An oncology department I'm familiar with has an entire "nurse navigator" whose whole job is to submit "prior approval" requests to "insurance" companies justifying why patients need a specific treatment, plus the nurses employed by the "insurance" companies reading those requests. I believe it's similar for any moderately expensive specialty. A common career path is care nurse -> burnout -> administration. Most of the administration is made up of people who could be providing healthcare.

And no, hospitals' most valuable resource are their billing computers. I think when it comes to providing actual healthcare hospitals are very stupid. You cannot partition any knowledge worker's attention into 10 minute blocks and expect them to achieve anything useful, yet that is what their entire system is designed around. The hospital doesn't have unilateral say of course (an "insurance" company won't pay one doctor the "price" of two if they spend twice as long with a patient), but they're still content optimizing within that status quo outcome - completely scatterbrained care.

And it's not like individual doctors are well rested or happy when you talk to them. The system clearly takes their toll on them (eg disappearing for 5 minutes to go retrieve test results that didn't show up before your appointment). In fact I'd say the vast majority of human talent in the medical system ends up completely wasted.

Looking at spending per capita it's clear that American problems aren't caused by lack of money in the system.

They are caused by high barriers of entry, which in turn are caused by entrenched elites gatekeeping jobs through absurdly high tuition fees, expecting everybody to take lots of student debt and a very litigation-friendly environment. These costs are then passed on to the general population through a byzantine system of health insurance that leaves a lot of people uninsured.

> Let's take a dream scenario: optimal organisation can make 20% more care available.

In 2020 UK spent 3278 GBP (~4400 USD) per capita on healthcare [1]. USA: 12,530 USD. That's about 3 times less or a difference of 200% [2].

In UK life expectancy is 81.2 years. In USA it is 78.79 years.

3 times more spent to get a worse outcome doesn't seem like "20% difference" to me. Of course there are other factors, but are they enough to overcome 3x difference? I don't think so.

You cannot compare healthcare systems on X doctors per Y patients basis, because the outcomes aren't linear. It's orders of magnitude more expansive to treat many health problems if you go to the doctor 2 years too late. And the outcomes are worse despite the higher costs. Guess what happens when people have to pay a lot for each visit - often they go too late.

[1] https://www.statista.com/statistics/472940/public-health-spe.... [2] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...