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.