It wouldn't be hard to cut spending by 30%. You could allow PA's or NPs to do surgeries if a board certified surgeon said they had done that surgery successfully 15 times (under their 'supervision') for instance. But you run into an interlocking set of desired quality controls and cost factors. Former president Clinton's statement that abortion should be 'safe, legal, and rare' is something of an allusion to that. It wasn't that people couldn't get abortions but the quality control was poor.