From the perspective of fifty years of medical practice, almost everything the medical bureaucracy did to reduce cost and improve care made it worse.
As with any problem, education might best be the starting point. Medical schools must lead the Renaissance of education, six years with a PhD degree and a much more vital role in continuing education and research. There is a need for much more science education in AI, the genome, and quantum physiology.
Older physicians should rotate back to their medical schools on fellowships. Research should come in balance with high volume clinical care at graduated low cost. Research must occur in medical schools, not corporations, drug companies, or secret laboratories. Subsidizing medical schools heavily will save wasted dollars elsewhere. The medical school clinics will ensure equal access to all and the highest standard of care.
Get corporations out of medicine. A hospital CEO has no business receiving a multimillion-dollar salary. Hospitals do not need a CEO but an administrator and a highly organized nursing staff. The same applies to corporation sponsored insurance. Corporations might provide insurance but should not restrict the choice of providers, nor should insurance companies. Doing so for quality reasons had the opposite effect. Family doctors quit in droves or went into other specialties. Robert Kennedy Junior's book may be controversial, but he validly criticizes corporate capture.
Subsidize primary care physicians with RN salary coverage and a small reimbursement for clinic overhead as a visit charge. This subsidy must support after-hour telephone coverage and cover-physician availability. No more, "If this is an emergency, hang up and call 911."
End mandatory guidelines. Guidelines are helpful but are inflexible, do not evolve well, do not cover everything, and, most significantly, do not cover multiple problems. Multiple problems are more often the case and frequently contradictory to the guidelines. Reduce the cost of CME and board examinations. Subsidize both. Give back responsibility for credentialing to the county medical society or state society akin to the lawyer's bar. It would be further helpful for county societies to have cooperative help from legal colleagues.
Perinatal care needs a limitation to liability, especially for the physician attending a delivery. Liability issues plague the dismal neonatal mortality rates. Some protection is necessary to allow family doctors and obstructions to risk obstetric work and give common access to prenatal care.
The distribution of healthcare remains a problem. Medical schools might provide extensions to rural areas. Six years of medical school would yield more clinical and laboratory research and the providers necessary for rural healthcare coverage, quality and access.
Civilizations under pressure often produce voices that crystallize their deepest questions. These are rarely kings or generals, but philosophers, teachers, and public figures who step into the square to provoke. Their role is not to rule but to make society face itself. In ancient Athens, that voice was Socrates. He wrote nothing. He simply asked: What is justice? What is virtue? What is the good life? His relentless questioning unsettled his fellow citizens, and Athens condemned him to death. He refused to flee, insisting that the examined life was the only life worth living. His death turned him into a symbol of Athens’ own unease. Our world has its own public voices. In recent years, Charlie Kirk became one of them. Whatever one thought of his politics, he drew large crowds, not only on American campuses but even in London and among Māori in New Zealand. He thrived on dialogue — fielding questions, sparring with critics, drawing applause. The style was different. Socrates aimed a...
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