The real problem was allowing the AMA to tightly control the supply of doctors for decades---that this would even be a solution to anything.

There is very real opportunism and profiteering among those advocating and providing this "solution." But they didn't create the months of waiting that normal folk have to see routine specialists or PCPs.

At the very least, they can get instructions on how to do first aid and when to go to the emergency room.

I remember talking to friends who were well-meaning but panicked about the ACA being passed because the system would be inundated with people seeking healthcare, and that it would lead to Soviet-style rationing. The rationing hasn't come from any five-year plan or the like, but simply the supply of doctors not keeping up with the demands of a growing population.

As I understand, the throughput bottleneck on training new doctors is the availability of funded residencies. So chiefly on the hospitals and the government (Medicare, mostly) to spend more.

The meme about AMA artificially limiting the supply of new residency slots turned out to be much more complex the more I read about it (and IMO mostly incorrect, at least as described by the just-so stories on the internet where I first learned about it).

The actual limiting factor is federally funded residency positions which are funded by CMMS, and were artificially capped by the Balanced Budget Act of 1997 during a widespread climate of financial austerity after Gingrich had led Republicans to retake the House in 1994 for the first time in decades.

At the time, AMA apparently did release a report that included support for reducing the number of residency slots, so that detail is correct. But the decision wasn't made by them, and federal healthcare spending was already on the chopping block (and was a politically attractive area to make cuts given the Clinton's administration failed healthcare reform proposal).

As early as 2006 [4], the AMA started releasing policy position statements requesting caps on federal funding to be increased, but it wasn't until the CARES ACT in 2020 that Congress funded 1000 new CMMS funded slots were funded (but limited to small gradual increases each year) and started to be implemented in 2021-2022. And they continue to advocate for increases that so far haven't been adopted.

So while there's a kernel of inarguable truth that the AMA and other medical professional groups did support certain caps back in 1997, it has always been, then and now, a policy decision by Congress. With the motivation to set limits driven by concern over federal healthcare spending inflating budget expenditures.

But it makes for a simpler, emotionally resonant narrative of a shadowy self-interested group pulling the strings at the expense of the public (that also conveniently redirects outrage away from the people actually empowered to fix the problem, or that federal spending is a crucial lever to fix the problem).

[1] https://www.ama-assn.org/press-center/ama-press-releases/ama...

[2] https://washingtonian.com/2020/04/13/were-short-on-healthcar...

[3] https://www.openhealthpolicy.com/p/medical-residency-slots-c...

[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC1785175/

You're not well-meaning if your concern is that other people getting a chance at what you took for granted (and you did, or else you would have understood that it wasn't a given and would have looked at making sure others weren't left out) will shut you out.

I was watching an interview of one of the white parents who opposed bussing in Boston in the 70s. He said something along the lines of, "We worked hard for new neighborhood schools and facilities, it was unfair that our kids couldn't go to them." Well, didn't the black parents work hard to get their kids access to a quality education? Of course. The next person interviewed was a black mother who quit her job so that she could work at the school her children attended, to make sure that they were safe.

It turns out that she opposed bussing, too; the goal of the black parents' lawsuits hadn't been bussing per se, but equitable access to resources. The government had engaged in malicious compliance: rather than keep all kids, regardless of race, at newly-improved neighborhood schools, they opted for a "solution" that only solved the problem on a surface level, and which was sure to draw ire, knowing that this rage could eventually justify walking back the changes. Look at Boston school demographics today; they achieved their aim.

To your "well-meaning" friends - and to everyone caught up in this type of situation - I ask you to think deeply about who is the actual bad actor. It's usually not the person that the wealthy or powerful or influential or "professional" are telling you want to take something from you. You have to actually be well-meaning to see through that smokescreen, though, and not just zealously self-interested.

There should definitely be an independent board like the fed (different decisions per area, maybe different boards per state) that determines need for the next 5 years. This is the way they do hospital beds (state level), but not doctors to address them! Of course we have to boot the fascist asshats to have a chance at it being independent.