Why Education Is Important

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U.S. health care costs are the highest in the world.

One basic cause of health care costs is medical education.

Medical education has not been considered in controlling costs.

In debates about the soaring costs of American health care, attention typically turns to insurance reform, pharmaceutical pricing, hospital consolidation, or corporate profiteering. These are important concerns. But they all address the visible structures of the system—the branches, not the roots.

I propose a long-range strategy that begins upstream. If we are serious about controlling both the clinical and financial excesses of what is often called the medical industrial complex (MIC), we must examine the institution that shapes the entire enterprise from the outset: medical education.

Medical schools chart the course of medicine. They determine how physicians are trained to think, what they are taught to value, and what they consider to be their responsibility. That intellectual framework does not stay confined to the classroom. It ripples outward into hospitals, insurance companies, pharmaceutical manufacturers, and device makers—the MIC. In short, it helps define the culture within which the MIC operates.

The proposal is straightforward: an independent federal investigation into medical education and its long-term impact on health care delivery and costs. This would not be a punitive exercise, nor an attack on biomedical science. Rather, it would be a comprehensive review—akin to a modern “Flexner Report”—designed to assess whether current training priorities serve the public’s needs in the 21st century.

One central concern is medical education’s persistent and overwhelmingly narrow focus on physical disorders. The biomedical model has produced extraordinary achievements, from antibiotics to organ transplantation. Yet the same model devotes remarkably little formal training time to the psychosocial dimensions of illness: prevention, mental health care, and social concerns, for example. Indeed, biomedical training permits only about 2% of total training time to non-disease, psychosocial areas.

This imbalance has consequences.

When physicians are trained primarily to diagnose and treat physical pathology, prevention often becomes secondary. Psychological distress, adverse lifestyle habits, chronic stress, trauma, loneliness, and unhealthy coping patterns—all powerful drivers of illness—may receive cursory attention. The result is a system that often understands diseases better than it understands patients. Further, the national mental health crisis cannot be separated from this training gap. Anxiety, depression, substance use disorders, and stress-related conditions frequently present first in primary care settings. But the clinicians may not be trained to diagnose or treat mental illnesses.

Meanwhile, deeper psychosocial contributors remain insufficiently addressed. The financial implications are substantial. A health care system oriented toward intervention rather than prevention will inevitably generate higher costs. We know that 80% of all heart disease, strokes, and diabetes can be prevented by addressing the (overlooked) psychosocial lifestyle factors that cause them: smoking, alcohol/drug use, obesity, sedentary lifestyle, and ‘stress.’ When emotional and behavioral drivers of disease are ignored, patients cycle through repeated visits, escalating treatments, and increasing pharmaceutical use. Expenditure rises when underlying stressors or social conditions remain unchanged.

The evolution of the medical industrial complex mirrors this narrow clinical focus. As medicine concentrated on technologically sophisticated interventions for physical disease, industries grew around those interventions. Hospitals expanded. Insurance mechanisms became more complex. Pharmaceutical and medical device companies flourished. By the 1990s, the profit motive embedded within this system had begun to overshadow medicine’s traditional commitment to patient-centered care.

Why Education Is Important

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Importantly, physicians have not been well positioned to resist this shift and have less and less control of the direction of medicine. Their education rarely prepares them to view cost, access, and systemic quality as intrinsic professional responsibilities. Broader structural concerns are often regarded as administrative or political matters—someone else’s domain. While many individual physicians advocate passionately for reform, the prevailing culture of training has not consistently equipped the profession as a whole to challenge the expansion of profit-driven priorities.

If educational practices help shape this reality, then meaningful cost reform must begin there. Changing entrenched academic norms is notoriously difficult. Medical education is steeped in tradition and institutional autonomy. Appeals from within the profession alone may not suffice.

That is why public engagement is crucial. Most Americans are acutely aware of the mental health crisis and the relentless rise in health care costs. What they may not see is how educational priorities contribute to both. A rigorous federal investigation could illuminate these connections. Its findings—publicly disseminated—could catalyze a broader conversation about what society expects from its physicians.

A modern review of medical education would ask fundamental questions: How is training time allocated? How are communication skills and psychosocial competence taught and evaluated? Are students taught to integrate emotional and social understanding into every patient encounter? Do curricula emphasize prevention as strongly as intervention? Are future doctors prepared to view cost and access as ethical issues, not merely economic ones?

Substantial reform flowing from such an inquiry would do more than rebalance coursework. It would establish a new professional narrative—one that integrates scientific excellence with psychological insight and ethical accountability. When health care is grounded in humane, patient-centered principles, the space for profit to supersede care narrows. Oversight of large medical conglomerates becomes more credible when the profession itself articulates and embodies clear moral commitments.

The financial cost of conducting a national investigation into medical education would be modest compared to overall health care spending. The potential benefits, however, could be profound. By reshaping how physicians are trained, we would gradually reshape the culture of medicine itself.

Health care reform debates often feel reactive, chasing crises as they emerge. But durable change requires looking upstream, to the formation of professional identity and responsibility. If we want a system that addresses both the mental health emergency and the unsustainable cost trajectory, we must be willing to scrutinize the educational foundations upon which that system rests.

Reining in the medical industrial complex may ultimately depend less on regulating its outer structures and more on redefining the values at its core.

Adapted from Has Medicine Lost Its Mind? (Prometheus Books, 2025).1

1. Smith R. Has Medicine Lost Its Mind?--Why Our Mental Health System Is Failing Us and What Should be Done to Cure It. Essex, CT: Prometheus Books (an imprint of The Globe Pequot Publishing Group, Inc.), 2025.

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