The Obamacare antidote: Your Personal Affordable Care Act by Vik Khanna; Book excerpt 5

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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 5. See here for Excerpt 1, Excerpt 2, Excerpt 3, and Excerpt 4.

From the Conclusion

Never forget that the healthcare industry is not about you. You’re just a cash flow mechanism for organizations that, as Otis Brawley, the illustrious physician and former leader of the American Cancer Society says, encourage “the patient be ground up as expensively as possible with the goal of maximizing the cut of every practitioner who gets involved.” If you are comfortable casting your lot with that crowd, now empowered and emboldened by the federal government, to chew you up even more, be my guest.

You should be zealously protective of your personal information, including whether you own a firearm. Healthcare data is as insecure as commercial data. As we continue a national debate over who gets to collect what personal data and under which circumstances, it’s important to remember that data is power. And, whether it’s the government’s goal to build a biometric database of Americans (who’s to say it won’t compel wellness vendors, health plans, or ACOs to turn over data just as the big phone and Internet companies have done or abstract information about things like gun ownership?), or your employer using health data to affect your job, you are better off suspicious than you are nonchalant. Your data is for sale, and, indeed, is being sold and traded as you read this. You are only fooling yourself if you think that it will not eventually be used against you in employment, housing, finance, medical care, or any other element of your life in which someone can use your information to twist your arm.

By the way, electronic health records and electronic medical records are two different things. Did you know that? Is anyone explaining that to the public? The electronic medical record is supposed to reside with a single provider. The electronic health record is supposed to be the comprehensive history of your health that can follow you wherever you go and contains data from all your care interactions. There is yet a third category, the personal health record, which is what you are supposed to be able to see; why can’t you view the electronic medical or health records as others see them? Here is what I would want to know about the electronic health records in my name: Who else sees that information? How is it abstracted, supposedly de-identified, and sold to or shared with researchers? Can I opt out of that process or better yet, is it an opt-in process? (A long but excellent treatment of the federal privacy rules is in this article by Richard Epstein: http://object.cato.org/sites/cato.org/files/serials/files/cato-journal/2002/5/cj22n1-3.pdf.) What exactly is on the screens that patients never see? Can I see the data trail of where my information goes or who accesses it, just as I can see who inquires about my credit history? If not, why not? The government used to use population surveys to gather data, but the advent of technology is changing the dynamics without a full understanding of the ramifications.

The data trove about you will only get richer when screening and checkup recommendations morph into requirements, and people who could not care less about your dignity as an individual or the privacy of your information, use it to manipulate your behaviors. We live in a time when the pursuit of data is the grail quest for government agencies and their private sector partners, such as major universities, who paint their data needs in a comforting glaze of benevolence: their data collection is all for your own good. The electronic medical records that John Colmers once claimed were the solution we were all waiting for are really just you…in digitized form, and lost from your own control (and probably your doctor’s), packaged and sold to people looking to use the information to advance their own agenda. That agenda could be as basic as “I need to justify a new grant” or as subversive as “how do we get more people to use the things we want them to use? What do they fear, and how can we use those fears against them? How do we control their choices, even their thinking about when their lives should end? How can we turn the clinically insignificant into the monster under the bed in the middle of the night to create levels of dependency never before seen?”

Truth in policy and medical markets is rarely objective and immutable. It almost always projects an agenda, which can be truly beneficent, or subversive. To know which truth you are being told to believe, you must be willing to peek behind the curtain, discern motives and, in the words of Deep Throat “Follow the money.” In this e-book, I have been clear and blunt: my truth is that you are much more important to your long-term health than the healthcare industry because until and unless you develop a problem that it can fix, your interests are not aligned with it. Your interests are more closely aligned with those of your family, friends, and co-workers with whom you share an interest in living free of both disease and industrial or government intrusion. My truth is that a high level of fitness, pursued consistently over the course of a lifetime will do more than anything else to protect you from things likely to kill or sicken you prematurely. This truth will remain so until our knowledge of genetics goes many layers deeper than it presently does.

There is no truth in the idea that your choices don’t matter, that they don’t have costs and consequences, or that I am responsible to pay to fix you if you won’t try to fix yourself. There is no truth in the notions that Obamacare was inevitable or that it is insurmountable. My truth is that we brought about Obamacare: first, by electing and re-electing political leaders who don’t care one whit about health, but who do care about the healthcare industry that lines their pockets; second, by fooling ourselves into believing that we can have our medical care cake and eat it, too. Even leading Republicans now admit that Obamacare is NOT repealable. If that’s true, then it really is up to individual Americans to do their level best, as individuals and families, to ensure its ruin by upending its basic premises.

If you are more interested in preserving your dignity and self-respect, and fixing some of what ails you yourself (simply because it’s in your power to do so), then you need to launch Your Personal Affordable Care Act. The feds are wrong in believing, as they do about workplace wellness, that medical care costs will fall because cash incentives will induce widespread behavior change and risk factor changes. Spending more leads to, well, spending more, and the only way to spend less is to spend less.

What really motivates people is the opportunity to gain mastery over an element of their lives, also known as self-efficacy. When people gain mastery over a puzzle, they are also much more interested in sharing that information and their approach with people who share their dilemma. It is enlightened self-interest, which also has the virtue of beneficence because it is not done through governmental coercion. This video on motivation says it more eloquently than I can.

The medical care industry is on a trajectory that is unaffected by what most Americans do because most of them don’t do what’s been outlined here. Most Americans don’t exercise, don’t eat well, don’t manage their stressors, and, they talk a lot about changing, but actually do less of it than they claim. This is the medical care industry’s ideal customer, because it’s the one that will swallow pills, see specialists, and get unneeded diagnostic testing for little or no reason, as sheep are wont to do. Don’t be a sheep; be a shepherd of your dignity and resources.

It may take you a year, two years, three years, or longer to bring yourself as close as you can to the seven standards of ideal cardiovascular health I pointed out at the start. But, with each successful step you take, the closer you come to being someone who is more in charge of his or her own health future, because you are acting out a plan that is both scientifically grounded and doable. A lot of what you should be doing for yourself is physical but the biggest challenge you’ll have to overcome is believing you are tough enough to create health with the propulsive force of your own intelligence and imagination.

I started this e-book with allusion to the Titanic and will end with the same. Your Personal Affordable Care Act is about you and everyone around you grabbing an oar and starting to row away from the iceberg. You can’t depend on political and healthcare industry leaders to redirect the ship, because, like the captain and crew, they don’t see the iceberg, and even if they did, they wouldn’t know what to do because they are not prepared for the collision. That approach will lead to an eventual complete breakdown of medical trust, because, like in all systems, the savvy, wealthy and well-connected will be able to get in their own lifeboats to minimize the damage to themselves while everyone else will get what’s left.

It takes a very mentally tough person to row against the tide. If you pursue the truths and strategies I’ve outlined, you will get pushback from all quarters: your employer, your less informed friends and relations, your medical care provider, and your health plan. Only you can determine whether you have what it takes to withstand that onslaught. Developing that measure of resilience will take time. Which is why it’s all the more important to start now. Time is the most precious resource of all. While you can always make more money, you can never get back wasted time. The time to shift your healthy lifestyle focus onto yourself is now. There is no way to know whether you’ll succeed in adding time to your life, but, to paraphrase President Lincoln, you may find that no matter the length of your life, you will be a happier, more energetic, confident, optimistic, stronger, and robust person. And, when it’s all said and done, isn’t that what should really drive you?

The medicalization of our lives has led us to a point where the medical care sector alone is never targeted for down-sizing or even right-sizing. It is trite Washington-insider banter to clamor for a smaller, more effective military, but what of applying this same principle to healthcare? Where is the national challenge to improve ourselves so much that hospitals are forced to downsize or close, and there are as many unemployed doctors as there are unemployed lawyers? Where is the messaging that what we need is a smaller, more efficient, and less error-prone healthcare industry, in which greed is not the core value? Instead of these challenges to change and improve, we are encouraged to drown ourselves in a more-and-bigger-is-better approach to medicine for which there is a 50-year track record of futility.

Somewhere, Ivan Illich, the radical Catholic theologian who foresaw that the medical care system would one day become our nemesis, is laughing at us.

 

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