Do Not Go Gentle Into Obamacare; Good Health Should Burn And Rave At Close of Day

REUTERS/Mike Segar

John R. Graham Independent Institute, National Center for Policy Analysis
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Vik Khanna, a management consultant and executive fitness coach, has written what is probably the angriest anti-Obamacare book available. But the self-published Your Personal Affordable Care Act differs from other anti-Obamacare books in that he doesn’t really propose a detailed alternative to Obamacare. Instead, he uses Obamacare as platform from which to launch an appeal for personal responsibility and his approach to health and fitness.

This approach is nothing against which any reasonable person would argue: Eat more fruit and less junk food; exercise to improve your heart and build lean muscle; sleep more and watch less TV. Khanna is no crackpot. But Americans have been telling ourselves this for years. Khanna appears to hope that the federal take-over of our health care instituted through Obamacare will finally cause freedom-loving people to cry out “No!” and take responsibility for our health and fitness instead of succumbing to the government-medical complex.

According to his own blog, Khanna is “healthcare’s angry man.” “I am the anti-lemming, the human bulldozer, the irresistible force meeting the immovable object of Americans’ casual indifference to their own health and to the persistent drumbeat of ever more government intrusion into their lives.” Ayn Rand meets Vic Tanny.

Khanna is careful to distinguish fitness from so-called “wellness”, an employer-sponsored industry which he argues creates no value. (Khanna’s previous book, Surviving Workplace Wellness: With Your Dignity, Finance, And (Major) Organs Intact, was a merciless criticism of the workplace wellness industry.) Nor is he a fan of the countless health and fitness apps and gadgets which have exploded on the scene.

This passion for individual responsibility leads Khanna a little overboard in his criticism of the “healthcare industry”, a term he uses to bundle together wellness vendors, hospitals, physicians, drug and device makers, and anyone else who profits in that politicized environment.

Indeed, Khanna refuses to use the term “healthcare system” because that would be a group of components working towards a common goal, instead of what we have: A swamp of cronyism characterized by back-door deals struck by the industry with politicians. Fair enough: Steve Brill has written about Obamacare’s cronyism in grisly detail in his massive America’s Bitter Pill (which I have not cracked open because I share a colleague’s view that 500-plus pages is too long for a report on sausage-making in Washington.)

Revolted at the healthcare industry, Khanna issues sweeping – sometimes overly simplified – condemnations of preventive screening and therapies. The list of interventions that he criticizes is exhaustive. I read the book in the Scribd version, which has functioning hyperlinks to the latest, most critical studies that he cites to support his charges. These studies are serious and worthy of attention. However, cherry-picked studies are no substitute for thorough literature review, and readers should be cautious about jumping to conclusions about the merits of interventions that are still under dispute within the medical profession.

Nevertheless, when it comes to public policy, and the role of the state in health care, Khanna nails it. The obsession with universal coverage is irrational: The cost of treating the uninsured is a minor, almost trivial, share of health spending; and insuring young (mostly healthy) people will also have a very small effect.

Khanna is one of few who recognizes the perverse outcomes that Obamacare creates by increasing the healthcare industry’s power. Because hospitals use their emergency departments as profit centers, visits to emergency departments are up since Obamacare rolled out. The rebates from health plans with high profits, which the administration touts as consumer-friendly, are actually plan-friendly: Regulated profit margins, combined with mandatory coverage, motivate health plans to increase medical spending, especially on healthy people. (This explains why health plans do not lobby against Obamacare’s requirement that they pay for annual preventive check-ups.)

A few of his bon mots are worth the price of admission alone: “the government and its clinical agents are succeeding in promoting the idea that good health is something that comes from the healthcare industry. It is as absurd a claim as saying the nation’s economic prosperity starts with the Internal Revenue Service.”

People who think that the government is responsible for its citizens, rather than that the citizens are responsible for the government, won’t like Khanna’s message. For the rest of us, it is an effective broadside against government-controlled health care.

John R. Graham is Senior Fellow at The Independent Institute (www.independent.org), Oakland, CA and Senior Fellow at National Center for Policy Analysis.