Dysfunction: Humans behave in ways that are not in our ultimate self-interest, and yet we repeat those behaviors over and over. That’s dysfunction. Whether it’s as obvious as using drugs or alcohol, or it’s bingeing on food, emotionally abusing ourselves or one another, compulsively shopping, polluting the planet or freaking out when someone proposes a change that threatens us in the short-term but would save us in the long-term, we are hardwired to behaviors that are “insane” on the face of them. Of course, there are reasons for these behaviors, reasons that date back to survival patterns developed in infancy and childhood, but these behaviors are nonetheless self-destructive.

Denial: Our dysfunction is destroying our physical, mental and spiritual health individually and collectively. But we hate looking at these realities. In fact, more often than not, we pretend our behaviors aren’t self-destructive at all, and there’s nothing wrong. “Overwork isn’t destroying my body.” “There is no man-made climate change.” “My child is not peeing in his pants every day.” That’s denial of the problem’s existence. But even when we admit there is a problem, we can deny our part. “It’s not my fault.” It’s the government’s fault; it’s the school’s fault; it’s my ex’s fault. Why do we engage in denial? Because we haven’t yet learned to see the truth without feeling shame. We’re already filled with shame for many reasons, and recognizing the ways in which we are dysfunctional adds more shame to the shame that’s already killing us.

Delusion: We want something to be true, and so therefore it is. That’s delusion. Even though we deny our dysfunction, we still have the uncomfortable feeling that all is not well, so we create delusions. Here are some examples of delusions about ourselves: “She really loves me, even though she cares more about my money than my health.” “I’m competent at my job, even though the company has been going downhill since I took over.” “If I have a facelift, I’ll keep my husband’s love.” “I’m still a great driver, even though I’ve lost my peripheral vision.” And here are some examples of delusions around how a problem will be fixed: “Our marriage is fundamentally sound. We just need a vacation.” “The free market will take care of all these irresponsible loans.” “My child is taking drugs. He’ll grow out of it.”

Dysfunction, denial, delusion: What do they have to do with the health care debate?

Dysfunction: The system is broken. Our lifestyle is undermining our health, and our health care system doesn’t work. It costs too much; too many people are without adequate coverage; it is filled with fraud, bloat and redundancy; it’s economically unsustainable; doctors don’t have enough time with patients; there aren’t enough general practitioners; medical decisions are too often determined by fear of malpractice suits rather than good medicine; and patients are overmedicated and unhealthy.

Denial: We are not impacted by the epidemics of obesity, diabetes and other preventable diseases that are caused by our addictive eating and drinking, and we can continue to allow these epidemics to fill our hospitals, cause loss of work and reduce our life expectancy and quality of life. We are not impacted when others have untreated infectious diseases that we can catch; we are not impacted by the high cost of health care for people sitting in emergency rooms because they have no insurance for primary care; we are not impacted by doctors having to work by the insurance industry’s rules rather than their own best judgment. Other people can get cut off or denied care, but it can’t happen to me!

Delusion: The system is fundamentally sound. We’re a healthy nation, and most of us are getting the health care we need. Even if it’s full of holes, don’t rock the boat!

As we know, delusions have a way of collapsing. The U.S. economy is staggering under the weight of the dysfunctional health care system, our children are obese and our health is degenerating. Is that what we want?