"Nothing changes until something changes." Simple but true. Nothing changes until something changes in America's approach to health care — also true but not so simple. Yet there is only reform chatter, not change (from the rise in the usual background noise of Washington, the National Security Agency knows there is an attack planned). I say chatter because no one is hearing anything but rumblings. There is no debate. Where are the ideas? There is no conversation that has reached the rest of the country.

What has been lofted in trial balloons is not change. Therefore, nothing will change. We will still be ranked low in most categories of health as compared to other developed countries. There is talk about a public plan for the 46 million uninsured citizens. But handing insurance cards to the 46 million will not fix the problem. It will only make matters worse. The problem is systemic. The whole body is ill, not just the legs. So now millions more will continue to receive the expensive, error-plagued, disorganized, crisis-focused, specialty-driven, inefficient bureaucratic mess.

Rearranging finances is only part of the solution. The task of true change must be nothing less than a cultural revolution inside medicine itself. Culture is founded upon the premises from which grow values that become cultural norms, which direct behavior. So it is important to first examine a key premise, which is at the foundational root of the medical mind.

This assumption is that the individual doctor knows best. As a physician, I am here to say that it just ain't so. We are human beings trying to do what is right in a complex, busy, ever-changing world with a very complex person with individual needs sitting in front of us on the exam table. In silly hospital gowns, I might add. However, it follows from the first supposition of physician supremacy that we do not make mistakes. If one does not commit errors, then there is no need to build safeguards or procedures to prevent them. If there is a bad outcome, it is the patient's fault for being so sick or so different from everyone else that the traditional care didn't work.

If also follows that if the physician is king, then no one else of lesser rank can reign. Therefore, we continue to produce doctors at an average personal cost to the medical student of close to one quarter of a million dollars in individual debt. No wonder graduating medical students want a high-paying specialty just to pay back the loans and overdrawn credit cards. So there have to be lucrative forms of practice to make up for all the years lost to education. Reducing class sizes without eliminating costs is silly and saves no one anything.