Big Food vs. Big Insurance

By MICHAEL POLLAN
Published: September 9, 2009
Berkeley, Calif.

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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.  


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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Comments on: "Big Food vs. Big Insurance" (4)

  1. Excellent, excellent article! This is so important–really gets to the heart of what’s wrong in this country, and Michael Pollan is the bomb! Thanks for posting!

  2. I absolutely love this line:
    “The American way of eating has become the elephant in the room in the debate over health care”
    I think Pollan’s books should be read by everyone High School age and older. Here’s why: Once you understand a bit about the politics and economics of food and about the production of processed food, you realize how wacko our food system is and how manipulated you’ve been, and it becomes easier to make smart choices about food. When you move towards whole, natural and organic foods, I believe you move towards the path to recovery as well.

    A note about recovery: I recently read an article about actress Jenny McCarthy who “cured” her son of autism. She said he wasn’t cured really, but was recovering. She likened it to being hit by a bus and said you don’t get cured from being hit by a bus, you recover. I thought about Morgellons, and how so many folks are looking forward to the cure. If you are waiting for a cure, then you are probably very invested in finding the cause, and you are probably frustrated that they are not doing more to find one (I don’t know who “they” are supposed to be, and “they” don’t seem very interested anyhow.) If, on the other hand, you are of the mindset that you are working on recovery, then you are taking charge of your own destiny. Also, if you are angry and kickin around conspiracy theories, then you are at odds with the world and you can’t actually recover. I mean this literally; it is almost as if there is some physical mechanism that makes people with Morg paranoid, and yet this paranoia keeps you from recovering. We truly have to focus on love and light and healing (not cures–that’s different) in order to get better. We have to choose it daily–by what we read, who theories we subscribe to and our personal habits.

  3. sistertocommonsense said:

    Susan,
    You are very wise. We need to be proactive and calm down. I can not tell you how many I speak to who are screaming on the phone. I tell them “calm down” get off of the internet, stop looking for a magic bullet.
    I have gotten to the point where I will hang up the phone and give them time to cool down and when they are calmer they can call me back.
    It is getting to where I can not take all these phone calls and so I am now sending them to this safe harbor.
    Sister to Common Sense
    You are right about Jenny McCarthy, she became proactive and worked with diet with her son and has been very vocal against the use of vaccines on children.
    NO ONE Can make wise decisions in Panick Mode

  4. Hello Mr. Common Sense,

    I was directed to your web site by a patient. I find your site to be informative and well balanced, and I do appreciate your making reference to my site. If interested, you are welcomed to include one or more of my articles (as appearing in my site) in your site. I would suggest the one entitled “On the diagnosis and management of Neurocutaneous Syndrome, a toxicity disorder from dental sealants.” Let me know what you think. I will be out of the country from Wed. Sept. 16 to Wed. Dec. 30. Regards.

    Omar Amin

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