For the past 45 years, I’ve earned my living working in so-called “health care” — more specifically in health policy with my principal focus being on the financing of and payment for medical care.

I say “so-called health care” because I think it is profoundly important to clearly distinguish between health care, medical care, and public health care. Health care (as I have all-too-often said) is what I do in my kitchen, what I do in my gym, and what I do in my bedroom. None of which involves my “health care providers” or my “health plan”.

My health care providers provide medical care. My providers might help me identify the need to change my way of life, but changing my way of life is something I have to do for myself. Diet and exercise are health care. Prescription drugs are medical care. And my “health plan” provides coverage for medical expenses. My health also helps me manage the expense of the medical care I need mostly by negotiating fair and reasonable terms of payment.

Over the past 50 years, only twice has my medical coverage been provided by what could be reasonably described as a “health plan”. In my twenties my coverage was provided by Anchor — a staff model Health Maintenance Organization owned and operated by Rush Presbyterian St. Luke’s Medical Center. And when I worked for the federal government my coverage was provided by Kaiser-Permanente. Both of these health plans combined the organization, delivery, and financing of medical care under a single corporate enterprise. The rest of the time my coverage was provided by insurers who had no responsibility for the actual medical care that I received. These arrangements separate — you could even say fragment — the organization, delivery, and financing of medical care. The basic distinction I am making is simple: in the one I was a patient; in the other I was a customer (a.k.a. member).

What about public health care — also just referred to as public health or public health services? Public health does directly affect the health of the people who together comprise the community. Clean water and sewerage. Clean air. Immunization. Safe highways and byways. Safe workplaces. These are all crucial determinants of health but need have nothing to do with the organization, delivery, and financing of medical care, which is sometimes distinguished from public health care/services which are designated personal health care/services.