To identify the behaviors and beliefs that keep us separated from the desired happiness/health/wealth balance, I have labeled them “health care sins.” And, to identify a path of restoration, I would like to propose behaviors and beliefs that will lead us to a system of “health care redemption.”

As a spoiler alert, I don't believe we are living in a truly broken health care system. However, I do believe we have been systematically removed from the personal nature of health care through years of good ideas that have outlived their usefulness to the point that the accidental and unintended consequences of those ideas have left us with a loss of hope.

What are these health care sins?

I have been compiling a list that now totals 21 health care sins, but my list is by no means an exhaustive accounting. Due to the nature of emerging treatments, technology and adaptation, we'll need to address and adjust this over time.

To start, let's take a quick look at one big health care sin (idolatry of insurance) and one little health care sin (lying to the doctor).

The idolatry of insurance Our health insurance contract is the all-encompassing benevolent God that dictates that health care sets us up to fail when seeking our happiness/health/wealth balance.

Spending the majority of my adulthood selling health insurance, I have taken a full gulp of the health insurance flavored Kool-Aid. I mean, without insurance, how would I ever see a doctor? How would I ever afford a surgery? Yet, I never spent two hours researching a doctor's pricing, personality or quality ratings for my own care. I always assumed my insurance would do that for me.

I freely admit that I fear the potential financial impact and long journey to recover from medical debt in the event of a drastic illness or freak injury. That has been reinforced by a genetic history of heart problems, strokes, and diabetes from both sides of my family. As a child, I experienced many visits at the hospital with family members when “it might be the last time.”

I never spent time researching the safety-net in my community, because I always assumed someone else would do this for me.

Then there's the other side of the coin. The doctor's office participates in the idolatry of insurance during your very first interaction. With a vast portion of revenue for a provider paid by the brand name insurance logo, is it any wonder you are asked who your insurance is before “how can we help you” when you schedule a doctor's appointment?

The dehumanization of the patient experience is a direct result of the idolatry of insurance. It happens every step of the way, from the frosted glass window when you are greeted in the manner of border patrol asking for your papers, to the conversation with your doctor about the non-therapeutic procedures and tests you must endure just to check-off a list of protocols in order for your insurance to pay (or maybe because they need to bill for more services). During the enormous set of hoops and hurdles for any procedure or even prescription fill, you are only viewed in the value system of your insurance company's ability to pay.

Both our personal responsibility to do our homework ahead of time and the provider's office attitude have so much room for improvement, we can redeem this issue.

Here, I suggest two simple conversation changers to drive a “health care redemption”

For you and me, the future face of the savvy consumer, I suggest a bold and unwavering willingness to address the cost, quality, and evidence-based treatment discussions with our doctors. While sitting in that exam room, we assume we are at the mercy of the white coat versus being a collaborative participant in our care. I suggest we role-play these three questions prior to each visit:

1. What is the cost of this care if insurance was not paying the bill?
2. What quality metrics do you track for your office? How do you track the efficiency of your patient care?
3. Is there a reputable body of evidence to back up your care recommendation I can review? And, what is the suggested treatment if I choose not to do XYZ?

For the office or facility that employs the front-line intake of customer service, I suggest an increased awareness and education of the financial resources that provide the insurance.

1. Know that the “employer” who pays for the private health insurance that every office covets is paid in large part by that employee. On average, the employee directly pays 30 percent or more of the insurance costs and indirectly pays the other portion through wage stagnation or larger employee deductibles and copays as a direct result of the higher costs of health care.
2. Know that the community they serve is making a choice in terms of reduced funding in education, public works and sustainability efforts as a direct result to the burden of health care costs rising faster than inflation and taxes for the last 20 years, with no reduction in sight.
3. Know that the employee or former employee/retiree they are interacting with is likely on the cusp of medical debt and will make care decisions not based on the logo of the ID card, but on their ability to make rent in light of any treatment plan costing more than $800.

If we activate the human factor in health insurance, we can reverse the idolatry of insurance and journey forward toward health care redemption.

Lying to your doctor

I never understood this one until recently. Why would you ever not speak up about your own health when you have already scheduled and carved out time for a visit?

There are many potential factors, but the most likely is a shortage of mental capacity during the office interaction. The emotional drain of reliving all of your symptoms is no small task.

There is also the very real insecurity of admitting you are not your optimal self. And as a patient, you want to focus on one symptom at a time, leading to an omission of relevant details.

Plus, what if the doctor wants to suggest a treatment that is expensive, and you don't want to admit you aren't financially prepared?

The doctor's office plays an active role in this equation, too.

The doctor typically asks you to complete a small stack of paperwork before your appointment. Depending on whether this is your first provider visit or whether you are on your fifth referral determines how thoroughly you complete that intake paperwork. At some point, that stack of papers and endlessly repetitive requests for your medical history and prescription usage incentivizes the patient to omit answers.

The handoff from intake to nurse to provider often creates a reinforcement to the patient belief that no one reviews any of the information on those forms prior to the interaction you are paying to receive. It doesn't take long for a patient to become less thorough when they believe the doctor won't actually review any of the intake information.

Because the documentation of the provider is clearly designed to maximize billable events, the patient quickly learns to keep their mouth shut. They know they can only talk about the most important ailment or symptom in that extremely rushed timeframe.

I suggest two simple steps to achieve a health care redemption:

For the patient:

1. Journal or make a simple list of all your symptoms ahead of your appointment and take a companion with you to listen or prompt you to complete the list you both discussed ahead of time. If you are feeling frisky, ask the doctor if you can record your visit so you can remember all the advice given.
2. Commit to knowing there is no fault in seeking to be healthy. Simply say it out loud before the visit and then silently in the exam room. You are paying for this privilege and you deserve to be heard.

For the provider:

1. Reduce all redundant intake paperwork and refuse to launch any intake technology vendor designed to scrubbing our intake data to identify and increase billable events. The new age of the health care consumer will see through these third-party parasitic technology providers and distrust you.
2. Don't compromise eye to eye contact with the patient when documenting the visit and make sure that all information on the new patient intake is reviewed by you, not just a team member who isn't considered a collaborative partner in the eyes of the patient.
3. Discuss the role that personal finances will play in all treatment plans versus the assumption insurance will pay for it all. This includes the assumption that all patients might forego treatments if insurance denial or price would be a barrier to care.

These are just two examples of a list of 21 health care sins I've compiled through discussions and interviews with providers, patients and industry insiders. Tackling the gargantuan mountain of flaws that prevent us from living our desired balance of happiness, health and wealth is not a small undertaking. However, it is not an impossible journey. Sure, there are problems and extremely powerful entities that profit from dysfunction. However, the power of our community is greater as we engage all eyes and all minds to focus on this course correction.

My benediction

Enlightenment doesn't allow for regression, it calls for action. You are now on a new journey and you are now more complete than ever and better equipped that you ever were in the past to complete this journey. You are not alone; you are surrounded by family members, friends, neighbors and every other sojourner who is seeking the fixes, working and compiling data on behaviors and trends that will let us move forward. Even though you are not alone, you are also no less important. Health care at its core is a sample size of one, and that one is you. This journey together is extremely personal. May you never be marginalized, left behind or discounted. Let us practice health care redemption together and right the wrongs of our health care sins.

Read also:

Hi, my name is Eric, and I'm a recovering carrier rep

My ethical dilemma