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?

So, does our system focus on population and personal health and do clinicians establish a health baseline for patients? Or develop guiding principles and objectives for the individual and leverage science, sociology, technology, medicine and behavioral psychology to evaluate health status and build a strategy for maintaining and improving health with appropriate care? Not placing the waste and cost burden on caregivers, I'm simply asking if we are allocating health resources appropriately for improving and maintaining health, or are we experts at effectively delivering care through insurers and provider systems?

Imagine a brief intake with a clinical social worker or pre-care health advocate prior to seeing a caregiver. Someone who'd inquire about your current health. How is your home life? How do you manage your responsibilities? How's your sleep, exercise, diet, addiction and stress? Do you have any health goals? Imagine if our health profile was a living document that chronicled our health history, both goals achieved and areas for improvement. What if our in-taker had a consultation with our caregiver or attended our visit to ensure a full picture of our health was presented?

Uninsured, under-cared, access challenged, and quality outcomes have become the anchor issues for our national health care debate. But health education, partnering, and negotiation with our caregivers and being stakeholders in our health status is overlooked and hit-or-miss.

I pushed back on a second hypertension medication with a commitment to weight loss and exercise with my primary caregiver. I felt armed with reasonable information and endeavored to partner to achieve my health goals. Even our automobiles have service records.

A single payer, Medicare for All health care alternative will not reduce the resources and services consumed by Americans; it will only alter how payments are made. The idea of leveraged purchasing or collective purchasing like a grocery co-op works if we're all consuming the same groceries; and if we have leverage to buy elsewhere or defer purchases. But our health consumption is inelastic. Take the grocery co-op example. If we negotiated orange prices and a sweeter, seedless version became available, we would want it. But we'd compare the price and make a pragmatic decision to consume traditional oranges until our budget changed or we traded out some other consumption. When it comes to our health care, we will not compromise for an acceptable treatment therapy or surgeon when a superior one is available – who would choose an average knee replacement over an excellent one? So, Medicare for All will not stem our health care appetite without Americans collectively changing our culture and preferences to accept less costly and intensive treatments without perceiving sacrifice or rationing. We just don't trust what should be adequate for all while we hear about better options being available.

We have not attacked adequately the health of Americans and the factors acting on the whole individual. We are expert and efficient at delivering health care; but we are inadequate with patient-centric health strategies and encounters that focus on deepening our understanding of patient health.