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.
Categories: Uncategorized
vnssykmt 1thehealthcareblog.com xvasuyci [url=http://www.google.com]9thehealthcareblog.com[/url] uqmivozh
For those of us that take care of our health, there will be no changes. But just because there is an ACA does not mean that these people will stop. There will always be that junk food junky with bad bones and high cholesterol, the over salter with hypertension, but there is also Aunt Judy with RA and HTN that does all that she can to be healthy but it doesn’t work, nor can she afford to go to the doctor.
This post and his responses clearly indicate the need for the ACA – since he probably developed his obesity in respond to the stress of his Father untreated mental illness as the result of not having any coverage..
In fact it is hard to see any logic in his argument since he lacked health insurance and still got fat therefore it would seem to indicate that it was the lack of health insurnace as a child that lead to either his obesity or his lack of control?
Most research shows that adverse childhood events have a dirct link to adult health problems.. But I guess if we just hold kids accountable for being born into poor neighborhoods with mentally ill parents we could prevent that?
Clearly the editorial board needs to review this type of post
http://leeny5432.skyrock.com/3195982811-even-to-his-name-has-changed.html
Ah yes – nothing like complaining about mixing up arguments from someone who apparently has only a one sided view of “freedom” –
That’s OK, Al – I’ll accept your concession 🙂
Aquifer writes: “you are the one to deny “liberty” – how can one be free when one has no access to health care?”
I won’t even comment on this as it is so foolish it speaks for itself. You would probably be happier in a fascist state where liberty is compromised, but the government says it will take care of your needs.
You mixed up two different arguments when you added the dumping of toxins to your liberty argument. You will have to live within your state of confusion. At this point you can no longer be taken seriously. Bye.
The Fed’l gov’t has the power to promote the General Welfare … There are 2 main principles of construction used in construing laws 1) whatever is not forbidden is allowed 2) whatever is not allowed is forbidden – you appear to adhere to the later, but where does it say that the “the general Welfare” is limited to whatever you claim it is? That is your construction – but you are not on the SC and they are the ones who “construe” ….
A Scalia fan? Hey, you like Thomas, too?
No, Jefferson replaced property with happiness ….
I wasn’t confused about where the replies go so why did you find it necessary to “change venues”?
Terrific! ISTM you are the one to deny “liberty” – how can one be free when one has no access to health care? I am the one who would restore that liberty …
Well, let’s see – mandating that you have an obligation to not dump toxins in my drinking water supply promotes my liberty to be free of toxins in my drinking water …
Aquifer writes: “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) ”
Once again you seem to have a problem. I placed property in parenthesis for exactly that reason. Jefferson replaced happiness with property.
Aquifer writes: “Are you confused?”
No, but apparently you are.
Aquifer writes: “PS – and precisely how does the Constitution define “general Welfare?”
Simple, the powers granted to the federal government are delineated in the following articles. If the “general Welfare” clause was to open the doors for the federal government regulating everything there would have been no need to limit its responsibilities in the following articles.
Admittedly many people that wish the Constitution to be treated as toilet paper errantly turn to that clause, but really don’t understand its meaning. Politics seems to trump the Constitution. If one wished the federal scope to be broadened there is always the Constitutional Amendment which would be totally unnecessary if one thought the general welfare clause meant one could do whatever they wanted.
Aquifer writes: “Ah so it’s a one way street, you have no objection to my limiting my liberty to safeguard yours, but you have no intention of returning the favor …”
You create straw-men where none should exist. I want you to have the same choice with regard to your liberty as I have with regard to mine. You are the one willing to deny liberty to another.
How can mandating an obligation to another promote liberty?
Al,
Are you confused?
Comments at end of the blog to prevent confusion.
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?
Al,
PS – and precisely how does the Constitution define “general Welfare”? Somehow i didn’t notice a delimiting list …. and so you think that Medicare is “unconstitutional”?
Al,
Ah so it’s a one way street, you have no objection to my limiting my liberty to safeguard yours, but you have no intention of returning the favor …
btw “Al” and “Al Lewis” are two different people
“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.
I didn’t forget the Bill of Rights, but based upon your rhetoric I thought you had.
How one interprets the Constitution is based upon one’s personal philosophy, but if the federal government was truly provided the right to do all those things then there would have been no need to delineate the powers of the federal government and there would have been no need to set up a system for Constitutional Amendments.
I have no objections to you giving up your liberty as long as it doesn’t affect mine.
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?
No, i don’t believe that 51% of the population can vote to enslave 49% – even if they wanted to, or have you forgotten the Bill of Rights and the courts – some wry for your pastrami …
Art 1, Sec, 8 – “The Congress shall have power to lay and collect taxes …. to ….provide for the ….general Welfare of the United States ….”
So who decides what is meant by “general Welfare”? Medicare has passed muster for decades, expanding it for all would make it even more “general” ….
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.
@Aquifer: “Baloney! Sorry but that is the most appropriate response to your first sentence ”
Pastrami. I can’t help the way you express yourself so I will repeat what I said. “It appears that you believe 51% of the people should be permitted to enslave 49% if it occurs at the polls.”
“But they also said, Art 1, Sec 8, that …”
Then they went on to specifically delineate those things that were responsibilities of the federal government. I suggest you read a bit further and a bit deeper.
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 …
Kay –
It is because too many believe what you appear to believe that we are in the fix we are in – convinced that “TINA” to the duopoly because you have been told so, by whom, pray tell? There are other choices at the polls, choices that support the positions and programs that a majority of people support in poll after poll – but these positions are held by 3rd parties that folks have been brainwashed into believing “can’t win”. So they vote only for those who they have been told “can”. What a self fulfilling prophecy! Anyone who meets the legal qualifications for office and is on the ballot can win if enough people vote for him/her – that is a simple fact … Yes we have non-corp candidates on the ballot available to be chosen – why don’t you choose them?
Al,
Baloney! Sorry but that is the most appropriate response to your first sentence …
Well the founders also thought, apparently, that human bondage was legal and that slaves were 3/5 of a person. So they weren’t batting a thousand … But they also said, Art 1, Sec 8, that ” ,,,Congress shall have the power to lay and collect taxes …” Is that your definition of “slavery” – being taxed to support the “general Welfare” ? Which sections of the Const. do you pick and choose to emphasize?
Al, you need to read closely. The choice of who runs is up to the parties and not the voting public. The public gets to choose between two candidates, maybe three, presented to them. The illusion when we vote one way or the other is that we’ve “chosen” and approve. It’s often a lot like your father asking whether you want a public flogging or a couple of weeks shut in your room to atone for your misbehavior. Your choice would be neither but you have to make a choice…..Congratulations on being chosen to speak for the founders of the nation, by the way. Impressed.
It appears that you believe 51% of the people should be permitted to enslave 49% if it occurs at the polls.
I think that is foolish thought and so did the founders of our nation.
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.
This discussion has strayed into the very odd……AQUIFER: Suggest you give up the illusion held by a great majority of this country.: “…decisions we have made at the polls” is the great lie. The rich produce two or three candidates and advertise/support them. They are not often the choice of the majority of the populace, left to choose between the lesser of two evils. Cannot be candidate without money or pledging puppethood to those with money and power.
The government we have, for better or worse, was placed there as a result of decisions we made at the polls – if we don’t like the results of those decisions, we can make others …
Can’t speak for Egyptians, can you?
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?
Hot Off the press this morning, inequality by segmentation..yes look at the big 10 health apps funded, most of them sell data…so sounds like that’s what moves a VC to shell out money as they want a return, and see how the marketing now is reflecting this with the Penn State wellness program fail with wanting to assess a penalty, follow the data and the money and you have your answer…Look at their demo model, all about changing behavior whether you are a problem or not but the marketing to sell it judges everyone from the start as “being a problem” they want that data to sell like I have been saying it’s an epidemic and money is big when you see Walgreens pulling in billion a year selling data. I’ve only been pointing all of this out for about 4 years now.
http://ducknetweb.blogspot.com/2013/09/10-biggest-mobile-health-investments.html
Thanks, ljj2.
@Aquifer: “we are the government…”
Why do you say that? Because the government is elected? Were you part of any of those nasty governments that were duly elected by the people. Do you think the people of Egypt are the government? How about the Copt’s of Egypt?
We are the government is truer when the government doesn’t impose obligations on people. The Constitution imposed a specified list of obligations and suddenly you take the preamble and add that to the list. I don’t follow your logic or your understanding of history or individual freedom.
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.
We are the government ….
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 ….
Al-
You are absolutely correct suggesting that if we value individual freedoms then the government should not impose obligations on free people period.
This present government is tampering with the Constitution by virtue of imposing the ACA because as Vik Khanna pointed out that the act removes the concept of personal responsibility by imposing lifelong rules in a system many do not want, or refuse to be a part of..
~ljj2
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.
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?
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
Well then we appear to be on the same page after all – Green it is!
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.
Ditto, got it,
Al
While voting Green may promote humor in your circle- voting D/R only sorrow for the vast majority ….
” preferably Green …”
Thanks for the entertainment.
Stop voting Dem/Rep – vote 3rd party, preferably Green …