The Obamacare antidote: Your Personal Affordable Care Act by Vik Khanna; Book excerpt 2

The Affordable Care Act is a lie

Author’s Note:

I am deeply grateful to Rachel Alexander and Steve Laib of The Intellectual Conservative for their willingness to carry this series of excerpts from my new e-book, Your Personal Affordable Care Act: How To Avoid Obamacare. As conservatives, we need to speak bluntly about the fact that not only is nothing free, but freedom — from government and industry intrusion into our lives — comes at a price in responsibility and accountability. My e-book provides the roadmap for doing just that.

This is Excerpt 2. Excerpt 1 is available at this link.

From The Introduction

We have met the enemy in our endless rage against medical care costs, and, to speak the unspeakable, the enemy is us. Our failure to take ownership of our own health is like a crack in the foundation of a building that will grow into a ebook_6x9_v4 with blue stripe after pixel checkcolossal collapse of what was once fundamental to being a competent and independent adult. We are left with the fact that our willful denial of personal responsibility as the irreducible natural law of good health empowers both a gluttonous government and medical care industry that care less about well-being than they do about power and control. Hence, the American conversation about personal health suffers from a distortion that is unique in the developed world: the government and its clinical agents are succeeding in promoting the idea that good health is something that comes from the healthcare industry. It is as absurd a claim as saying the nation’s economic prosperity starts with the Internal Revenue Service.

Winston Churchill once said “We contend that for a nation to tax itself into prosperity is like a man standing in a bucket and trying to lift himself up by the handle.” I contend that funneling a person through a greed-soaked healthcare industry in pursuit of health is like telling someone who’s trying to break an addiction to go live with his suppliers.

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Health is not a medical product; it is your (birth) right, but like all inalienable human rights, it is exercised fruitfully only with serious attention to its attendant responsibilities. Health is only rarely the product of interaction with the healthcare industry; a very small proportion of people account for a large proportion of healthcare spending, and most of those people are sick enough to really need help. For them, it is imperative to have an efficient, highly functional system that delivers high quality care with accountability. And guess what? We don’t even have that. For the rest of us, getting medical care has become a game: we try to get others to pay for everything we want, and health plans and providers are only too happy to function as middlemen who take a piece of all the action. Their positioning of health as a medical product is as ridiculous as university administrators claiming that a formal education yields wisdom…

…The only people and organizations who don’t want your independent thought and action are the ones who feed off, and profit from, your neediness – health plans, government, medical care providers, and drug companies who want you to sacrifice your time, money, confidence, and self-respect on their altar. Have you ever noticed that they never turn to us and say, “We have taken enough”? When Americans complain about welfare cheats, there is no bigger welfare-state cheater in our society than a tax-advantaged healthcare industry that keeps telling us universal efficiency and effectiveness are just another trillion dollars and 10 more years away. The healthcare industry makes the defense industry look like the Little Sisters of the Poor.

Almost all of this is our fault. We are lazy. We eat horribly. Incredibly, about 20% of us still smoke, and we think that health is something that is achieved on autopilot or comes out of a supplement bottle. Health is achieved through will, by conscious engaged decision making moment-by-moment, day-by-day, week-by-week, month-by-month, year-by-year, and, eventually, lifetime-by-lifetime. It comes person-by-person, family-by-family, and eventually, community-by-community.

Promoting a better, leaner, more efficient healthcare industry is everyone’s responsibility, but we can do it only if we are better, leaner, and more efficient ourselves. We must relearn the differences between personal responsibility and shared risk, which is what insurance is about. We can and should expect each other to do the basics for ourselves, while realizing that the big ticket items – heart surgery, chemotherapy, transplants – are costly items that require pooling and sharing of risk because they are otherwise wholly unaffordable. But expecting insurance to cover every teensy weensy discomfort of modern life has dragged us into the tunnel of waste and excess. There is no light visible ahead, and the tunnel will be without end if we are unwilling to change our ways. Imagine how much your auto insurance would cost if it covered all your routine services. Even for car companies such as BMW, which sells routine maintenance as “free” for the first few years, don’t kid yourself, it’s all built into the price of the car.

I know this because for the past 30 years, I have seen the American healthcare industry from the inside out. I know of no other healthcare professional who has been on the inside of health plans, major healthcare providers, the drug industry, government, and the patient advocacy community and been revolted by what I have seen and heard at nearly every stop. Even more to the point, I practice what I preach, and I have since age 18 through good and bad financial times, through debt, divorce, career upheaval, and personal crises that brought me to my knees. I. Don’t. Quit. Do you?

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Regrettably, our addiction to all things medical is not limited to services as benign as checkups for people who don’t need them or to seeking antibiotics for the nonbacterial. Provocative, inflammatory, emotive marketing now forms the core of healthcare outreach to the un-accosted and generally healthy because they are the pipeline of new patients even if they don’t need medical care. This simple but sinister strategy intentionally frightens people into clinical engagements far more likely to financially benefit healthcare providers than help patients. From labeling obesity a ‘disease’ and an ‘epidemic’ (it is not the former, and an epidemic is both prevalent and virulent; two-thirds of American adults are not obese, and you cannot catch it the way you catch a cold, although there does appear to be a social element to the problem) to all manner of most cancer screenings, the medical care industry now surpasses car dealers of yore who used to sell you paint sealants and rust proofing that did neither, but also didn’t hurt your car. The same cannot be said of cancer screenings that not only don’t save or extend lives, but put patients on a clinical treadmill to nowhere, replete with opportunities for adverse events. Screenings also create unnecessary anxiety in people simply by raising the specter of disease. Fear is not healthy, and it’s bad enough to actually be sick, but what is the sense in scaring people who aren’t sick?

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Obamacare’s scope exceeds even the post 9/11 legislative fervor to protect us by making government an uninvited and frequently unwarranted guest in the personal lives of the overwhelming majority of Americans who pose no threat to national security. Indeed, Obamacare shares some very disturbing characteristics with these other grand schemes: it is not based on evidence although it claims to exalt evidence; it is a disjointed work in progress that was marketed to Americans as a ready-for-prime-time be-all and end-all; it promotes government as a solution to a problem that is largely a government creation, then expects us to applaud the government’s heroic somersaults to make itself into something that no one wants it to be: a savior.

My assertion that Obamacare steers us away from the tried and true American approach to public health is borne out by history. The 20th Century was a period of remarkable enlightenment about how to protect public health. Much, if not most, of the thinking was about how to effect the environment so that people could remain healthy, safe, and engaged in their lives without being unduly besieged by the medical care system. Among these public health achievements were: vaccinations, safer cars and roadways, safer consumer products, modern sewage systems, cleaner water and air, better prenatal care, enrichment of foods with essential nutrients (especially vitamin D, niacin, and folic acid), improved building codes, banning of leaded paint and gasoline, improvements in food safety, attention to workplace safety, alcohol and tobacco use education and control, and, the development and dissemination of antibiotics. All of these achievements except antibiotics had an underlying theme: they were about reducing the risk of illness and injury so that people could live their lives without complex, costly, and avoidable medical care to resolve preventable problems. Antibiotics both saved lives otherwise lost to infectious disease, and they allowed treatment of these ailments to move outside the hospital to less expensive and dangerous community settings.

Obamacare turns its back on these powerful and effective approaches. President Obama is the first modern American chief executive to visualize the health of the American population not with a big lens, but with a microscope that forsakes environmental and educational improvements, which were the bedrock of our 20th Century successes. He trades them for a command and control approach that intentionally targets individuals. In taking this approach, the President belies his own claim for what underlies his strategy: evidence. While he proclaims that Obamacare will bring evidence-based medicine to the land, he denies evidence of the most important tools for improving population health, improving quality, and containing cost growth.

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Shamefully, the government couldn’t even get the launch of the vaunted healthcare.gov right. It’s inconceivable that in a culture where EBay, PayPal, and Amazon.com process billions of dollars in transactions daily, in many currencies, we couldn’t launch an insurance enrollment website. This incompetence reflects the unwarranted belief that technology is some kind of fairy dust that solves problems by its mere presence. If access to medical technology and reliance on medical experts were all we needed to achieve health, you’d think we would have arrived at medical nirvana already. Instead, we are in a hell of medical mediocrity, driven by greed and enabled by a government that just can’t say no to anything the healthcare industry asks for. It’s pretty unlikely that the people and organizations who have been misleading you and ripping you off for decades are going to change their tune now that they’re being propelled and supported by federal law.

Obamacare’s second, and for the purpose of this book, fatal, flaw, is its promotion of the healthcare industry as the solution to the dilemma created by unhealthy lifestyles, which is reparable only by living healthier lives, not getting more medical care. Getting too much medical care is bizarrely and uniquely American. Obamacare codifies it, promotes it, and irrationally positions it as the wrong answer to an incorrectly stated question: is the clinic the source of good health? The right question is “what is the source of good health?” And, that answer is families, churches, communities, schools, workplaces, and individuals choosing freely in an open market, with the understanding that choosing unwisely is costly and that you should bear some, if not a lot, of those costs.

Since 1965, when the federal government created both Medicare and Medicaid, thus launching the modern healthcare financing era in the U.S., we have borne witness to a steady encroachment into our lives by the medical care industry. With that encroachment has come a growing emphasis on a very uncertain principle: you become healthy and sustain health by engaging more deeply with large institutions, such as the government, health plans, and health systems, and by relying upon the judgment of professionals. Far too many of them have primary motivations, whether conscious or unconscious, which are clouded by personal economics and not logic or science. Their missions frequently are not to promote health, but to facilitate, and then control, how we get and use medical care, and to ensure their own growth and prosperity as the expense of our own. The medical care industry took advantage of the government’s interest in reducing the burden of healthcare costs in the later years of life and has successfully clawed its way backwards, trying to influence behaviors, decisions, and choices at ever-earlier ages. The pot of money at stake is huge: about $300,000 per person over the course of a lifetime, with half of that money spent after age 65.

This was all predicted quite clearly and accurately by Ivan Illich, a radical Catholic theologian who theorized that the medical care industry would harm us more than help us. He called it the medical nemesis (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732338/pdf/v057p00927.pdf). Illich’s claim that good health derives first and foremost from conscious and engaged self-care was, however, both prescient and compelling.

Illich was not alone. Thomas Szasz and Petr Skrabenek (use this URL to read his treatise, The Death of Humane Medicine: http://bradtaylor.files.wordpress.com/2009/06/death-of-humane-medicine.pdf), both doctors, also wrote about these issues in compelling, contrarian ways. I find Skrabenek particularly powerful when he posits that the government-driven pursuit of “health” is really just a form of controlling people. The government empowers large corporations to act as its enforcers. The enforcers direct the consumptive behaviors of individuals, make those individuals pay mostly non-negotiable prices for their consumption, and squelch the idea that individuals should have control over their own health.

The only way to fix the U.S. healthcare industry is for each of us to continuously fix ourselves, and the only way we can fix ourselves is to stop acting like our choices don’t matter or are coerced. The only way to keep from spending increasing amounts of hard-earned treasure on medical care is to need less of it, and that’s feasible only with a solid, reliable, sensible, and, most importantly, achievable healthy lifestyle strategy that is designed to help you and your money avoid Obamacare. As a believer in markets and personal freedom and responsibility, I certainly understand if you decide to look the other way, pretend the things outlined here don’t matter, keep doing what you’re doing, and keep blaming modern life, or your parents, or big companies for your dilemma. Wonder what you’ll think when you wake up one day in post-op connected to a respirator after your heart bypass? Who will you blame then?

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