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Fwd: Big Food vs. Big Insurance

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  • Dr. Lapin
    I was astounded to look at the little newsletter my daughter brings home from school every month that shows the food offered by SFUSD. Frosted Flakes for
    Message 1 of 1 , Sep 11, 2009
      I was astounded to look at the little newsletter my daughter brings home from school every month that shows the food offered by SFUSD. Frosted Flakes for breakfast? It barely qualifies to be called food. And the lunches? Practically as bad. No fresh vegetables, or whole grains, which we know are the backbone of a healthy diet. How do we expect our children to learn if we give them junk food?

      Dr. Lapin

      Inicio del mensaje reenviado:

      Fecha: 11 de septiembre de 2009 6:45:59 p.m. PDT
      Asunto: Big Food vs. Big Insurance
      Responder a: moderator@...

      Big Food vs. Big Insurance

      Berkeley, Calif.
      September 10, 2009

      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 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, 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 to treat obesity, $116
      billion 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 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

      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 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.

      Michael Pollan, a contributing writer for The Times
      Magazine and a professor of journalism at the University
      of California, Berkeley, is the author of "In Defense of
      Food: An Eater's Manifesto."


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