Healthcare Reform: A Theoretical Perspective
    
This is part of a network of sites comprising about seventy pages that define the problems and solutions in great detail.  Some of the statements contradict conventional wisdom.  But I would challenge you to suspend judgment for the moment and examine the logic.

Imagine the problem as a football game.  The Starfield article describes part of the problem and it offers a partial solution.  But the medical community has not significantly responded.  Yet the article is extremely scholarly and well documented, so let's say that this moves the ball to the ten yard line.

The Davidoff article addresses why doctors can't change and ascribes it largely to shame.  But it doesn't tell us why shame so severe in the first place.  Yet it is an important piece of the puzzle and so we might say that the ball is now moved to the twenty yard line.  No points are scored at all until the ball reaches the goal line, and yet in order to do this requires a number of steps along the way.  

The very fact that we spend so much money on healthcare and education and continue to have serious problems in these areas is a valuable clue.  It tells us that we are overlooking areas of great importance.   As a society, our minds are not functioning as they should.  I view the problem as 80% mental and 20% economic.  One of the reasons that so little progress has been made is that most efforts have been trying to find economic solutions, neglecting the root causes.

Howard Gardner, Professor of Education at the Harvard Graduate School of Education, noted that preschool children learn at a prodigious rate.  But as they advance in their education, they tend to learn superficial facts, but fail to grasp the fundamentals.  Commonly, children often are able so solve problems that people with advanced degrees cannot.

I have concluded that cults are much more prevalent in our society than most of us realize.  They usually don't look like cults.  Their appearance is deceptive.    As I use the word, cults are groups, large or small, that have beliefs and priorities that are out of sync with the real world.  They are dictatorial, rigid, and employ mind-control tactics such as shame, extended drills, excessive repetition of routine activities, control over social environment, loss of privilege, and manipulation of social status.
    

I believe that most of society, particularly the best educated of us, are victims of this phenomenon, and that is the reason that we have such difficulty solving our many social problems.  When you get into a discussion with a cult member, it usually leads to an irreconcilable argument.  Cult members react rigidly as they have been programmed to do, rather than responding with flexible logic.

We should never underestimate the power of mind-control tactics, even when done with the best of intentions.  These are the methods terrorists use to program their members to commit mass murder in suicidal acts.  In recent history, governments have used these principles to enslave their entire populations to do the same thing, e.g. Japan in WW II.  We are all far more vulnerable than we realize.

The cult mentality breeds denial to compensate for the conflict with reality.  It is maladaptive, however, because it serves to get in the way of our perceiving reality correctly.  If doctors are the third leading cause of death, then they are either murderers, or their minds are dysfunctional.  I believe that the latter is the case.  I should hasten to add that this same issue extends to all of society - it just makes a bigger impact in the case of doctors.

Now, there is only one path to becoming a doctor.  I propose that we take immediate steps to allow multiple pathways, as long as at the end of the process, the student can prove his or her competency. 

In its raw form, there would be no risk, cost or burden to the public or the government; in fact, they would be drastically reduced.  The students would voluntarily organize the program, a task much less onerous than the present system.

We must stop using denial and freely admit that we have, to a greater or lesser degree, been influenced by cults.  The alternative is to continue to go around in circles and lead unhealthy lives.