I left. My heart was pounding, and I spent my spare time for the next few days thinking through better, less confrontational answers that might have helped the situation. None of them were the "silver bullet" answer.  I heard through the grapevine the next time I was in the office that she was still a patient and still tough to work with, but appeared to be more engaged in managing her health. One step at a time. "Everybody wants the easy answer."

We all do.  The patient wanted what she got from all of her other service providers – an easy way out, another chance, a free play.  She wanted a pill to fix her problem, not having to change her sedentary, deep-fried, high-carb and salty snack-based life.  She wanted the world of "no fault" customer service to apply to her blood glucose levels.

I blame human nature. This attitude starts with every visit to Starbucks. L.L. Bean. Nordstrom. The dry cleaner's near my house. Insert name of your favorite customer-focused retailer here. We have all been spoiled by the "no problem, just bring it back" mentality, and it's killing us. In almost every other area of our world, customer service levels have been rising and making most of our decisions a "no fault" issue. We don't have the feedback loops we need, the cause and effect awareness that keeps bad behaviors in check. Good customer service is affecting our personal ownership of our health.

As an expert in risk management, I have been watching the world change as we become more insulated from the direct impact of our decisions. The new generations entering the workforce have gotten a medal for every game they played in soccer, win or lose. Shoppers are accustomed to answering few questions on the return of purchases. No-fault insurance. No-fault divorces. Miss a deadline? Pay more, but still get in.

Flash back to the patient in the office. She wanted a better result, and was going to find a doctor that would agree with her version of the facts, not the reality that she had a chronic condition. For the ACA to work, we citizens have to confront our behaviors and manage our health, with the key metrics how healthy and productive we are, how sick we get and how often. 

The core answer to "bending the curve" is well-being. We have avoided the hard truth of our behaviors for more than a century, and now the ACA is here. Certainly not a perfect set of answers, but it is the law, and it is in force.

The ACA is a bitter pill for most. Young Invincibles will be paying a penalty for not joining the risk pool. Generous plans will face a "Cadillac Tax."  Insurance agents who specialize in individual health policies may need to expand their practice into other services. People with high political stakes in the outcome. But, the sooner we communicate with our fellow citizens that we are all in this together, and that engagement is better than avoidance, the better our outcome.

And we all want a better outcome.