In the early 1990s, I began my health care career as a group insurance underwriter. Shortly thereafter, the Clinton administration called for an overhaul of the private system and a move to a government sponsored program. The industry responded with a relentless assault led by pharma, insurers and conservatives against big government.

With the reform’s demise, we witnessed the expansion and development of managed care, consumerism, chronic condition management, centers of excellence (catastrophic cases, e.g. cancers), wellness and a host of quality and outcome evaluators. The attention would be shifted from industry waste, discriminatory pricing practices, windfall profits, consolidation and variant clinical quality to the patient and his/her lifestyle, decision making, under-education, addiction and insatiable appetite for pharmaceuticals. A collective industry sigh ensued.

The concepts and rivalries of the 90s reform era lived and breathed through President Obama’s ACA and are still adjudicated in the spheres of public and political debate today. What politicians, voters, agents, and the media continue to conflate is the gapping divide between health and care and health care. The health care industry delivers medical goods and services through various delivery systems, financial arrangements, administrators and pharmacies to treat patients; primarily those with health insurance. But, does our system as currently constructed focus on health and effectively deliver the care targeted to maintain and improve health?

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