My Personal Affordable Care Act–A Manifesto

The Founding Fathers had one.  Karl Marx had one.  Bertrand Russell and Albert Einstein had one.  And, now I have one: a manifesto, declaring my intent to live my life with as little interaction as possible with the US health care system by doing what the Affordable Care Act (ACA) tells me by omission I do not need to do: take responsibility for myself.

This is my Personal Affordable Care Act.

My manifesto is an algorithm for thriving in spite of the government’s naked and absurd attempt to define health as something that begins in the clinic.  My goal is to make myself and my family as scarce as possible within the health care system.

The ACA is a collective solution to the mass failure of individual will.  Our transformation into an information culture actually worsened the malady.  We are so conditioned to success at the speed of a search engine that, like the person who aspires to retire early, but refuses to save, we’ve forgotten to manage the fundamentals.

First, that every healthy lifestyle decision you make today, from diet and exercise to outlook and mood, requires thought and an exertion of will.  Even in the age of Google, volition matters, and choosing not just wisely, but strategically, is an option available to most people.

Second, despite revolutionary democratization of medical information, we still don’t do our homework.  Americans visit physicians 3 times per year on average, and the number one reason for the visits is “cough.”  Really?  You need to go to the doctor for a cough?  Unless you have a fever, chest discomfort, bloody sputum, or the cough lasts for weeks and keeps you up at night, it is almost certainly viral or related to an allergen and self-limited.

It’ll get better soon; try an over-the-counter remedy.  Drink some tea with honey.  And, stop badgering your doctor to give you an antibiotic for something that isn’t bacterial, because that particularly lame demand is responsible for the emergence of antibiotic-resistant superbugs.

The second most common reason for physician visits is backache, for which the leading the contributory factor is a bulging panniculus…or big gut.

Third is our expectation that someone else will fix the problem for us.  Your physician cannot fix your bulging panniculus.  Only you can and when you do, even if only a little, you’ll have the richest reward of all…the sense of accomplishment that comes from personal betterment.  We’ve spent so much time and energy waiting for someone else to do the work that we’re disconnected from the fact that the dilemma started with each one of us.  My parents may not have had much, but they had the dignity of doing everything they could for and by themselves, before they held their hands out for help.

To that end, I hereby resolve to:

  1. Admit the obvious. To paraphrase 12-step-self-help programs, the first step in solving a problem is admitting you have one, or, in this case, that we have met the enemy and it is us.  It is simply inconceivable that if we were a lean, fit, nonsmoking culture with clarity about the distribution of risk and cost impacts that we would have ended up with the ACA or any of its derivative shenanigans.  Instead of getting the health care system that we all think we deserve, what we got is our just desserts, in part because we spend too much time eating dessert…in front of the TV…and then sneaking out for a smoke during timeouts.

  2. Lead my family by example. I will use meals, car rides, and games of catch as opportunities to teach my son the real facts of life…that the person you become derives largely from the choices you make every day.  If you choose to consume detritus (caloric and cultural), smoke, drink to excess, refrain from exercise, and treat knowledge and love with nonchalance, then you end up looking and acting like someone who’s excelled at those things.  Look around you.  We’re great at it.

  3. Use technology smartly, but not obsessively. Most apps are for the motivated like me.  They’re toys.  The app that tracks a run is trivial compared to the run itself and no app will get you to move.  That comes from somewhere deep inside.  The apps I love are LoseIt.com, a diet tracker I use to help restrain my affection for snacks and Scotch, and Strava for aerobic exercise.

  4. Leverage preventive medicine that works (i.e., age- and situation-specific vaccinations, colonoscopy every 10 years after age 50, blood lipid screening every 5 years, and checking my blood pressure periodically when I am in Walgreens; many other preventive recommendations are physician-patient discussion items, such as whether to take aspirin daily), but I will not be seduced by the far greater amount that doesn’t, which has much more to do with excess capacity in the medical care system than it does clinical sense.  I know from nearly 30 years in this business that to most health care system administrators, I am a reimbursable data point and nothing else.  Just another cog in their unquenchable drive to “optimize payer mix” and “maximize reimbursement.”

  5. Stick with physicians I like, trust, and can communicate with, not because I want their love and devotion, but because everyone needs a good fixer. Stellar strategy or not, health is unpredictable and acute events will still happen (which is why you carry insurance).  When they do, I want a fixer who fixes and then leaves me alone.

  6. Use social media to drop the hammer on health plans, health systems and medical care providers who don’t meet my customer service expectations. We spend too much time twiddling our thumbs about quality reporting.  I’ve got some quality reporting for you: treat me or my family rudely or incompetently, and I will light you up Twitter, Facebook, Google+, and everywhere else I can think of.  Too bad that when Josie King was dying in Johns Hopkins Hospital, social media was not the force that it is today.  Health care entities need to remember that they are vendors to the rest of us.  It’s also useful to remember that the privacy laws only work one way: I can disclose anything I want about the quality of a health care interaction I’ve had to anyone I please and, as long as I don’t defame, slander, or libel, I cannot be stifled.  They, on the other hand, open themselves up to enforcement actions and civil liability if they disclose personal health information about me.

  7. Use the American Heart Association’s standards of ideal cardiovascular health as my benchmarks, because adults who have all seven have a 63% lower death rate than adults who have zero.  The seven are: normal weight; regular exercise; high quality, plant-rich diet; no smoking; normal blood lipids, blood sugar, and blood pressure.

  8. Know as much about myself as possible, so that if I start slipping in one measure or another, it will register with me, thus, prompting me to take corrective action.  I will know my waist measurement, my waist to height ratio, how fast I can run a mile, how many pushups I can do, how well I eat every single day, and my resting heart rate, which I will aim to keep below 60 bpm.

  9. Keep my emotional and spiritual center through regular meditation and prayer, because health is not all about the body, and, at any rate, these things may help improve some cardiometabolic markers.

And I will to do all this even though the government’s underwriting restrictions for health insurance premiums establish contrived parameters of only age, family composition, smoking, and geographic area.  Hence, my strategy will earn me nothing because the premiums I pay will not reflect my diligence but largely the habits of people living around me which, in Missouri, the land of toasted ravioli and creamery custard, is not a happy prospect.  This is, of course, a stark contrast to every other form of insurance in the known universe.

Trying getting auto insurance after you’ve had a DUI conviction or homeowner’s insurance if you refuse to put a fence around your pool.  You pay dearly for those choices.  My payoff will be what it has been for the last 30+ years…I pay almost nothing in the form of copays and deductibles each year, because I don’t use the system.  But, other than that, the system will not reward my personal effort, even though my work sets me far apart from the rest of the populace.

Here is something that I will not do: I will not break the law, which requires me to have health insurance, and I will not advocate that it be defunded or otherwise delayed.

I am a nonpartisan conservative, and I am appalled at the machinations in Washington.  Not only was the conservative Heritage Foundation the fire starter for the individual mandates that eventually emerged in both RomneyCare and the ACA, conservatives who now strong arm the administration are running roughshod over a core conservative principle: you play by the rules.

You don’t like the rules?  Maybe field Presidential candidates that don’t repulse half the country, and you’ll win elections so that you can write the rules.  Not that winning elections has mattered before.  If conservatives had made meaningful health care market fixes during the, oh, twenty years they held the White House after 1980, then the ACA likely never happens.  Instead, it’s been legislated and adjudicated.  Get over it.

Conservative opposition to the ACA relies primarily on the strategy of small-minded petulance and, remarkably, overlooks that even bedrock, everyday middle-America conservatives might find it a lifesaver, because most of us aren’t earning a 7-figure living whoring ourselves (or pining to do so) on K Street.  Second, conservatives needed to let the entire ACA play out without obstruction.

If it fails, then you make its failure the everlasting legacy of this President, Vice President and Congress.  Of course, you also end up with a mandate for change, and, well, see above for how deftly you’ve handled that responsibility before.  But…if it works, then you cheer for the good of the country.  And, in my stripe of conservatism, what’s good for the country comes first even if it isn’t my political cup of tea.

Patriotism before politics and petulance.  Instead, conservatives have made a weak President seem strong, and are losing votes every single day from people who might have been open to calls for incremental alterations.

The conservative message on the ACA is incoherent and its messengers are dolts whose leadership skill set is as desolate as the lunar landscape.  My conservative, take-responsibility-first approach will not relieve me of the need to carry and pay for health insurance, something I’ve done my entire life anyway.  But, it will minimize as much as is humanly possible the amount of time and treasure my family or I will expend dealing with doctors, hospitals, health plans, and their dimwitted cousins, the wellness vendors.

And, when I do deal with them, it will be on my terms, not theirs.

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.

43 replies »

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  9. Hi Mitch, thanks for the follow-up. I am mostly with you on strategy and completely with you on results. Grains and sweets in moderation, and in the context of a diligent exercise regiment, are harmless.

    I eat a very broad diet that includes small amounts of a lot of different foods. Like you, I cost my insurer nothing, and I don’t know anyone my age (almost 57) who comes even within spitting distance of my overall fitness level. You and I are pack leaders. The rest are just sheeple.

  10. Vik:

    Finally read the link, thanks for forwarding. I agree wholeheartedly that the issue os more complex than just sugar, it is of course refined carbs the worst of which (I believe) is high fructose corn syrup. I also understand onesity is complex and is also influenced by factors such as stress, lack of sleep, chemical pollutants.

    Having said that, I don’t think anyone would argue that eating in a way different and contrary to how we evolved is good for us. I am a paleo guy (and was before the term existed) and know what it does for me. No grains, almost never anything sweetened, natural/organic/grass-fed when possible, nothing electronice for at least an hour and ususally two before bed…..you get the idea. I have remarkable health markers, take no medicine. I cost my insurer nothing.

  11. I am only 22 and i would not regard myself as smart as many of you guys.

    I do step outside of my house though (Work 40-50 hour weeks and school). I go to 7-11 often with my co worker in the morning, but rarely buy anything. While i am there i see him buy a slice of pizza, taquitos or other processed foods (any bread product in the store); only to wash it down with some drink with high amounts of sugar and/or high fructose corn syrup.

    I believe it is important for all of us to remember that many people in our society, do not eat correctly. A couple seconds ago i was attempted to say the poor and not society, but i realized that that is far from the truth. We are taught how to make money to fulfill our desires, and not control them.

    The perfect example is Obamacare. The affordable health care act plainly spells out how Vik is right in the sense that we need to change our lifestyles. I believe this can be reputed, but only by nitpicking.

    We are told that we need an ample (couple of millions) amounts of young uninsured people to sign up into this act. But why? I may be wrong in my assumption, but i believe the reason to stem from the assumption that young people are inherently healthier. Therefore they will go to the doctors less and effectively put money into the system without taking it out.

    If this truly is the reason, than there is no reason that we could not provide affordable healthcare to everyone. Provided that we have healthy citizens. But this is not the case as many of us are aware.

    Before i go into this next segment, I must state that the health of others is their own concern. It is when the health of one person effects another, that we have a problem.

    I believe that we have a major problem in our society today. I am a man that believes in social responsibility. That we not only need to help others. Not in the sense of giving handouts, but the opportunity to see that there are other possibilties. Who am i to judge a mans happiness? But also, Who am i to say a man may not be able find more joy in something else?

    It is quintessential to eat properly and keep a correct diet with exercise, especially for many of Americans who do not have health care. If people are not as healthy as possible under this socialist-health system (not healthcare, but the well being of everyone having an impact on the rates of others) we can support those who can not always be healthy regardless of what they eat. those who gain life threatening illnesses. Those who can not diet their way out of cancer.

    To believe that we can provide healthcare to everyone without; a) working towards reducing the costs of the actual service provided and b) promoting the well-being of our society is no less than presumptuous.

  12. “By which I mean, everyone should pay for health care services out of pocket, except for major unexpected costs ”

    But it’s the major medical costs (hospital care) that are driving unaffordable costs. You think consumers will be able to do a better job at negotiating price than an insurance company? If that were the case the uninsured market would not be a problem now as they are the ultimate out of pocket market.

    The present system is insurance negotiates cost then sells it’s services to consumers in competition with other insurance companies based on cost and service. Is that not a competitive market?

    Your POV is based on a myth that health care can operate like any other product. Do you think I could have negotiated my hip surgery here in U.S. for 1/3 what I was quoted – after all I was paying cash? What negotiating power and reason would patients be able to lower price? What negotiation would take place in the ER?

    You are also misinformed arrogant about the level of skill the U.S. has over Canadian or European institutions. Canadian wait time issues have been better addressed over the past several years due to extra resources being applied to particular areas where wait times were more of a problem – like the problems of an aging population living longer. Canadians never wanted to abandon their single pay system to solve the wait time issue. They did get response and action from their politicians though, more so than the U.S. gets from its political system.

  13. I like medical tourism. In fact, it should be the standard in health care.

    By which I mean, everyone should pay for health care services out of pocket, except for major unexpected costs (they’d buy catastrophic insurance for that). Then patients would choose among different providers. You wouldn’t go to India necessarily but you could go to another provider in the same city or state.

    This would lower prices and raise quality across the board as providers compete for customers/patients based on price and quality of care.

    That’s hard to do now because payments are handled by third parties (government or private insurance). Patients don’t have an incentive to seek out the best price, if they know someone else will be paying for it.

    People don’t come for U.S. health care based on price. It isn’t cheaper here. (Maybe it would if we had the out-of-pocket free market in health care that India has.)

    Rather, they come if they’re in a country with “universal health care” that… really isn’t so universal for people who are on a waiting list for months or years. So they find an escape hatch by using our health system.

    Or, if they have money to spend and want the very best, they come because the top hospitals in the U.S. are also the top hospitals in the world.

  14. “However, I can’t help but notice that when people in Canada, Europe, and elsewhere want the best medical treatment they come visit the U.S. How many people go the other way?”

    How many people come this way? I went to India for accredited hospital and world class surgeon for hip surgery – at less than 1/3 the cost. Medical tourism is two way street. Tell me how many come here for cost?

  15. “You think they’re risking their lives for U.S. Health care? Really!”

    No. There are bigger factors involved. East Berliners weren’t thinking of the West German health care system when they tried to sneak across the Berlin Wall either.

    However, I can’t help but notice that when people in Canada, Europe, and elsewhere want the best medical treatment they come visit the U.S. How many people go the other way?

  16. “Also, I’ve never experienced either of the two Cuban health care systems. But Cubans have experienced one of them (the one that is not shown to the outside world), and its quality clearly does not dissuade many of them from risking their lives to escape to Florida.”

    You think they’re risking their lives for U.S. Health care? Really!

    Does that mean North African refugees are risking their lives for Italian socialistic health care?

  17. We cannot take pride in our violent crime rate or our car crashes.

    My point is that life expectancy depends on many things, and the health care system is just one of those things. It’s unlikely that any health reform, socialist or otherwise (except possibly beefing up emergency care) would reduce deaths by traumatic injury.

    Also, I’ve never experienced either of the two Cuban health care systems. But Cubans have experienced one of them (the one that is not shown to the outside world), and its quality clearly does not dissuade many of them from risking their lives to escape to Florida.

  18. Looking at all the charts helps to develop the proper perspective.

    There is just decimal point differences in the data for non fatal injuries life expectancy compared to countries with more socialized health care – and that includes spending at least twice what other countries spend.

    The wealth per health chart shows the U.S. below countries with less GDP.

    I don’t know if we can take pride in the fact that violent crime skews some of the data – can you Douglas?

    So is your point we don’t want Cuba’s system?

  19. “A healthy lifestyle may not prevent pancreatic cancer but it reduces or eliminates a lot of morbidity and mortality.”

    Marie, I don’t think anyone disagrees with that, but how do you get at risk populations to achieve it? It’s not just flicking a switch with a manifesto.

    America is a junk food culture, and culture is very hard to reform, especially when corporate America does not cooperate, not the least of which is marketing to children.

    Maybe you would like to eliminate drunk driving with a manifesto.

    “how do you define affordable’

    How do you define “affordable” Marie? Obviously you think disease caused by unhealthy lifestyle is not affordable. How would you define “healthy lifestyle”?

  20. A healthy lifestyle may not prevent pancreatic cancer but it reduces or eliminates a lot of morbidity and mortality. Diabetes, obesity, smoking lack of physical activity etc, are costly over time. Eliminate those costs and apply that money towards catastrophic illnesses like pancreatic cancer.

    Kelley, how do you define affordable, high quality care that is accessible? You need define your terms if you want to have a debate. Which I would welcome.

  21. I’m about to over simplify an absurdly complex situation but please indulge.

    Most humans can rationalize their way out of any given situation, (as indicated by Vik and some of the comments). How you do so depends on your financial class, education, background, current environment etc.

    So acknowledging my premise of over simplifying can we agree: Many (drug companies, insurance companies, hospitals, administrators, physicians, nurses, device companies, patients, caregivers, congressmen, lobbyists – you get my point) are wrong AND many are right?

    Somewhere in the middle lands what I think we all want which is access to good quality, affordable healthcare for our populace and the good news is we live in a society where we can openly debate our issues. Yet most of the “we” (general populace) aren’t having these debates. Why?

    I have my thoughts but would love to hear yours.

  22. All that is fine but lots of people get really sick even when they live right and use resources appropriately. Good intentions don’t pay when you have pancreas cancer.

  23. According to the AHRQ, 1% of US adults account for 21% of medical care spending. For those seriously ill people, virtually their only path to quality of life and even survival is the medical care system.

    If the remaining 99% of adults are responsible for most of the medical care spending, it means that costs are widely dispersed across the population, indicating that most people are likely somewhere between the stage of having risk factors but no disease up to having disease that is successfully managed through primary and secondary prevention. Those people, even the ones on Medicaid, can help themselves by improving their choices.

    If you tell them that they don’t have to, or they can’t, or they shouldn’t try, or the system will take care of them, you create a self-fulfilling prophesy of financial and clinical disaster, because they just continue drifting down the path they are already on. The ACA is the health policy equivalent of Daniel Patrick Moynihan’s warning about the welfare state would do to the black family.

  24. Baton Rouge is in Louisiana.

    Yes, the NHS in the UK..the same NHS that has page explaining wait times for procedures to its citizenry: http://www.nhs.uk/choiceintheNHS/Rightsandpledges/Waitingtimes/Pages/Guide%20to%20waiting%20times.aspx. Perhaps the administration can successfully copy that website, since they did not think to copy the functioning RomneyCare website from MA.

    Actually, I work in the deep South on healthy lifestyle behaviors in low-income communities. The people in our communities have ready access to Walmarts, which is a good thing (my yuppie neighbors and I shop frequently at Walmart as well) because the prices are great.

    But, even with low prices, people often don’t know how to choose well (a failure of the educational system and the local culture), and we help them understand how to do so. They are very adept at taking the ball and running with it, because it takes only a little education in financial and health literacy to help someone see the benefits of doing better for themselves in whatever increment they can manage.

  25. Agree with Peter1 here. Even if poor health were simply due to “failure of the individual will” (a highly sophomoric, empirically and philosophically questionable claim), the solution would not be to tell these “failing” people pejoratively that they just need to buck up and take control of their own lives. Motivational pro-tip: do not begin by insulting those that you wish to motivate. It is the surest way to fail at your goal. Phrases such as “As for your constrained reading comprehension…” don’t add much to any serious conversation, but instead serve to just bully and reduce debate to ad hominem filled rants. If phrases such as these are indicative of the ways you aim to make other people take a more active role in their health (and I agree with you that this would be a good outcome for all involved), you will not get too far. Additionally, if this is your manifesto and you hope it to serve as anything other than an opportunity for you to show the world how much better you are than those you look down upon, I would highly recommend taking it back to the drawing board.

  26. Vik:

    While I agree with much of what you say it is a dangerous oversimplification to call the health problems in America a mass failure of individual will. Americans didn’t wake up in say 1970 or so and become sloths.

    If you came from another planet and saw our “system” you’d see these outcomes: diabetes, obesity (33% obese, 33% overweight. That’s over 200 million people!), Alzheimer’s, arthritis, and on and on. You’d wonder why. While the answers are complex, much of it can be traced to diet. Too much cheap industrial oil leading to a never-before-seen in evolutionary history omega 6 to omega 3 ratio, trans fats, excessive consumption of refined carbohydrates especially sugar and especially especially high fructose corn syrup. You would see this, and know that as biological organisms we can’t expect a different kind of outcome with that type of input. The care system (it has nothing to do with health) can only try to be efficient dealing with the symptoms.

    And while yes individuals have a role to play here, so does government. FDA scientists opposed GMO crops; Reagan’s FDA commissioner former Monsanto executive over-ruled them. We subsidize less healthy food, and that can be changed. Even now something as seemingly straightforward as moving to healthier school lunches ends up with pizza being classed as a vegetable.

    I could rail on but you get the point. There is a large and important role for government. Calling it a mass failure of individual role is far too simplistic and (while I know not intended; I admire your work) smacks of class-ism and elitism.

  27. “Obviously, I meant hip replacement, not hip transplant.”

    Yes, a significant omission to the argument- I should have jumped on it.

    Actually you are wrong on both counts. It was a re-surfacing.

  28. “it was almost certainly manufactured by one of a handful of companies worldwide”

    Smith & Nephew (for profit), English I believe. You know, the one with National Health.

    If you read my sentence I said “rigged” for profit. All health care systems world wide use private, for profit, suppliers yet their prices are much better than ours. Are you a supporter of the RUC in setting physician reimbursements? Are you a supporter of the fact that Medicare is not allowed to negotiate drug prices?

    “People in MS also earn less and are less educated, which speaks to the real fundamentals of what’s wrong with the health culture in MS.”

    “No one’s making anyone buy a bag of Fritos instead of a bag of apples.”

    Gee, by your response and manifesto they should be able to act by free will, regardless of the environment they live in. Why is the Mason-Dixon Line now known as the obesity line? They haven’t read your manifesto yet?
    I guess they could shop at Trader Joes, well actually not until Oct. 31st. The Baton Rouge store will be the only one in MS. Maybe they should just drive to the one in your yuppy neighborhood with it’s higher incomes and better education – except for your broader understanding of why those populations cannot exercise your free will choices.

    As to BCBS being “non-profit” that issue has been discussed before on THCB. Non-profit in the U.S. has become meaningless, especially for BCBS. I won’t waste my time giving you a tutorial.

    The problem with libertarian views is they are naive about cause and effect and devoid of real world solutions. They use the solution of “if just”.

  29. So, your problem with the US health care system is the quest for the filthy lucre? Guess you better give back that hip because it was almost certainly manufactured by one of a handful of companies worldwide, all of which are for-profit, and several are public. Did you think it was manufactured by garden gnomes?

    Huge components of the US health care system are already not-for-profit (NFP), or, more properly stated tax-exempt, such nearly all hospitals and health systems and prominent health plans, such as Kaiser. The entire BC/BS system, started by hospital and physician groups respectively, was initially not-for-profit and is now a mix of profit and NFP. The issue is not profit, per se, but judgment, which both our population and our political leaders lack in spades.

    As for the claim that individual behaviors don’t influence costs, you might explore the characteristics of populations regarded as the world’s healthiest (see, for example, http://health.howstuffworks.com/wellness/preventive-care/7-countries-home-to-the-worlds-healthiest-people.htm)…in every single one, people are active, strive to find balance in life, and eat sanely. They’re happier than we are, live longer, and spend less on medical care. In fact, that same matrix is visible in the US when you compare individual states.

    People in CO, for example, are far more likely than people in MS to exercise vigorously and eat well. They also live longer and are the least obese, most fit US population. People in MS have a far higher rate of utilization of the two most expensive kinds of health, hospitalization and emergency department use, and even though the population in MS is younger, they have shorter lifespans. People in MS also earn less and are less educated, which speaks to the real fundamentals of what’s wrong with the health culture in MS. As income and education rise, so too, does the frequency of positive health habits, and there is a concomitant decrease in utilization. We are the fattest, laziest culture in the history of Western Civilization, and we pay for that every single day.

    The net result of a healthy lifestyle is not an assurance of perfect health until death, but that it shifts the disease/risk odds in your favor. It is risk mitigation, not risk elimination, just as getting into car with multiple air bags does not mean you’ll survive every possible collision. In fact, I will be so bold as to predict that, unlike you, I will not need a hip transplant (unless I suffer a traumatic injury). Why? Because I have spent a lifetime running and lifting and had a better than “pretty much proper weight,” whatever that is. Why do those particular exercises matter to joint health? Because articular cartilage benefits from cyclical loading, which encourages healthy remodeling.

    The complaint about federal food subsidies is true, but hackneyed. No one’s making anyone buy a bag of Fritos instead of a bag of apples. I shopped at Trader Joe’s last night while my kid was in karate class and walked out with a bag full of fruit, vegetables, and bread. Each bag of apples was the same price as a big bag of chips.

    As for your constrained reading comprehension, I don’t have time for a tutorial. You might, however, try Khan Academy an online educational enrichment site. My fourth-grader uses it for math and reading improvement. It is FREE and NOT-FOR-PROFIT, which seems more your speed. It is, however, underwritten by huge corporations, so I hope that doesn’t put you off.

  30. Probably not Luke. Hospitals don’t increase the life expectancy of the average American. Lifestyle does. The US has the highest rate of obesity in the world and double that of Canada. Obesity generates a lot of income for the medical establishment and it is not our only bad habit.

  31. When I think of our healthcare, I also remember something I have learned about Canadian healthcare system.. They are spending 6% of their GDP on healthcare, while we spend 12% and they live on average few years more than we do! their system is twice as cheap and they are living longer… oh yeah there is another example, that of Cuba where Cubans live longer than Americans.. how can this be? Something is gotta be wrong with our healthcare.

  32. “the Affordable Care Act (ACA) tells me by omission I do not need to do: take responsibility for myself.”

    Why does ACA say that, when it relies on INSURANCE to cover illness? It has co-pays and deductibles just like the insurance you had before ACA.

    “The ACA is a collective solution to the mass failure of individual will.”

    Cancer is not individual will, neither are many other very expensive need-a-hospital illnesses. My disappearing hip cartilage was not due to my lack of will or my healthy eating, exercise, or pretty much proper weight. My uninsured self was able to go to India (because I have resources) and pay less than a third what it would have cost me here – including air fare and hotel. Other people I know who got the same operation in the U.S. not only paid over $8000 per year in premiums but had to pay an additional $8500 in deductibles and co-pays. They’re still paying it off (and their premiums) after many years hoping they don’t contract another major hospital event.

    The enemy Vic is gouging by a rigged for profit system. The enemy is junk food supported by the agro-industrial complex and the subsidies it gets.

    You’re dreaming in a Wonderland of if individuals would act independently this would be solved.