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Well, it seems just about everybody.

The ‘change-speak’ - including the healthcare-system-is-broken’ mantra — appears to be now part of everyone’s talking points. The tone is often self righteous and the pronouncements made as though this is still news, or that saying so takes an act of some courage. No, my friends, all this is not news but is truly common knowledge and part of popular culture.

What continues somehow not to be news, or uncommon knowledge, has to do with the quality question: what are we getting for our money? Real change, I believe, won’t happen until the majority of people become obsessed with that fundamental question. While the chorus of folks who share this understanding is growing, the national horse race on healthcare continues to place it as an also-ran in the official program.

So who’s leading change in healthcare? Everyone and no one. No one at least, until we see leadership that proposes change in a way that’s real, on the ground.

When as a young child I listened to my French-Canadian aunts and uncles talk amongst themselves around the dinner table, where everyone smoked heavily and drank dark, boiled-to-a-black-syrup coffee, I would hear them speculate endlessly about their own physical ailments, which I found, again as a young child, profoundly disgusting yet inexplicably riveting.

“I’ve had seven operations, one uncle would boast,” showing his scars with pride and defiance, as though he had survived deliberate assassination attempts by his doctors through courage alone.

The women would talk of things that made my cheeks flush. I pretended to focus on the card games we were playing while reflecting a demeanor of total disinterest in the smoky but tarty conversation swirling around me. I held my young self aloof and beyond reach of these frailties of the ‘old’. My role was more in line of the detached family anthropologist than the family doctor, I thought.

I was named after a beloved uncle who died at a young age — about my age, in fact, at the time, I was told. “The doctors killed him,” another uncle whispered to me flatly. And in an emotionally rich family of French Canadians who laughed and joked 99 percent of the time, being told anything in that manner meant this was serious business. The last time I had heard that tone was when my grandfather threatened to send me to “reform school.” So I paid attention.

And since another part of the family tree consisted of friendly but shadowy heat-packing gangsters, I often wondered about the fate of that doctor.

My parents were factory workers of the lowest and finest order.They sent me to Catholic school paying three dollars a month for the privilege. Parochial school healthcare of the day was more religious than corporal: a healthy soul was the prime directive.

Mostly I learned how to deal subversively with authority. Our nuns were members of the ‘Sisters of Mercy’ gang meaning, of course, that they were merciless to us. Thus my learning of the various truths about the body as I grew up consisted of a continuous series of shocking encounters.

During a family outing, I fell and cut myself. Walking into the house bleeding, my aunts went into a state of apoplexy rushing me out yelling that there was a pregnant women in the house and that she should never “see the sight of blood.” That ‘fact’ was duly noted in mind permanently from then on.

My gentle uncle Edward would play the piano for us on occasion. He had a sweet and childlike disposition. He also had epilepsy. In the middle of one song, on a lovely Sunday afternoon, he had a seizure. Again, the uproar, the rushing out of the children — accompanied by a fearful silence and absolutely no explanation of any kind. We were too afraid to even ask. It was all so mysterious and dark.

I had a few encounters with the healthcare system as a child. Born in a country hospital, tonsils out at a young age — hated the ether, loved the ice cream — a typical experience of the times. One accident I did have, falling to the street with a milk bottle in my hand, resulted in a trip to the family doctor to stitch up a serious cut to my thumb. The image I remember most is sitting there, bleeding, on the edge of a paper strewed wooden desk, in an unkempt office, with the doctor, cigarette dangling from his lips, joking whilst he prepared a long hooked needle. I didn’t faint but I should have. I was later hospitalized. A tendon had been severed and needed to be repaired.

Teeth were also not a high priority health item in my clan. No hide nor hair of a dentist was seen until at 18 years old I forced marched myself into a dentist office to begin the long and painful rehabilitation of my mouth. I have working class teeth, the kind that exude a history of struggle and psychological defense. The truth is I was embarrassed for a good part of my childhood and afraid of what had to be done. Bad dreams about bad teeth were frequent and while the eventual dental work was daunting, a great burden was lifted from my heart when I finally dragged myself in for care.

These are some of the phantoms that weigh on me when it comes to healthcare. I have been both damaged and rescued; I am suspicious and appreciative; I have been hurt and healed. As a patient I bring a complexity to healthcare that runs deep; as a healthcare wonk, I bring that same history to my work everyday. Age does help soothed the rough edges here and there. And I suspect I’m not alone in having old phantoms revisit from time to time.