An open enrollment conversation about healthcare, the security of the familiar, and the courage to question our choices.
It’s that time of year again. Open enrollment.
The annual ritual of comparing premiums, deductibles, copays, networks, and out-of-pocket maximums. We shuffle numbers around, contemplate the possibility of catastrophe, and try to make a reasonable financial decision about something none of us can entirely predict.
And somewhere in all that risk assessment, I wonder whether we’ve forgotten to ask a rather important question.
What are we actually trying to purchase?
I’ve had several conversations this week with people exploring alternatives to conventional health insurance. Different ages, different circumstances, different financial concerns. But beneath the questions about cost, I kept hearing something remarkably similar.
People want access to care. They want someone who knows them. They want to ask questions before a small concern becomes a larger problem. And they want some financial reassurance that a medical emergency won’t undo everything they’ve worked for.
None of that seems unreasonable.
Yet we’ve constructed a healthcare system in which paying for medical expenses and actually receiving meaningful care can be two very different experiences.
And here’s what I find particularly interesting.
Many people are deeply dissatisfied with their healthcare arrangements. They’re frustrated by the expense, frightened by the bureaucracy, and uncertain whether their insurance will actually serve them when they need it most.
But when presented with a different way of engaging in their own healthcare, they hesitate.
Sometimes for very good reasons. Sometimes because they don’t fully understand the alternatives.
And sometimes simply because it’s different.
Why are we so reluctant to reconsider a path that isn’t taking us where we intended to go?
How Did We Get So Attached?
Our relationship with health insurance didn’t develop entirely by choice.
During World War II, wage controls and favorable tax treatment helped employer-sponsored health insurance become an increasingly important form of compensation. Over subsequent decades, tax policy, collective bargaining, and employment practices reinforced that arrangement.
Eventually, having a good job and having good health insurance became almost synonymous.
And here we are.
For many Americans, access to affordable insurance remains tied to employment. Some stay in jobs they would otherwise leave because they’re concerned about losing coverage, access to medications, or continuity of treatment.
Economists have a term for this: job lock.
Think about the irony.
We may remain in work that compromises our physical or emotional well-being because we’re afraid of losing the financial arrangement intended to protect our health.
Of course, for someone managing an expensive chronic illness, taking costly medications, or supporting a family, maintaining employer-sponsored coverage may be an entirely reasonable decision.
But how many of us have actually examined the alternatives?
How many understand what their insurance truly costs, including the employer’s contribution, deductibles, copays, and other out-of-pocket expenses?
And how many have simply accepted that this is how healthcare works?
We’ve inherited an arrangement, developed expectations around it, and built much of our financial security upon it.
Then there’s the language.
Coverage. Protection. Benefits. Security.
These are reassuring words.
But they don’t necessarily tell us what happens when we need care.
And perhaps that’s where the relationship deserves a closer look.
An Expensive Promise
According to the Centers for Medicare & Medicaid Services, the United States spent $5.3 trillion on healthcare in 2024, approximately 18% of our gross domestic product.
Yet in the Commonwealth Fund’s 2024 comparison of ten wealthy nations, the United States ranked last overall, last in access to care, and last in health outcomes. Oh my…
We have extraordinary medical capabilities. We can diagnose and treat conditions that were unimaginable a generation ago.
But the brilliance of modern medicine doesn’t automatically translate into a coherent healthcare experience.
A Yale-led research preprint released in August 2026 estimated that a universal, single-payer system could reduce annual U.S. healthcare spending by approximately $1 trillion while expanding access. The projections depend on assumptions about implementation and have not yet been peer-reviewed, but they raise a provocative question.
If there are potentially less expensive ways to organize healthcare, why have we become so attached to the one we have?
And the cost isn’t merely financial.
In a 2026 KFF survey, nearly half of insured adults reported that their insurer had denied, delayed, or altered access to care within the previous two years.
These experiences can have consequences beyond frustration.
Imagine receiving a serious diagnosis and discovering that, alongside managing your illness, you’re now responsible for navigating specialists, referrals, authorizations, appeals, billing disputes, and decisions you barely understand.
Perhaps you’re frightened. Perhaps you’re exhausted. Perhaps you’re still trying to comprehend what is happening to your body while someone hands you another packet of paperwork.
And we call this healthcare.
I don’t say this to diminish the extraordinary physicians, nurses, and clinicians working within medicine.
But even the most dedicated practitioner cannot single-handedly compensate for a fragmented system.
Insurance provides important contractual and regulatory protections. Yet those protections don’t necessarily spare us from delays, administrative burdens, financial uncertainty, or the emotional exhaustion of trying to obtain care.
Receiving care eventually is not the same thing as being cared for throughout the process.
We have become remarkably sophisticated at accounting for the financial cost of medicine.
But I wonder whether we’ve adequately accounted for the human cost of obtaining it.
The Security of the Familiar
Here’s the paradox.
People are frightened of the healthcare system they depend upon.
Yet they’re also frightened of leaving it.
We’ve spent generations associating health insurance with security. We pay our premiums, carry our cards, and trust that somewhere within this enormously complicated arrangement lies a promise of protection.
And sometimes that protection is substantial and indispensable.
But sometimes we’re paying enormous sums for limited access, fragmented care, and financial obligations we don’t fully understand.
Why does the familiar arrangement feel safer, even when it isn’t working particularly well?
This is where I find an Ayurvedic understanding of the mind rather interesting.
In Ayurveda, manas describes the mind through which we receive and process experience. Buddhi is the faculty of discernment, helping us distinguish what is beneficial from what is not.
Our perceptions are shaped by experience, memory, emotion, and conditioning. And what feels familiar isn’t necessarily what serves us best.
Discernment asks us to examine that difference.
Are we making decisions based on a clear understanding of our circumstances, or are we allowing habit and fear to make them for us?
This isn’t an argument for abandoning caution. Choosing a healthcare arrangement carries genuine consequences. But shouldn’t we examine the arrangement we already have with the same curiosity and rigor we apply to something unfamiliar?
Perhaps the greater risk isn’t always choosing something different.
Sometimes it’s never questioning whether the familiar choice still makes sense.
What If We Began With Health?
Here’s an important assumption worth examining.
We’ve become accustomed to accessing healthcare primarily when something goes wrong.
We develop symptoms, make an appointment, receive a diagnosis or treatment, and hope the problem resolves.
But what about the relationship we have with our health before illness arrives?
This is fundamental to the Integrative Ayurvedic Medicine approach I’m creating in realtime.
Health isn’t simply the absence of disease, nor is it something we can purchase through an insurance policy.
It’s an ongoing relationship between ourselves and the conditions of life.
Our digestion, sleep, movement, stress responses, relationships, environment, and the rhythms of our lives all participate in the expression of health.
And the more we understand those relationships, the better equipped we may become to recognize meaningful changes, seek appropriate care, and participate in decisions about our well-being.
That doesn’t mean we can prevent every illness.
It doesn’t mean good habits guarantee good outcomes.
But it does mean we can develop awareness, establish trusted relationships, and build a foundation of care before we’re forced to navigate a crisis.
We don’t have to begin at zero when something goes wrong.
And perhaps this is one of the most overlooked opportunities in healthcare.
What if we invested as much attention in cultivating health as we do in financing illness?
That requires a different understanding of personal agency.
Not the expectation that we must become experts in everything or somehow control our health.
But the ability to participate meaningfully in our own care, supported by professional expertise, trusted relationships, and a growing understanding of ourselves.
Good healthcare should strengthen that agency, not replace it.
A Different Way to Organize Care
Which brings me back to those conversations I’ve been having this week.
What surprises me is how few people realize that accessible, comprehensive, relationship-centered healthcare can actually be affordable.
We’ve become so accustomed to paying enormous sums for healthcare that the possibility of receiving more personal attention and consistent support for less money almost seems suspicious.
This was part of the thinking behind the Threshold Membership at Origins Health.
Rather than expecting one insurance product to provide everything, I wanted to bring together three complementary forms of support.
An ongoing relationship with health. Through Origins Health, members receive individualized integrative care, preventive guidance, and support from someone who knows their history and understands the larger circumstances influencing their well-being.
Accessible conventional medical care. Through direct primary care, members have access to virtual primary care and other available clinical services, with in-person medical care remaining essential when appropriate.
A different approach to significant medical expenses. Through medical cost sharing, members participate in a medical cost-sharing community that voluntarily shares eligible medical expenses according to established guidelines.
Medical cost sharing isn’t insurance. Sharing isn’t guaranteed, eligibility restrictions apply, and members remain responsible for their medical bills. It doesn’t provide the same legally enforceable coverage obligations or out-of-pocket protections as ACA-compliant insurance.
Those differences matter, particularly for people with significant ongoing medical needs.
But so does the difference between paying for an insurance policy and having meaningful access to care.
For people whose circumstances are well suited to this arrangement, combining these three services may provide substantial savings alongside a more accessible, personalized, preventive healthcare experience.
And that’s what I find compelling.
Not simply that we may be able to spend less.
But that we may be able to organize our healthcare around something more meaningful.
Prevention. Relationships. Medical access. Financial preparedness.
And perhaps most importantly, participation.
We don’t have to wait until we’re sick to begin receiving care.
We can develop relationships before we desperately need them. We can ask questions, explore concerns, and become more knowledgeable about our own physiology.
We can use conventional medicine when it’s needed while cultivating the everyday conditions that support health.
And we can make informed financial decisions based on our actual needs rather than assuming the arrangement we’ve always known is the only reasonable option.
The Question Worth Asking
There are enormous questions surrounding the future of American healthcare.
How we finance medicine. How we distribute resources. How we make care more accessible and equitable. How we protect people from financial catastrophe without creating unnecessary suffering in the process.
Those conversations deserve serious attention.
But perhaps we shouldn’t wait for an entire system to change before reconsidering how we participate in our own health.
As open enrollment approaches, I hope people will consider more than the price of a premium.
Consider what kind of care you actually receive.
Consider who knows your health history, who you would call when something feels wrong, and who might help you navigate a complicated diagnosis.
Consider whether your current arrangement supports your health before illness or just finances intervention.
And consider whether the security you feel comes from understanding your choices or simply from their familiarity.
Health is a relationship, not a destination.
We may not know exactly what the future of American healthcare will look like.
But we don’t have to surrender our relationship with health while we wait to find out.
And if the path we’re following isn’t taking us where we intended to go, perhaps it’s time to ask ourselves why we’re reluctant to explore another.
If you’re interested in exploring a different approach, learn more about the Threshold Membership at Origins Health, including integrative care, virtual primary care, and medical cost sharing. Understanding the benefits, limitations, eligibility requirements, and financial risks of any arrangement is essential to making an informed decision.
