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By Professor Steven Yates
February 7, 2017

“No problem can be solved from the same level of consciousness that created it.” —Albert Einstein

“You never change something by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” —Buckminster Fuller

The (Un)Affordable Care Act, Barack Obama’s signature legislation, has been a disaster. I probably don’t to argue this before most readers of this site. With the start of the “Trump years,” the GOP-controlled Congress looked to have its best opportunity ever to get rid of this disaster.

Some have gotten cold feet, however. In a sense, this is understandable. As they look at the details and see that since the law went into effect, its fine-print complexities have insinuated themselves deeply into the insurance, health care and Medicare bureaucracies, changing them from the inside to fit its requirements. The idea of striking Obamacare down all at once has its appeal, but to those on the inside, doing so looks like it might risk a situation where, in a very short period of time, not just millions of people are uninsured again, but hundreds of thousands of employees in these industries are left high and dry: needing to make decisions, some medical and some financial, with no idea what the rules now are.

This is the problem when industries are placed under the thumb of massive bureaucracies. The latter make themselves “indispensable.” They expand into new areas, which become the scene of still more constantly-changing laws and regulations. This is also the problem when much of the population hasn’t been educated to think independently. Toss out the rule book, and they are at sea!

Be this last as it may, we need is to wake up and realize we are kidding ourselves if we think the present mess has a centralized “fix.” I sincerely hope “repeal and replace” doesn’t mean what it sounds like, because if it does, the GOP will replace one mess with an even bigger mess, and the GOP will own it. I am led to believe Donald Trump is working on a “fix.” I hope he doesn’t replace one form of centralization for another form of centralization. For the same reason, it won’t work, and he will end up owning the resulting mess.

Get rid of this kind of system we must! Its price tag is too high, and many of its “benefits” are illusory. The other day Simon Black (of Sovereign Man) wrote why his elderly stepfather, a Medicare patient, was dropped by his doctor. There is no summing this up:

“… [P]hysicians across the country have been firing Medicare patients; and according to a late 2015 study from the Kaiser Family Foundation, 21% of physicians are not taking new Medicare patients.

“Much of this trend is based on stiff penalties and financial disincentives from the Affordable Care Act (Obamacare), and 2015’s Medicare Access and CHIP Reauthorization (MACRA) Act.

“MACRA in particular is completely mystifying.

“The law created a whopping 2,400 pages of regulations that Medicare physicians are expected to know and follow.

“Many of the rules are debilitating.

“For instance, MACRA changed how physicians can be reimbursed for their Medicare patients by establishing a bizarre set of standards to determine if a physician is providing “value.”

“As an example, if a patient ends up in the emergency room, his or her physician can incur a steep penalty.

“This explains why my stepdad was dropped by his doctor.

“The healthcare system has been broken to the point that physicians now have a greater incentive to fire their Medicare patients than to treat them.
“One Florida-based physician summed up the situation like this:

“I have decided to opt-out of Medicare, acknowledging that I can no longer play a game that is rigged against me; one that I can never win because of constantly changing rules, and one where the stakes include fines and even potential jail time.”

“The irony is that all these new laws and regulations were designed to “save” Medicare.”

Most people do not know it, but the medical profession has one of the highest rates of mental health disorders such as depression, substance abuse as a form of coping, and suicide. There is abundant malfeasance: absurdly long hours causing sleep-deprivation; there is bullying and abuses of power; etc. Medicine and health care have become extremely high-stress occupations. Burnout is common. A young MD suffering from depression or who has become hooked on “uppers” to stay awake during a 24-hour shift knows he needs help but fears seeking it because doing so could cost him his medical license and end his career.

Moreover, the third leading cause of preventable death is the medical profession itself (exceeded only by heart disease and cancer). Illnesses, injuries and deaths do occur in hospitals due to physician and surgeon error.

A major factor here is drowning medical professionals in thousands upon thousands of regulations they are expected to understand and comply with; penalties for not doing so range from debilitating fines to prison time.

Thus what Americans have is the world’s most expensive, most bureaucratic, and arguably least functional health care system. This system cannot be “reformed.” It can only be escaped from, until its dysfunction in the face of superior alternatives collapses it. This article is about escaping this system. It will require a paradigm shift of major proportions, especially in this age of entitlements, dependences, and a population that can’t think without a book of rules to follow. We cannot simply “repeal and replace” Obamacare. We need a different way of thinking about public health.

Two preliminaries. (1) We have to realize what disasters like Obamacare and MACRA are intended to do. Obamacare’s primary purpose was not just to insure the uninsured, although doing so, for as many as possible, did make it look good on paper. What Obamacare was intended to do was Make Money for Big Pharma and Big Insurance. Money lost from insuring preexisting conditions was more than made up for via skyrocketing premiums, and deductibles high enough to make the system unaffordable for those of modest means. It and MACRA were designed to increase the level of control over the public as well as over the medical profession. When the federal government can unconstitutionally force you to buy health insurance, and unconstitutionally sic the IRS on you with whopping $600-plus penalties if you don’t, your aren’t free. As George Carlin put it in one of his best routines (warning: language!), “You have owners! They own you!”

Obamacare may have been designed to fail, to pave the way for a single-payer system. Why is single-payer bad? It works in, say, Denmark, does it not? Perhaps. Denmark’s population is a little over 5 and a half million. Over 324 million people live in the U.S. (more, if you count illegal aliens). It is insane to think a system workable in small countries can be just as effective in a country with a population almost 60 times higher!

So what’s the answer?

Some years ago (late 1990s, to be exact), I took a series of courses in health promotion and education. It was, by most standards, an unusual program. There wasn’t a lot about health; leaving aside what I thought even then was an unhealthy obsession with sex, there was far more psychology, directed towards behavior change. I’d been thinking of a new career. I saw useful ideas in the program. But it became clear: what was good here was incompatible with top-down enforcements typical of bureaucracy. What I learned about myself (surprise, surprise): I don’t have the patience or temperament necessary to fit into a public health bureaucracy. For one thing, I tend to ask questions instead of following a book of rules blindly. After a couple of stints writing reports for a consulting group (and one collaboration journal article with one of the leaders) I abandoned the career option. But not the ideas, which I’ve used myself with some effectiveness.

They are the key to the best replacement for Obamacare.

The program called them the Three Levels of Prevention. That, as it turns out, is a misnomer. A far better phrase: the Three Levels of Health Care.

The first level is that of Primary Prevention. The second, Secondary Treatment (my term). The third, Tertiary Care (my term).

I’ve seen all three in action. The first is by far the most important if Americans, as a society, want to get control over their health care. So I’ll spend the most time on it.

Primary Prevention is everything you do to avoid getting sick, injured, etc. It draws on the adage that an ounce of prevention is worth a pound of cure. Primary Prevention involves learning about nutrition, including how to read food labels in stores. People who do not do this, are setting themselves up for trouble later in life. I have no special diets to offer here. I know people who have gotten results with, say, the Paleo Diet. I’ve not studied specific diets such as this, though, so I cannot be either for them or against them. Since our body systems are all slightly different, as are our habits and levels of motivation, what “works” for one person may not be as effective as what “works” for another. What matters is, you absolutely need to know what you are putting in your body, and be sure it really belongs there. Remember: food corporations and grocery chains don’t care. They just want to sell you products and Make Money. It’s a buyer-beware world. It is up to us—we, the people—to educate ourselves and each other about what’s in our food, and eat the right things. Much of this is common horse sense. You cannot get enough fresh vegetables and fresh fruits. Nuts are also good. Meat is optional; it contains an abundance of protein, but you can live without meat. It is harder to digest than fruits and vegetables. What counts is getting vitamins and other necessary nutrients. I try to eat at least one orange and at least one apple per day. I also feast on broccoli. It was an acquired taste, but I can now eat it cold, with a salad. Cooking it actually robs it of some of its nutritional value.

Primary Prevention may involve learning to grow your own food. When you do, you know exactly what is in it. It involves knowledge about food preparation — what happens to food when ingredients are mixed, cooked, and so on. Primary Prevention has some don’ts. Minimize your alcohol intake. Shrink your caffeine intake. Do without if you can (the latter, alas, is a hurdle I’ve not cleared — but as a coffee drinker I rarely have more than two cups per morning). By all means reduce your intakes of white bread and sugar. Stay away from high fructose corn syrup laden soft drinks! It is common knowledge that these lead to obesity, and obesity comes with its own set of health risks. But don’t do so-called diet drinks, either, as artificial sweeteners come with additional problems. Eat less salt. Steer clear of fast food, unless it’s a salad, and other junk food. And above all, don’t smoke!

Never forget, where food is concerned you’re invariably dealing with people who have their grubby paws out, waiting for your hard-earned cash. They don’t care about your health. They care about Making Money. It is up to you to assume full ownership of your health! That’s what Primary Prevention is all about!

Primary Prevention also involves exercise, whether for weight control or other purposes. Joining a health club or gym is optional but not required. Taking long walks is a form of exercise. Primary Prevention involves stress reduction (walking on back streets or roads is again very good for this; so are deep breathing exercises), getting enough sleep at night, establishing a routine for maximum productivity, and other things that, at first glance, might not seem to have much to do with health, but in fact do if your aim is a life that is all it can be: a life of wellness, or well-being that is more than a mere absence of illness.

Lest the preceding sound “new-agish” to some readers, getting right with God and maintaining a prayerful relationship with Him is, in my humble opinion, the ultimate stress reducer and potential maximizer of personal wellness.

Primary Preventive actions strengthens your body’s systems. We all learned about the ‘germ theory of disease’ as children, but “germs” are all around us. The point is for our systems to be able to resist the ones that make us sick. That’s called building up our immune systems. Proper nutrition, including sufficient quantities of vitamins, etc., helps accomplish this. As does avoiding risky behaviors of all kinds.

Little if any of this can be had in classrooms. Never forget, too: public education is not designed to truly educate but to socialize, to transform children and adolescents into mindless consumers and obedient sheeple. You must take charge of your health education.

Ask yourself: which is easier to control: an alert and healthy populace that practices all the above? Or a sickly, overweight, lethargic sheeple who have no idea about nutrition or how to read food labels and no incentive to learn? Which group Makes more Money for corporations, e.g., those which comprise Big Food (Monsanto, Tyson) and Big Pharma (Merck, etc.)?

A healthy population, moreover, does not need as many services from doctors, clinics, hospitals, and so on. A healthy population has fewer worries over who is insured and who isn’t.

All reasons why there is little real incentive for serious health education in a society based on mass consumption and control, where Money has become a surrogate for God.

To learn Primary Prevention is to begin to secede from the present-day health care system. To communicate Primary Prevention to one’s loved ones is to inspire them to say this, and to educate others in the benefits of health self-reliance.

In that case, what about the other two Levels of Health Care. At the risk of sounding anticlimactic:

Secondary Treatment is medical care in the familiar sense of going to the doctor and getting a diagnosis you hope is correct, prescription medicine you hope will work and not have nasty side effects, etc. Its purpose is to restore your body system to its previous state (health). Always remember: most likely your doctor has been taught only which drugs are most likely to “cure” what, and may know little or nothing about nutrition and Primary Prevention for the reason already stated: they don’t Make Money! Your best bet is to minimize your need for Secondary Treatment, and we’re back to Primary Prevention. Never forget: these days, for all the reasons stated above, your doctor is under tremendous pressure, including time constraints as he/she has to cram as many patients as possible into his workday.

I believe that if the present mess continues — if we do not scrap altogether the idea of a centralized health care payment system on the Obamacare model — we will see a shortage of doctors within the next ten years. That alone will make Secondary Treatment less of an option, and not an option at all if you’re in the boonies and can’t find a doctor to treat you!

Tertiary Care tries to establish new stability after a severe disruption — such as a stroke or a heart attack. My mother was a stroke recovery patient with partial paralysis on her right side, so I saw Tertiary Care first hand. I have encountered claims that strokes can be treated at the Secondary level and their damage reduced to almost nothing if it happens fast enough (within an hour or so). I have not investigated these claims, so I cannot vouch for their authenticity, but they are interesting. Since my parents lived in a rural area, this was not an option for my mom. Her Tertiary Care treatment involved blood-thinning drugs (again, there can be side effects), physical therapy, and speech therapy. Tertiary Care also involves family members: at the time, my father and myself: counseling, patience, fall prevention, how to maneuver a partially disabled elderly person into and out of bed, etc.

Tertiary Care is no fun. Hence it behooves us all to learn what might make it necessary, and we’re back to sound nutrition and other best Primary Prevention practices, as these will reduce your risk of heart disease or stroke later in life. It is important to realize that in real health education, we are discussing processes that exact their worst effects after long period of time. Hence to appreciate the value of Primary Prevention is to become a Long Term Thinker. You cannot live exclusively in the present. Indulge today, and you’ll pay the consequences tomorrow.

Educating the Three Levels of Health Care offers the only viable way out of our present morass. Has anyone noticed: there is not a word about actual health care in the (Un)Affordable Care Act? Of course not! Again: its purpose was not health care but about how it was to be paid for, and again who Makes Money! I’ve had economics-types tell me, The problem with Primary Prevention is, it doesn’t sell. If that’s the case, we can forget about ever again having a healthy population, and about stopping the advance toward a world government that answers to global corporations—including those which profit handsomely from people being sick!

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The alternative to bureaucratic, centralized systems — including anything similar that ends up intended to “replace” Obamacare — is to withdraw from them, to refuse to participate in them beyond the minimal requirements of the law. What you withdraw into are systems whose fundamental principle is self-reliance: educating one’s own and each other, as opposed to dependence on strangers with their hands out, or on the public education system.

Those who practice Primary Prevention will find their health care costs dropping to almost nothing. They won’t need insurance. They won’t need Medicare. The problems posed by our present health care nightmare can be made to go away only if the bureaucratic, centralized systems that created the nightmare are rendered obsolete!

2017 Steven Yates - All Rights Reserved

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Steven Yates is an independent scholar and author with a doctorate in philosophy. He is the author of the books Civil Wrongs: What Went Wrong With Affirmative Action (1994), Four Cardinal Errors: Reasons for Decline of the American Republic (2011), and the ebook Philosophy Is Not Dead (2014).

He is an expatriated American living in Santiago, Chile, with his wife (a Chileno) and their two cats, Bo and Princesa. He owns Final Draft Editing Service, which caters to Chilean academics needing editorial oversight with their English (although he accepts U.S. clients as well as clients from elsewhere); he and his wife are also starting a food preparation concern early this year.

He will be seeking a publisher for his first novel, to be entitled Reality 101, later this year, and is also at work on philosophical projects tentatively entitled The Fifth Stage of Civilization: After the Postmodern and Into the Future and A Christian Philosophy. He might also be building his own house soon. Do stay tuned!




Primary Prevention is everything you do to avoid getting sick, injured, etc. It draws on the adage that an ounce of prevention is worth a pound of cure. Primary Prevention involves learning about nutrition, including how to read food labels in stores.