A free society depends on its citizens assuming personal responsibility. No society will remain free for very long if it not only fails to encourage self-reliance, but establishes policies that reward dependency, or does not permit poor choices to be penalized. The debate over the future of healthcare in America is not going very well. Many people justifiably fear that nationalized healthcare will lead, e.g., to healthcare rationing, or to a diminished quality of care. We have healthcare rationing now, though, whenever an insurance company refuses to pay for a procedure. As we struggle to identify the best way to proceed, what we need to realize is that not all our options have been put out on the table. Moreover, those in government are simply assuming that people should be dependent on them and on "establishment medicine," as I will call it. In particular, too many Americans assume that it is the federal government’s job to take care of our health needs. Some Americans began making that assumption in the 1930s. By the 1960s, it had become the prevailing mindset.

Thus we now have the following dilemma: entitlement policies such as Social Security, Medicare, and Medicaid are popular. More than that, I have no doubt that we will find (especially in nursing homes) people whose very lives depend on them. These policies are also doomed. With an aging population, we will soon have more people taking out of the system than we have paying into it. All three are therefore unsustainable over the long run. They will eventually go broke. Everyone knows this; the only disagreement is over how long it will take. Entitlement policies are examplars of healthcare collectivism, we might call it — policies of intergenerational welfare that lead to taxes on working Americans to support those who for reasons of health or aging can no longer work. As baby boomers retire and begin to have health problems, the part of the population taking out of the system is destined to get larger no matter whose agenda we pursue.

The real objection to proposed measures like Obama-care is not that they contain this or that measure, but that in the long run, the country can’t afford them. Those who believe that President Obama can spearhead an overhaul of the entire health care system without adding anything to the deficit are simply delusional. Yet it should be clear why so many people are tempted by Obama-care. The status quo can't last! Is there any way of resolving this mess without the terrible recognition that healthcare rationing is going to be inevitable no matter what we do?  

We have mostly missed a healthcare option known as primary prevention. To some people, the idea is a bit wacky, associated with alternative medicine, found on the leaflets you can pick up in health food stores, etc. This is not a fair assessment. With the obvious need to contain costs amidst an aging population, and the obvious desirability of avoiding further government intrusions into healthcare represented by Obama-care, promoting primary prevention on a wide scale is actually the most rational approach to take.

We may speak of three levels of healthcare. Two are well known, though not necessarily by those names. Secondary treatment is what you do to restore health after having gotten sick. Typically it involves seeing a doctor, taking whatever drugs he prescribes, etc. Tertiary care is a term we might use for what is done following, for example, a stroke, where restoration of the person’s previous state of wellness isn’t possible. Tertiary care may involve treating not just the patient but the patient's family unit. Primary prevention is the term for a full range of activities one can undertake to either avoid getting sick or to delay the onset of infirmity requiring tertiary care for as long as possible.

It is also, obviously, the most desirable of the three if, as a society, we are serious about containing and eventually reducing healthcare costs in a fashion that is humane. Primary prevention includes such practices as eating a proper diet, exercising regularly, not smoking, not drinking to excess or ingesting harmful recreational drugs, and not engaging in, among other things, risky sexual behaviors.

Part of our problem today is that Americans’ eating habits are terrible. Too many of us virtually live on nutrient-deficient processed food and junk food. We ingest too much sugar and too many damaging chemical additives ranging from flavor enhancers such as monosodium glutamate (MSG), artificial sweeteners that are worse than sugar (e.g., aspartame, a known carcinogen), and preservatives the long-term effects of which aren’t even understood. We do not get enough minerals such as calcium. All of these contribute to the long term deterioration of our health, and in society at large, they guarantee that our healthcare problems will continue to worsen with time.

Everyone knows about the worrisome levels of obesity, including in teenagers and even children. Kids are obese because they eat too much junk with no significant nutritional content. While of course people’s systems are different and some are more genetically vulnerable to certain conditions than others, many disease conditions can be linked directly to the absence of primary prevention practices. If we had been taking primary prevention seriously all along, we would have less diabetes, less heart disease, fewer cancers, fewer breathing disorders, fewer sleep disorders, less osteoporosis, and possibly less Alzheimer’s disease which is being seen at younger and younger ages.  

Unfortunately, most healthcare practitioners simply assume that secondary treatment and tertiary care are inevitable. Establishment medicine pays, at best, lip service to primary prevention. Occasionally, you still hear doctors who ought to know better saying, for example, that nutrition has nothing to do with health. One doesn't need an MD to know that this is absurd! If you do not give your body systems what they need to sustain themselves, they will eventually malfunction—just like an automobile that is not properly maintained — and you will suffer the consequences.

The problem is that establishment medicine is under the thrall of the multibillion dollar pharmaceutical industry, otherwise known as Big Pharma. Doctors are essentially taught in medical school that if they don’t prescribe drugs and engage in invasive procedures, they aren’t really practicing medicine. Big Pharma’s influence is everywhere in modern society. This explains why almost every third commercial you see on television advertises a drug (“Ask your doctor if _____ is right for you”).

If we are to bring the healthcare crisis in America under control, this must change. Establishment medicine cannot fix most chronic health problems with drugs or invasive procedures. It can only treat symptoms and then attempt to deal with the unwanted side effects of multiple drugs (and reap the enormous profits available). Sometimes surgery is necessary, of course; but honest medical professionals will admit that much surgery is preventable, because the conditions leading to it were preventable.

As commentator Joel Skousen put it in his September 11, 2009 World Affairs Brief:

The overall system, including government regulators [e.g., the FDA], medical boards, medical colleges, pharmacies, and even insurance companies is controlled by protocols dictated by or suborned by drug company money. These protocols, especially those related to internal medicine, are hostile in the extreme to natural health practitioner methods that are cheaper and more effective in the long term. Medically trained doctors give lip service to prevention but don’t really have a good understanding of nutrition and endocrine health that is the key to good health and longevity.

Unfortunately, therefore, primary prevention is unlikely to gain much traction within the existing healthcare industry — including from so-called reformers. The reason is not hard to see. Doctors, hospitals, and other healthcare providers make more money off sick people than they ever will off healthy people. Moreover, if insurance companies pay the bulk of the costs, there is little incentive for individuals to learn healthy behaviors; the unhealthy ones do not exact a penalty. It is crucial to realize: Establishment medicine has a vested interest in a sickly, dependent population that requires continuous treatments, leading to long-term care situations!  In a sense, we have never really had a healthcare system in America. We have had a sick care system — amidst one of the unhealthiest populations in human history, relative to our level of knowledge and technical know-how. And as much talk as we hear about change, we will not see the changes from establishment medicine that really are health promoting.

For the same reason, we cannot count on the FDA. The FDA approved aspartame for use in artificial sweeteners, after all! It has approved numerous other chemical additives in foods that subsequent studies have proven decisively are harmful to a person’s health over the long term.  This is because the FDA, like establishment medicine itself, is bought and paid for by Big Pharma and huge food corporations (Monsanto, Tyson, etc.).

Since we cannot count on either the mainstream medical profession or the federal government, if we want to be healthy we have no option other than to take matters into our own hands. The first step is learning about primary prevention. The key is education about nutrition. I have discovered nutritional information in those health food stores to be of great value. Those who promote natural health have published some very good guides on how to prevent common ailments, and how to treat them without seeing doctors or taking prescription medications. At least some personal health maintenance, especially for those who know they aren't eating enough nutritious food, involves taking a regimen of dietary supplements, including common vitamins such as C and B-complex, and minerals such as calcium. Big Pharma would like to wipe out the dietary supplement industry. Dietary supplements are, of course, far less expensive than prescription drugs and far more effective at preventing nuisance colds, the flu, and other common ailments than drugs and vaccines. Calcium, meanwhile, is known to prevent osteoporosis which is a major contributing factor to dangerous falls in elderly people.

This is not a panacea, of course; and for many people, it will not be easy. Many factors cause us to give our dietary habits short shrift: lack of interest, lack of motivation, or simply the sense of no time to do it created by the rush-rush-rush of modern society. Given the realities of an aging population, though, we absolutely must begin a societal shift toward primary prevention.

The alternative is that in a few years, the costs of caring for increasingly large cohorts of aging, sick, and sometimes disabled generations starting with baby boomers will leave us with a choice as nasty as it is unavoidable: between de facto euthanasia (triaging elderly people and not dispensing life-prolonging treatments — the very thing Obama-care has been accused of) and the insolvency of the healthcare system! Continue on our present road, and the “death panels” Sarah Palin alleged were already in H.R. 3200 will become a horrible reality no matter whose healthcare agenda we adopt!  If this sounds apocalyptic, just do the math.

I am not suggesting yet another body of laws or policies. If anything, we should begin creating the conditions for eventually eliminating Social Security, Medicare, and Medicaid since they are unsustainable. We need fewer laws and top-down policies, and more health freedom of choice — which of course should include retaining our present freedom not to purchase health insurance if one doesn’t believe doing so to be cost-effective. We need what might be called a paradigm shift: away from medicine understood in terms of drugs and invasive procedures to medicine understood preventively. That is to say: a paradigm shift away from establishment medicine controlled by Big Pharma and toward self-reliance, taking responsibility for our own healthcare via primary prevention.

We have a lot of hurdles to clear, of course. The work to be done will involve education and networking. It would be nice to have both visible political figures and business personalities on board. What is most important to remember: genuine, lasting, long term change must proceed from the bottom up, and not be imposed from the top down. This is what it means to live in a free society. As we said at the outset, assuming personal responsibility means taking charge of our own health, with information, know-how, and proper habits. Communities that embrace primary prevention as a way of life will spend fewer dollars on doctor visits, hospital stays, and drugs; lack of affordable health insurance will be a problem that soon begins to solve itself. As our paradigm of what healthcare is all about changes, people will look better, feel better, work better, and live longer! Ironically, once we have genuine healthcare instead of sick care, we will all spend less money on healthcare! If this poses a threat to the present-day establishment medicine — Big Pharma, the FDA, and all their minions — then so be it!

 Steven Yates earned his Ph.D. in philosophy in 1987. He is the author of one book, Civil Wrongs: What Went Wrong With Affirmative Action (San Francisco: ICS Press, 1994) and numerous articles both in academic journals and elsewhere. He has taught philosophy at Clemson University, Auburn University, Wofford College, the University of South Carolina, Southern Wesleyan University--Columbia, and Midlands Technical College, and has held fellowships with or worked on projects with the Institute for Humane Studies, the Heritage Foundation, the Heartland Institute, and the Acton Institute for Religion and Liberty.

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Larry Brown said:

... Excellent article Dr. Yates! I've been told that the pre-communist Chinese practiced Primary Preventative care. You hired a doctor to keep you well. If you got sick for any reason, you fired that doctor and hired a different doctor. This gave the doctor an incentive to keep you well. One "alternative medicine" doctor states in his "junk mail" that there is not a disease known to man which is not almost unknown among a group of people somewhere in the world.

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September 22, 2009 | url
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Dan Harris said:

... Part 2 Hey, I am all about helping folks!!! BUT DON'T ASK ME TO HELP YOU FINANCIALLY with health care when you smoke like a fregin train, eat like elephant and live on junk food, nutrient deficient food-like substances. I mean at this point in this society WE are producing sick defective children. And is it really any suprise that when you live on food-like substances(nutrient empty junk) you are going to produce a child with a less than average ability to fight illness and desease?? Look its STUPID SIMPLE!! You eat like crap you are going to feel like crap!! And you cannot fight desease and illness living like that, in fact you PROMOTE IT!! If you don't want to get sick or get cancer or type 2 diabetes and a horde of other illness THEN eat FOOD NOT FOOD-LIKE SUBSTANCES! What is Food you ask? Listen, it has to be real and NOT man made, get it? Look at your plate when you eat, and if it came in a box, then you might as well eat the box too! Your plate SHOULD be at least half but better if 2/3 of you plate is covered with VEGATABLES!!! And no I am not a vegatarian, you have to have protein and good complex low glycemic carbs as well. Cancer mystery?? What a joke! Almost every common desease condition today is self induced either by you or the generation before you. Do you want to avoid the hospital the rest of your life??? Then don't get hit by a car, AND CHANGE WHAT YOU PUT IN YOUR PIE-HOLE!!! Its really that simple!!! Need help in distinguishing proper eating? Then I am here! Find me. Dr Dan

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October 04, 2009
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segamonI als said:

Great viewpoint! I think that this is a great viewpoint. It is important to change the nutritional and health habits of the American people. We are too involved in foods such as Burger King (yuck) and In-n-Out (yum!) and not involved enough in foods such as lean meat chicken (yum!) and lima beans (yuck). There ARE healthy foods that taste good. A look at the Japanese primary prevention is an important example. Their healthcare system may not be the best, but their culture and society eats a very healthy diet! :) I also agree with the idea that personal responsibility is of utmost importance and that we need NOT increase the government involvement in our day-to-day health.

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November 03, 2009 | url
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