by The New York Times
Big Food vs. Big Insurance
by Michael Pollan
To listen to President Obama's speech on Wednesday night, or to just
about anyone else in the health care debate, you would think that the
biggest problem with health care in America is the system itself -
perverse incentives, inefficiencies, unnecessary tests and procedures,
lack of competition, and greed.
No one disputes that the $2.3 trillion we devote to the health care
industry is often spent unwisely, but the fact that the United States
spends twice as much per person as most European countries on health care
can be substantially explained, as a study [1] released last month says,
by our being fatter. Even the most efficient health care system that the
administration could hope to devise would still confront a rising tide of
chronic disease linked to diet.
That's why our success in bringing health care costs under control
ultimately depends on whether Washington can summon the political will to
take on and reform a second, even more powerful industry: the food
industry.
According to the Centers for Disease Control and Prevention [2],
three-quarters of health care spending now goes to treat "preventable
chronic diseases." Not all of these diseases are linked to diet - there's
smoking, for instance - but many, if not most, of them are.
We're spending $147 billion [3] to treat obesity, $116 billion [4] to
treat diabetes, and hundreds of billions more to treat cardiovascular
disease and the many types of cancer that have been linked to the
so-called Western diet. One recent study [5] estimated that 30 percent of
the increase in health care spending over the past 20 years could be
attributed to the soaring rate of obesity, a condition that now accounts
for nearly a tenth of all spending on health care.
The American way of eating has become the elephant in the room in the
debate over health care. The president has made a few notable allusions
to it, and, by planting her vegetable garden on the South Lawn, Michelle
Obama has tried to focus our attention on it. Just last month, Mr. Obama
talked about putting a farmers' market in front of the White House, and
building new distribution networks to connect local farmers to public
schools so that student lunches might offer more fresh produce and fewer
Tater Tots. He's even floated the idea of taxing soda.
But so far, food system reform has not figured in the national
conversation about health care reform. And so the government is poised to
go on encouraging America's fast-food diet with its farm policies even as
it takes on added responsibilities for covering the medical costs of that
diet. To put it more bluntly, the government is putting itself in the
uncomfortable position of subsidizing both the costs of treating Type 2
diabetes and the consumption of high-fructose corn syrup.
Why the disconnect? Probably because reforming the food system is
politically even more difficult than reforming the health care system. At
least in the health care battle, the administration can count some
powerful corporate interests on its side - like the large segment of the
Fortune 500 that has concluded the current system is unsustainable.
That is hardly the case when it comes to challenging agribusiness. Cheap
food is going to be popular as long as the social and environmental costs
of that food are charged to the future. There's lots of money to be made
selling fast food and then treating the diseases that fast food causes.
One of the leading products of the American food industry has become
patients for the American health care industry.
The market for prescription drugs and medical devices to manage Type 2
diabetes, which the Centers for Disease Control estimates will afflict
one in three Americans born after 2000, is one of the brighter spots in
the American economy. As things stand, the health care industry finds it
more profitable to treat chronic diseases than to prevent them. There's
more money in amputating the limbs of diabetics than in counseling them
on diet and exercise.
As for the insurers, you would think preventing chronic diseases would be
good business, but, at least under the current rules, it's much better
business simply to keep patients at risk for chronic disease out of your
pool of customers, whether through lifetime caps on coverage or rules
against pre-existing conditions or by figuring out ways to toss patients
overboard when they become ill.
But these rules may well be about to change - and, when it comes to
reforming the American diet and food system, that step alone could be a
game changer. Even under the weaker versions of health care reform now on
offer, health insurers would be required to take everyone at the same
rates, provide a standard level of coverage and keep people on their
rolls regardless of their health. Terms like "pre-existing conditions"
and "underwriting" would vanish from the health insurance rulebook - and,
when they do, the relationship between the health insurance industry and
the food industry will undergo a sea change.
The moment these new rules take effect, health insurance companies will
promptly discover they have a powerful interest in reducing rates of
obesity and chronic diseases linked to diet. A patient with Type 2
diabetes incurs additional health care costs of more than $6,600 a year;
over a lifetime, that can come to more than $400,000. Insurers will
quickly figure out that every case of Type 2 diabetes they can prevent
adds $400,000 to their bottom line. Suddenly, every can of soda or Happy
Meal or chicken nugget on a school lunch menu will look like a threat to
future profits.
When health insurers can no longer evade much of the cost of treating the
collateral damage of the American diet, the movement to reform the food
system - everything from farm policy to food marketing and school lunches
- will acquire a powerful and wealthy ally, something it hasn't really
ever had before.
AGRIBUSINESS dominates the agriculture committees of Congress, and has
swatted away most efforts at reform. But what happens when the health
insurance industry realizes that our system of farm subsidies makes junk
food cheap, and fresh produce dear, and thus contributes to obesity and
Type 2 diabetes? It will promptly get involved in the fight over the farm
bill - which is to say, the industry will begin buying seats on those
agriculture committees and demanding that the next bill be written with
the interests of the public health more firmly in mind.
In the same way much of the health insurance industry threw its weight
behind the campaign against smoking, we can expect it to support, and
perhaps even help pay for, public education efforts like New York City's
bold new ad campaign [6] against drinking soda. At the moment, a federal
campaign to discourage the consumption of sweetened soft drinks is a
political nonstarter, but few things could do more to slow the rise of
Type 2 diabetes among adolescents than to reduce their soda consumption,
which represents 15 percent of their caloric intake.
That's why it's easy to imagine the industry throwing its weight behind a
soda tax. School lunch reform would become its cause, too, and in time
the industry would come to see that the development of regional food
systems, which make fresh produce more available and reduce dependence on
heavily processed food from far away, could help prevent chronic disease
and reduce their costs.
Recently a team of designers from M.I.T. and Columbia was asked by the
foundation of the insurer UnitedHealthcare to develop an innovative
systems approach to tackling childhood obesity in America. Their
conclusion surprised the designers as much as their sponsor: they
determined that promoting the concept of a "foodshed" - a diversified,
regional food economy - could be the key to improving the American diet.
All of which suggests that passing a health care reform bill, no matter
how ambitious, is only the first step in solving our health care crisis.
To keep from bankrupting ourselves, we will then have to get to work on
improving our health - which means going to work on the American way of
eating.
But even if we get a health care bill that does little more than require
insurers to cover everyone on the same basis, it could put us on that
course.
For it will force the industry, and the government, to take a good hard
look at the elephant in the room and galvanize a movement to slim it
down. 2009 The New York Times Michael Pollan is the author, most
recently, of In Defense of Food: An Eater's Manifesto [7]. His previous
book, The Omnivore's Dilemma: A Natural History of Four Meals [8] (2006),
was named one of the ten best books of 2006 by the New York Times and the
Washington Post. He is also the author of The Botany of Desire: A
Plant's-Eye View of the World [9] (2001); A Place of My Own [10] (1997);
and Second Nature [11] (1991). A contributing writer to the New York
Times Magazine, Pollan is the recipient of numerous journalistic awards,
including the James Beard Award for best magazine series in 2003 and the
Reuters-I.U.C.N. 2000 Global Award for Environmental Journalism. Pollan
served for many years as executive editor of Harper's Magazine and is now
the Knight Professor of Science and Environmental Journalism at UC
Berkeley [12].
Article printed from www.CommonDreams.org
URL to article: http://www.commondreams.org/view/2009/09/10
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