutiny. Administrative bloat is real and well-documented, but pretending physician incentives are irrelevant requires willful blindness. Numerous studies show that U.S. physicians earn multiples of their OECD peers while delivering no commensurate advantage in outcomes. Many doctors are motivated by altruism, but many are also motivated by status, income, and professional gatekeeping—normal human incentives in a high-prestige, high-pay profession.

Further, high patient throughput is not an accident. Fee-for-service reimbursement structurally rewards volume over care quality. Seeing 20–30 patients a day is not a moral failure of individual doctors, but it does predictably lead to burnout, emotional detachment, and assembly-line medicine. Incentives shape behavior. Ignoring that is not compassion, it’s denial.

>Physician reimbursement is only ~9% of national healthcare spending.

That statistic is repeatedly used as a rhetorical shield, and it shouldn’t be. Cost systems do not fail because of a single oversized line item; they fail because multiple protected constituencies simultaneously extract rents while deflecting blame. Administrative overhead, defensive medicine, pharmaceutical pricing, hospital consolidation, reimbursement incentives, and physician compensation are jointly optimized for revenue, not outcomes.

Nine percent of a multi-trillion-dollar system is not trivial. More importantly, physician compensation is not isolated—it drives downstream costs through referral patterns, test ordering, procedure rates, and resistance to scope-of-practice reform. Treating physicians as a sacred class exempt from economic critique is precisely how you end up with a system that is unaffordable, unaccountable, and structurally resistant to reform.

If the argument is “9% is too small to question,” then by that logic no component is ever large enough to examine in isolation, which is how dysfunctional systems persist indefinitely. Real reform requires abandoning moralized narratives and admitting the obvious: healthcare costs are the product of aligned incentives across many actors, and physicians are not magically outside that system simply because the story is uncomfortable.