The Affordable Care Act and the Death of Personal Responsibility

The Affordable Care Act and the Death of Personal Responsibility

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I was a chubby kid, which brought with it all manner of slights, both real and imagined.  My predicament was worsened because I came from an immigrant family, and my father was tormented by unrelenting and untreated bipolar disease.  When he was lucid, however, he taught essential lessons that neither he nor I knew at the time would become my life’s cornerstone: don’t trust the professions too much; advance your own cause through limitless learning; and, use exercise — all forms of it — as an irreplaceable lever for personal betterment.  My dad may have been out of it more often than not, but he swam, did calisthenics, played tennis, and boxed, and he walked vigorously right up until the end of his life.  I saw, I learned, I did (and still do).

Imagine, then, my chagrin at how the Affordable Care Act (ACA) effectively shears away the concept of personal responsibility and mastery of lifelong wellness skills  from the pursuit of actual health.  It was a huge missed opportunity to teach Americans about what’s first in the line of responsibility for good health.

Instead, the ACA’s philosophical foundation ignores the power that individuals have to impact their personal health trajectory, and it compels Americans to accept lifelong roles as patients in a system that many of them not only don’t want any part of but that they distrust and don’t understand.  It is exactly the opposite result that something called “health” reform should have produced.

The ACA’s obtunded vision of wellness is especially problematic.  The ACA seeks wellness through sickness by facilitating, for example, employer-sponsored intrusion into people’s health lives — particularly through the clinically meaningless and hopelessly cost-ineffective twins of health risk appraisals and biometrics, which literally create illness by over-diagnosing people with things that they don’t have.  This is both daring and appalling: turn more people into patients by convincing them that in order to become well they must first become sick, even though what they suffer from most are things that more medical care cannot fix: economic dislocation, fractured families, and jobs they hate.  That we are not the only Western society dealing with this issue is small comfort.

The AMA’s recent categorization of obesity as a disease is an aiding and abetting of the ACA’s sleight of hand.  Telling obese people that  they’re now all sick (even though many are healthier than their normal weight peers is inviting people who deserve better into a medical Twilight Zone.  It is a judgment that supports the ACA’s impetus to treat people like Pavlov’s dogs, hoping to induce behavior change through highly coercive incentives instead of through greater autonomy and mastery of essential lifelong health promotion skills.  The former cements authority-subject relationships while the latter builds self-respect and independence and reshapes the patient-provider context to create an environment in which interactions can be more limited and bounded by clear, understandable, and achievable expectations.

We have set ourselves up for a long-term worsening of health status by not framing health reform primarily in the context of how people can keep themselves from becoming patients.  By positioning the health care system as prescient and omniscient, we invite its eventual undoing because it cannot conceivably solve for us all the problems it has been tasked with at emotional and fiscal prices that we can afford.  It is like prescribing an antidepressant to someone whose life has left the rails.

I, for one, am not waiting for Washington to awaken.  As my father passed along vital health lessons to me, I am repeating the process with my son, now 9.  His preternatural devotion to learning and exercise is already obvious in academic performance, his persistently happy demeanor, and his asthma control.  In fact, his fitness has improved so much over the past two years that his medication usage is down by 75%, and he has not had a physician visit for asthma in three years.

Ivan Illich, the radical Catholic priest who wrote Medical Nemesis, really was prescient, as the ACA actually animates his prophetic vision of the rise of a medical state that diminishes and injures individuals in pursuit of its own enrichment and empowerment.  Who would have ever believed that almost four decades after publication of Nemesis, another radical, Barack Obama, would be the one to breathe life into Illich’s medical demon?

Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness.  An iconoclast to the core, he is the author of the Khanna On Health Blog.  He is also the Wellness Editor-At-Large for THCB.

Vik thanks his friend and colleague, Al Lewis, for his very helpful comments on, and contributions to, the development of this post.

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126 Comments on "The Affordable Care Act and the Death of Personal Responsibility"


Guest
Al
Jul 14, 2013

I think this post is on target and I think better than the one on Obesity and the AMA. We agree patients should take control over their own lives, but I hope you realize that organized medicine known as the AMA does not represent the practicing physician that is at the bedside.

Guest
Jul 15, 2013

Al: thanks for your note and for continuing to read my work. I enjoy jousting with you. BTW, I share (and sympathize with) your concern that the AMA does not necessarily represent the views of many practicing physicians. The problem, of course, is that they have the pedestal and the ear of people in Washington where the cesspool that is our political system, just seems to churn ideas that benefit and embolden the same old constituencies. I don’t know how to break that cycle (actually, I do have some ideas), but I do know the community docs need to find alternative ways to have their views heard. People like you, commenting on what you read at THCB and elsewhere is a good start.

Guest
ljj2
Aug 19, 2013

Vik,

I agree is AMA firmly owns the pedestal in DC and has the ear of people in Washington cesspool that is our political system feeding the pockets of the same old constituencies. I don’t know how to break that cycle either, but am interested to hear how one way that the people could affect “change”.
~ljj2

Guest
Aquifer
Aug 19, 2013

Stop voting Dem/Rep – vote 3rd party, preferably Green …

Guest
Al
Aug 19, 2013

” preferably Green …”

Thanks for the entertainment.

Guest
Aquifer
Aug 19, 2013

Al

While voting Green may promote humor in your circle- voting D/R only sorrow for the vast majority ….

Guest
ljj2
Aug 19, 2013

Ditto, got it,

Guest
Al
Aug 19, 2013

Can’t say I have been happy with the selection of candidates from either side, but I don’t see a green light from the green party either. One has a choice to laugh or cry. I choose laughter.

Guest
Aquifer
Aug 20, 2013

Well then we appear to be on the same page after all – Green it is!

Guest
Al
Aug 21, 2013

I wouldn’t go that far. Their platform is naive and lacks an understanding of the Constitution. As far as the environment goes everyone wants a clean environment and most love plants, animals and open spaces. But, people have a right to live and enjoy their lives something those that call themselves green frequently seem to abuse.

So yes we have some agreement, but how far depends upon how collectivist you might be and how much you are willing to infringe upon my being

Guest
Aquifer
Aug 21, 2013

Al,

Fair enough …

I suppose you are aware there is considerably more to the GP than fuzzy tree hugging ….

What do you find naive or unconstitutional?

Guest
Al
Aug 22, 2013

I’m not on the list to discuss politics in general. Though I find many of the Green Party’s desires to be admirable, the words used and the underlying politics strike me as collectivist even though that type of society might be the furthest thing in the minds of many that support the Green Party. The idea of federalism and the Constitution as a limiting factor to government seems to have been lost. We saw what such promises led to in the 20th century.

I think you should ask yourself the question whether or not you truly value individual freedom. When you impose obligations on free people that means you don’t. Also remember democracy is not a great form of government for democracy permits 51% of the population to enslave the other 40%. That is why we are a Constitutional Republic and that is why it is so dangerous to tamper with the Constitution.

Guest
Aquifer
Aug 22, 2013

Al,

My response “Vote Green” was a simple reply to a “what do we do?” post. As i believe in single payer or Medicare for all, the only way to get that is by supporting pols who do – that’s the Greens …

I would have said no more at that point, had you not responded with “laughter” …

“Collectivist” – not sure what you mean by that, but if you mean the idea that we do have certain obligations re our fellows, is that what you object to? Does individual freedom obviate any mutual responsibility?

Our entire culture, not just our technology, is moving in an “i” direction – and the irony is, the private, unaccountable, moneyed interests are gaining more and more control over our lives, all in the name of increasing our “individual freedom” –

That is the tension – the Constitution was written to set up a stronger central component than the failed Articles of Confederation – the Bill of Rights to prevent a “tyranny of the majority” – but we seem to have forgotten the Preamble – “We the people, in order to form a more perfect Union, ….promote the general welfare ….”

ISTM that the provision of healthcare is ground zero, in many ways, for the direction we go as a country – are we “a country” or just an aggregation of individuals whose sole concern is defending our “freedom” ? “Freedom “to do” or freedom “from”, as in Roosevelt’s 4 freedoms? Was Thatcher right that there is no such thing as “society”? If so, then there is no need to “organize” it, and if that is so, there is no need for a Constitution at all …

You are right, this isn’t the place, perhaps, to discuss political theory – but i can think of no other area than healthcare where the tensions between “I” and “we”, between the “rights” and “responsibilities” of an individual in a Constitutional representative democracy are so sharply brought into focus …

It is because, in some areas, I thought the responsibility of me as a part of “we” outweighed the rights of me as an “I” that i got into healthcare in the first place – I think we have gone too far in the “i” direction for too long … Where do other “healthcare providers” stand? What does the Hippocratic Oath really mean? what obligations does it impose?

So do i want a totally collectivist society? No, the private sphere has its place, but IMO, that place is not everyplace – THAT is a discussion i think should be had everywhere, always. Private enterprise, “the market” is not coterminal with the “general welfare” …. There is a time and a place for “collectivist” action – anyone who insists on solely one or the other is not only missing the boat, but sinking it ….

So, if I were solely promoting “collectivism”, i would be touting a purely socialist party – i promote Greens as a political choice because i don’t believe they are purely “collectivist”. Stein, a physician, described herself a “pragmatist” – you go with what works – though it may indeed work well in other areas, “the market” is not only a poor, but in many ways a counterproductive, model for the provision of healthcare, the “incentives” are all, IMO, in the wrong direction – THAT is a discussion I DO think we need to have on blogs such as this … That is a voice i bring here – if it is considered inappropriate, well what can i say – to me that is all the more reason to press on, in the belief that until it IS considered not only appropriate, but necessary, we will continue to flush ourselves down the drain …

End of soapbox ….

Guest
Al
Aug 24, 2013

Aquifer,

Collectivists like to interpret any passage of the Constitution in the fashion they feel fit and then complain about their decisions later. I don’t know if you are one or not, but many of the Green statements are. They are all too willing to impose obligations on others and not only that, but they don’t even know if what they wish to do will help or hurt. Your use of the preamble to the Constitution seems to indicate that you wish the Constitution to mean whatever you want at the time. Alternatively you may be unaware that you are picking out a sentence telling what the objectives are behind the limited specified federal actions that are permissible under the Constitution. If the founders had wished the document to actually mean what you think then there would have been no need for a listing of the duties that followed. Remember Constitution is for the federal government. Each State has its own Constitution and you can move to the state that best meets your needs

Roosevelt’s new Bill of Rights were a collection of ideas that may have helped some people, but they were ideas that could not be guaranteed and levied heavy obligations upon other people. To enforce Roosevelt’s idea in this area we would have had to become more like the fascist nations of the time. You might be horrified at my use of that term, but remember Roosevelt wanted powers he was not entitled to and when he couldn’t get those powers legally he wanted to pack the Supreme Court, illegally. Sound familiar?

Your ”I” and “we” is a little convoluted. What you really want is for party A to tell party B what to spend on party C. You also want to tell party C how to spend that resource. You don’t even have proof that your ideas in healthcare work. In fact the proof points in the other direction. I want you to feel good about yourself, but I want you to do it on your own dime, not on mine, or anyone else’s.

Guest
Aquifer
Oct 5, 2013

Al

So, you are an expert on Constitutional interpretation? A strict or loose constructionist?

Roosevelt was saddled with a SC much like ours – a bunch of pro business conservatives who felt it their duty to protect the sanctity of wealth from the scourge of democracy … They were the fascists ….

My is=deas on healthcare? hardly mine – just solutions that most of the other developed countries have adopted and whose citizens fiercely defend – citizens who look upon the American system with disbelief – how can any civilized country base the provision of healthcare for its citizens on the ability to pay instead of on need?

Guest
Al
Oct 5, 2013

Aquifer, do you know the basic ideas behind fascism? It doesn’t seem that way, but maybe you have a unique definition so I’ll leave it up to you to define your terms. The fascists of mid century past initially impressed Roosevelt. A few large businesses worked very closely with government and in many ways that is what Roosevelt was attempting to do.

The Supreme Court actually permitted some abominable legislation to stand. Do you really believe that Congress should be able to regulate the production of wheat intended for personal use even though the wheat would not travel across state lines? The Supreme Court said yes. So if you decided to grow wheat in your back yard for your own use you want Congress to be able to regulate it?

Maybe you call the SC fascists because they didn’t let FDR pack the court.

You have said enough to let us know what you think of individual liberty. By the way the case I referred to was Wickard v Filburn. If you want another case find the one where the government decided that when you went to a butcher you didn’t have a right to pick out the chicken of your choice. That too was a SC decision.

Guest
Aquifer
Oct 5, 2013

Al,

So what is it you think i think of individual liberty? Can one have liberty of one has no access to healthcare because one cannot pay for it …

One’s right to swing one’s arms ends where another’s nose begins – or is that right boundless in your universe ….

Perhaps “fascist’ was a poor choice of words on my part, i will grant you that, at least …

Guest
Al
Oct 6, 2013

Aquifer: Demonstrate how you are promoting liberty by creating obligations on others.

Example in healthcare: Tell me why one should have an obligation to give up money intended for his child’s well being in order to provide a nose job for another.

Guest
Aquifer
Oct 6, 2013

Al

As citizens, presumably we are signed on to the concepts enshrined in the Dec of Independence and the Const – the right to life, liberty and the pursuit of happiness – and the gov’t is supposed to guarantee those rights – your right to liberty may well obligate me to act in certain ways that I might not wish to, and vice versa … Liberty is not unbounded …

As for healthcare – apparently you don’t want to “give up your money” for anything other than your own desires –

As for a “nose job” – is that medically necessary? If your kid had no nose, might you think it “necessary” for him to have one? Or would you rather send him to school without one? And if you had no money to get him one, would you not be glad that others were willing to “chip in” for it?

Guest
Al
Oct 6, 2013

“the gov’t is supposed to guarantee those rights ”

No! The reason for the Constitution is to limit the federal government’s powers so that the people had the right to life, liberty and the pursuit of happiness (property) by being protected from government. You have things backwards.

“Liberty is not unbounded” That is correct, but the federal government’s infringement upon its citizens was limited by the Constitution.

Healthcare: Do you believe in property rights? Do you believe your personal and intellectual property is owned by another? None of us want to see a child go without health care, but it is a matter of trade offs. Should your child goes without because my child has a need? One has to be careful about creating obligations for others.

Guest
Aquifer
Oct 7, 2013

Declaration of Independence -” right to life, liberty and the pursuit of happiness” – (funny, it doesn’t mention property – that’s John Locke you’re thinking of, not Thomas Jefferson) “that to secure these rights, governments are instituted among men” (women added later) “deriving their just powers from the consent of the governed” . So the gov’t is set up to secure these rights – The Const. was the document the founders set up to create the gov’t whose job it is “to secure these rights”…

As for property – it deosn’t say the government can’t “take” it at all, but only after “due process” and just compensation” and the right to tax for “the general Welfare” is clearly stated …

I suspect you would rather return to the Articles of Confederation when the Fed. Gov’t was considerably weaker ….

One’s “personal and intellectual property” – how does one define that?
Is “personal property” co-terminal with “private property”? Are you entitled, for example to “own” the only oasis in a desert?

Should my child go without an X-Box because your child needs an operation? Yeah, i think so … What about you?

Guest
Jul 14, 2013

It’s my hope that you are targeting the hauteur of those in the medical profession, those who act as a dictatorial principal toward a student. I also hope you don’t have the naive “given” that all have the brain power, the family support, the funds, etc., ad infinitum, to develop responsibility for health management and health choices. That attitude is egotism at its worst.

Guest
Jul 15, 2013

I was going to respond to you until I saw that Mark Freeman took care of it for me. Thanks, Mark.

Guest
Mark Freeman
Jul 14, 2013

“Egotism at its worst” is having the guts to actually state one’s belief that he/she has the “responsibility” to manipulate and coerce an entire society to behave in a proscribed way. That is the hauteur. Patient’s can leave their physician should he/she appear to dictate. One cannot escape the hauteur of the “policy maker.” That is a very real and very frightening difference.

Guest
nyp
Jul 14, 2013

1. So permitting employers to require their employees to have their blood pressure and cholesterol levels checked equals “the death of personal responsibility”?? Sure.

2. What does the AMA’s decision to categorize some forms of obesity as a disease have to do with the Affordable Care Act?

3. I assume you applaud the individual responsiblity requirement, originally formulated by the conservative Heritage Foundation and adopted by Mitt Romney, that penalizes individuals who seek to shirk their responsibility to obtain health insurance for themselves and their families. You do agree with last year’s Republican nominee that “it doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way,”

Guest
Aquifer
Jul 14, 2013

nyp

Considering that that a recent study suggested that “overweight” folks may score better in certain categories than “normal weight” folks, and that every time one turns around the levels of various parameters that “need” to be treated with Rx seem to get lower and lower, methinks a healthy skepticism is indeed a good thing to cultivate. Not to mention which even the concept of “prevention” seems to consist of more drugs …

I don’t know where the author is coming from politically, but it seems to me that any physician who doesn’t emphasize to the patient that his/her health depends to a great extent on how well )s )he takes care of his/her body – eating, drinking, smoking habits – i.e. areas of “personal responsibility”, needs to refresh their ideas on what it means to be, become, and/or stay, healthy …

As for “personal responsibility” to get health insurance – that is an entirely different subject – I am of the opinion that is a societal responsibility to provide, and not a personal responsibility to get ….

Guest
Aquifer
Jul 14, 2013

Bravo!

” ….even though what they suffer from most are things that more medical care cannot fix: economic dislocation, fractured families, and jobs they hate.”

Reminds me of the description that Dr. Jill Stein gave for entering politics – she was frustrated with treating folks in her office and having to, as she said, send them back into the environment that was making them sick … So she is now into “political medicine” – putting healthcare in the wider context of social ills …

The author is correct – this medicalization of every aspect of the human condition serves only the pharmaceutical and medical procedure “industries”. If it’s healthcare we want to provide, two of the first places to start is the Dep.t of Agriculture and the FDA ….. And then we could make sure folks have decent jobs at decent wages so they can afford the food, shelter and education they need to stay healthy …

Guest
Jul 15, 2013

It also benefits the wellness industry. By far the largest single contributor to medicalization relative to the size of the field is the wellness industry

Guest
Craig "Quack" Vickstrom, M.D.
Jul 14, 2013

Spoken like a boss, sir! I agree.

Guest
E Tal
Jul 14, 2013

The author’s point of view may be summed up as follows:
If you’re obese it’s your fault, and you shouldn’t get any help solving the health problems that stem from this condition, otherwise you’ll never learn your lesson in personal responsibility.

May you die a slow and painful death for belonging to a large group of fellow Americans who have:

– Little or no education on healthy nutritional habits (can’t let the nanny state and Michelle Obama “indoctrinate” our kids now, can we? Only corporations are allowed to educate us via advertising)

– Little or no access to healthy food (can’t let the nanny state “pick winners and losers” in the food industry)

– Few or no means to pay for health insurance (because we’re better off spending twice as much of our GDP on healthcare as any other OECD country and getting worse results, in the name of the holy free market and insurance company profits).

The author makes his living running corporate wellness programs. Any government “takeover” of healthcare is bad for his business.

Guest
Aquifer
Jul 14, 2013

E Tal

You know, I didn’t get that impression at all from the article – In fact I got rather the opposite … We need to emphasize, foster and promote the “alternatives” to pills and procedures that comprise the bulk (excuse the pun) of modern medicine …..

It may be the author is pushing his business, but that doesn’t change what are, in my opinion, are rather trenchant observations about the state of modern “healthcare” …

Guest
Jul 15, 2013

That’s what you learned? Did we read the same article? If so, one of us would not score high on the reading comprehension section of the SATs

Guest
Aquifer
Jul 15, 2013

Shucks, Al, what did you get out of it?

Guest
Jul 15, 2013

Let me play referee here for a moment. I think Al Lewis’s note is in reply to E Tal, not Aquifer.

Now, having clarified that, Aquifer, thanks for your initial note. You understood exactly what I was trying to communicate. Thanks for your nice summation.

Guest
Jul 15, 2013

My bad,Aquifer–I was agreeing with you. I didn’t see what E Tai saw at all! I think I just posted this reply in the wrong place.

Guest
Aquifer
Jul 15, 2013

Al – maybe i do need reading comprehension upgrades – these threads always get me confused as to who is speaking to whom. So I am thinking that putting the person’s name at the beginning of the reply helps ..

Guest
Jul 15, 2013

@Aquifer, for some reason I can’t reply to your last message but I think what happened is that I thought I wrote the reply to E Tai in the right place but then I got distracted (I am very easily distracted) and by the time I hit “send” another message — yours — had appeared in between

Guest
Aquifer
Jul 15, 2013

Ha, ha – that happens to me a lot – but I think it is kind of funny, don’t you, that we can’t get our comments all lined up but we think we can organize medical records on-line :)

BUT, i hope this site doesn’t decide to use Disqus for comments – I have had nothing but trouble with that and can’t even get into it ….

Guest
Jul 15, 2013

Great Ceasar’s ghost! Sacrebleu!

How could the executive editor of THCB let this happen?!!

They published something that was meant to provoke and, egads, promote, too.

Duh.

P.S.: I don’t run corporate wellness programs. I critique them, and I develop organizational strategic wellness plans, which I then hand off to employers to do with as they please. Consistent with my writings, however, I warn employers not to be seduced by facile claims of wellness vendors and benefits consultants bearing good news about HRAs and biometrics and to focus their efforts on culture change first.

Guest
LJwalden2
Aug 3, 2013

Vik,

Who controls biometrics at large? And it seems focusing their efforts on culture change first is daunting because we are such a multi-faceted society. What are yours, or others’ thoughts on this?

LJ

Guest
Jul 14, 2013

An absolutely great blog. Thanks so much for your cogent comments. The only way to kill this monster is to defund it.

Guest
Jul 14, 2013

E Tal, he makes his living running corporate wellness programs because he’s seen the limitations of a nanny state, not the other way around.

As a surgeon, I concur with him. There certainly needs to be ways to help people to help themselves and a system that incentivizes personal change. But it is far too often that I see people who want the ‘system’ to (a) take care of their issues without effort on their part and (b) believe that anything short of perfect is an illness.

Hearing about his son reminds me of the story about how Jack La Lanne got started. He had asthma and was told by the establishment to take inhalers and stay at home, accepting his frailty. He heard a lecture one day about the benefits of exercise and started to practice himself. He continued this till his death in his mid-90s and recommended it for everyone to help improve their functional abilities and quality of life.

And the topic of medicalizing all ailment is one that psychologist Martin Seligman has researched and discussed for years. As society becomes more fractured, with fewer positive drivers, and more disjointed economy, church, government and family, we see a host of issues involving both physical and mental health issues. To treat all of that with prozac, lipitor, lopressor, lisinopril, and glipizide is counterproductive and something seen every day in doctor’s offices. Getting their blood pressure checked and diabetes screened on a regular basis is great to establish data points, but then what’s needed is a walking regimen, improved nutrition, some sunlight and positive upward spiral in their lives that comes in part of from personal effort.

Guest
Jul 15, 2013

m13, thanks for your comment. We need more of your wisdom in the trenches and in forums, such as this one. Please keep reading and writing.

Guest
nyp
Jul 14, 2013

So somebody tell me how corporate wellness programs, as encouraged by the Affordable Care Act, leads to “the death of personal responsibility” and the loss of our precious bodily fluids.

Isn’t this guy’s post really just a bunch of hot air?

Guest
Jul 15, 2013

Actually, you just insert my or Al Lewis’s name into the THCB search box or go to the Wall Street Journal or Health Affairs or The Doctor Weighs In, or my blog, and by the time you’re done you will have gotten quite an education on what’s wrong with ACA-fomented corporate wellness.

You could also just wait until later today or tomorrow and read the essay that Al and I wrote for AOL.com, in which we tell employees to proactively ignore this stuff. Of course, all this presumes a certain level of educability.

Guest
Nyp
Jul 16, 2013

“a certain level of educability”

Guest
td
Jul 19, 2013

Nyp: after reading the author’s reply to you, I am pretty sure his reference to educability was aimed at you, not employees.

Guest
Craig "Quack" Vickstrom, M.D.
Jul 14, 2013

I disagree with many of the responses. We can have personal responsibility, public health and a strong safety net. These things are not mutually exclusive. It’s all about how we structure the incentives, like everything else.

Guest
Aquifer
Jul 14, 2013

“Quack”

Ditto

Guest
Jul 15, 2013

Hey Quack (great nickname, BTW): your point is an excellent one. The only suggestion I would make is to substitute the “responsibilities and resources” for
“incentives”. It is unrealistic to expect that people should anticipate an endless stream of external rewards for pursuing what is really enlightened self-interest (i.e., the more I do to take care of myself, no matter how modest my circumstances, the more resources I have [financial, emotional, psychological] to do other things). And, indeed, people should expect that there is a safety net to catch them when necessary. Thanks for chiming in.

Guest
John T (Jack) Garland
Jul 14, 2013

What a spectrum of isolated points of view! I am with Dr Vicstrom, there is no reason we cannot have personal responsibility, public health, and a strong safety net.

First we need an improved MEDICARE for EVERYONE. That can cut total spending by about 30% (activities that serve only to enrich the insurance carriers) and thus allow coverage of EVERYONE for a little less than total now spent caring for about 3/4 of population. Financing care via the tax system will also remove a huge burden from businesses, which may allow them to hire the people they need.

I agree we tend to over-medicalize life in USA, but if folks are freed to seek care (see above) then good, comprehensive care will include advice about what each person can do (exercise, diet, etc), and that can be supplemented by public health and school programs to promote good habits. As a retired endocrinologist, I have seen medicine from both sides.

Guest
Jul 15, 2013

I think that many of the respondents here are missing the main points of this post at least as I see them. The wellness provisions of the ACA are a non-evidence-based, unscientific disaster. They are largely based on the successes claimed by the Safeway CEO – which, of course never actually happened. There is no available evidence to suggest that the kinds of coercive, incentive-laced solutions promoted by the so-called Safeway Amendment will improve health or save money, and,as the initial post suggests growing evidence of potential significant iatrogenesis both physiological and psychological – including (as the Prevention Institute and others have pointed out) cost shifting to those who can least afford it and pissing off people who don’t care to be coerced into turning the workplace into a doctor’s office, inevitably leading to decreased engagement at the workplace and all the negative consequences that occurrence portends – I am all for promoting health for individuals and organizations – but this medicalized coercion is not the way to go – As far as the AMA is concerned the transparency is glaring – They went against their own scientific advisory council to make their decision – because the decision has nothing to do with science – Really? In the short time doctors have with their patients, the limited training most of them have in nutrition, exercise or behavior change, they are going to waste a few minutes of their time doing more hounding of fat people to lose weight? – (after all, most fat people don’t know they are fat because it doesn’t come up that often in this culture – and when they do get hounded it works so well) – that’s why the AMA went against the recommendations of science? Maybe, but could it maybe have something to do with getting all these very effective weight loss approaches covered by insurance -weight watchers. Jenny Craig and bariatric surgeons are out partying after this decision – Jon

Guest
Jul 15, 2013

Thanks for your note, Jon. I love your concluding sentence…that Jenny Craig and bariatric surgeons are out partying after this series of policy foibles. Indeed, if I actually ran corporate wellness programs, as some of the less engaged commentators noted, I would be out partying with them, because the ACA gives me the push to go wild. Hey, that’s a great name for it: Wellness Gone Wild. Thanks for the inspiration, Jon.

Guest
Dr. Rick Lippin
Jul 15, 2013

It is time that we ALL (patients and providers ) “come clean” about the mutual lie that we have been living and hawking.

The $2.2 trillion dollar plus US organized medical enterprise has little to do with human health outcomes. This has been known for several decades!

see http://www.unnaturalcauses.org

Dr. Rick Lippin
Southampton,Pa

Guest
Jul 15, 2013

Rick: you are right on, as usual. Thanks for contributing.

Guest
Craig "Quack" Vickstrom, M.D.
Jul 16, 2013

Truth.

Guest

I have enjoyed reading this comments and this post. Thanks.

Guest
Jul 15, 2013

ARCPoint, good to hear from you, and thanks.