Pollan: American way of eating is elephant in room in health care debate

[Guest guest]

September 10, 2009

OP-ED CONTRIBUTOR

Big Food vs. Big Insurance

By MICHAEL POLLAN

Berkeley, Calif.

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 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

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. "

http://www.nytimes.com/2009/09/10/opinion/10pollan.html