Pollan on health care reform

Why forcing health insurance companies to stop denying coverage on the basis of chronic diseases or pre-existing conditions could help turn the tide on reforming the farm bill.

http://www.nytimes.com/2009/09/10/opinion/10pollan.html?pagewanted=1&_r=1&ref=opinion

Big Food vs. Big Insurance

By MICHAEL POLLAN
Published: September 9, 2009

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.

Vern

http://outlawvern.com/2009/09/09/bulworth/

Bulworth

Recently I was reading last month’s Rolling Stone article about the Democrats caving on all the meaningful parts of health care reform. It paints a convincing picture that if they give up on the public option then the plan won’t help much, could even make things worse, will hurt the Democrats politically and hurt the chances of real reform happening any time soon. I thought jesus, what is wrong with these people, we elected them for “change” and now the opportunity to do what we asked them to do makes them run around in a panic, peeing on the floor like a dog on the 4th of July. (Another American reference for you there.) Are they really all in the pocket of insurance companies? They have the majority, they have the majority of the people. You really worried those dumb fuckers at the town hall meetings are gonna be mad if you give them cheaper health coverage? I don’t think that’s worth losing sleep over.

You flash back to a few years ago when the Republicans controlled everything, had everything they wanted, including two wars and all kinds of rampant butt play in their overseas prisons, and still saw themselves as victims. They overplayed their hand. The Democrats are doing the opposite, they have the chance to do something great for their country and their children and grandchildren, they would rather do nothing at all. They’re folding their cards too early. Fuck you motherfuckers. Why can’t somebody cut the shit and stand up for what is obviously right?

mp_bulworthAll that was on my mind but also I had recently watched SOUL MAN so my solution was to watch another well-meaning but racially questionable satire, BULWORTH. Starring and written and directed by Warren Beatty, BULWORTH speaks to alot of this anger I have, but it does it in a way that makes me cringe. And I don’t think this is supposed to be uncomfortable comedy like THE OFFICE or something.

Beatty plays Senator Jay Bulworth, a Democrat who’s on the eve of his re-election campaign and hasn’t eaten or slept in days. When an insurance lobbyist (Paul Sorvino, KNOCK OFF) bribes him to kill a reform bill, Bulworth takes out a huge life insurance policy and hires an assassin to kill himself. He’s stressed and has nothing to lose so he just starts Telling It Like It Is at his campaign stops. For example at a black church he tells them that the Democratic Party doesn’t care about them because what are they gonna do, vote Republican? At a Hollywood industry party he says “my people aren’t stupid, they always put the big Jews on the schedule,” then starts flipping through his notes saying, “They must’ve put something bad about Farrakhan in here somewhere.”

bulworthIn South Central two young (very stereotypical) black women are so impressed by his candid statements that they volunteer for him, which means they follow him around cheering him on, snapping at people and gossiping. He goes to a club with them and, unfortunately, learns about rapping. And starts doing it. Throughout the rest of the movie.

Most of the ideas behind the movie are admirable, and there are other things I like about it, which I’ll get into. But there is no way to get around the rapping. He freestyles horrible nursery rhyme type lyrics and says them slowly, syllable by syllable, in a bizarre style that’s part out-of-touch-white-guy-attempting-to-co-opt-what-he-believes-to-be-black-slang, part speech impediment. He makes Vanilla Ice seem like Rakim or Slick Rick.

Late in the movie, after Bulworth rhymes to Don Cheadle and a gang of underage crack dealers in South Central, one of the kids asks, “Is that how white people rap?” It’s the movie’s only acknowledgment that he’s horrible at it. I mean, I never thought we were supposed to think he was good, but his entourage acts like he is, and nobody ever cringes or runs away like you want to do at home watching the fucking thing. The main joke, definitely, is that all these stuffy white people have to hear rap, and listen to The Truth from this guy, who by the way is on a spiritual quest assigned to him by a homeless street preacher played by the controversial poet Amiri Baraka.

But I guess if you look at ISHTAR (to be honest I’ve never seen the whole thing) it’s clear that Beatty finds something really funny in people performing awful songs. Still, I’m not sure he understands just how painful it is to watch this one.

I remember I read somewhere that Warren Beatty was hanging out with Suge Knight when he made this movie, as research. But I’m not sure he found the authenticity he was looking for. He kind of makes it seem like most black people are selling crack or working for crime lords, but have the potential to do good if only they would decide to get it together. Perhaps when nudged to do so by a white politician. And it’s a little painful to see Halle Berry trying to act “street,” saying “yo” and acting tough. She does look good with dreadlocks though. I can see why Bulworth goes for her. I would think the rapping would actually be a dealbreaker though. This was before Eminem raised people’s standards for white rappers, but I still don’t think anybody is gonna forgive how this guy raps. I sure won’t. Ever. Never forget.

What I do like about the movie is that it comes from a left wing point of view but criticizes the Democratic party as compromised and sold out. From my point of view most Democrats are too centrist, but the mainstream media usually doesn’t acknowledge that point of view. They offer Democrats as the furthest left you can get without being a communist (or sometimes they consider them actually to be communists). Senator Bulworth has sold out his values, promoting himself as more conservative to try to get votes. With Halle Berry he talks reverantly about the Black Panthers, but on TV he complains about welfare being “out of control.”

Usually in a political movie you’re either gonna have one side as the good guys and one side bad, or all politicians bad. In this one Republicans don’t even really figure into it. It’s not about the right wing at all. The blame is on the Democrats, arguing that they are the ones who believe in health care as a right, they’re the ones that should be doing something about it, but they never do because they’re more worried about campaign money than about their constituents and their country and the human race and things that are good. And that’s why BULWORTH is relevant now (despite the rapping), because we have the same thing going on now. Republicans just want to stop health care reform because they want to make Obama look bad, and as a bonus they get to cause the deaths of many poor people, which is a hobby many of them enjoy. But it’s not in their court, it’s up to the Democrats. They could and should do it and would do it if they weren’t mostly a bunch of dumb assholes.

The opening scene is actually a really good one. It’s a montage of Bulworth in his office watching all the different variations on his new TV spots, repeating the same bullshit about welfare and “the new millennium.” And then he just starts to cry. It’s a really effective scene because the commercials seem pretty real and you just have to hear the same phrases over and over and over, not only showing you what empty slogans they are but showing you how he must feel having to say the same shit every time. He just feels like a phony. Because he is a phony.

Believe it or not the movie is scored by the great Ennio Morricone. But then it also uses some great hip hop songs like “100 Miles and Runnin’” by NWA and “The N**** You Love To Hate” by Ice Cube. It’s a bizarre combination, but strangely appropriate. When I reviewed ORCA a few months ago I talked about how Morricone’s music seemed to infuse the whole thing with depth, make it seem profound and poetic. Here’s an even better example of how fucking good the guy is. At the end, Bulworth embraces gorgeous young Halle Berry. As a viewer I’m still thinking this movie is ridiculous and what the fuck would she see in him and no way would this ever happen and neither of them (especially her) are particularly three-dimensional characters, but somehow, with the music, it seems kind of touching, like we have watched these two teetering on the edge of falling in love and invested ourselves in them and now we are relieved to finally see it coming to fruition. Completely unearned by the movie, but collected in full by Morricone.

And the end credits are really cool – a suite of Morricone music with hip hop songs by Ol’ Dirty Bastard and others occasionally fading in and playing for a bit and then drifting away as the orchestra continues.

Yeah, I guess I mainly just like the opening scene and the end credits.

Djokovic v. McEnroe: How can you not love this?

I almost feel bad about all those times I called him Quitter or Chokovic.

Were The Sex Pistols the first modern hipsters?

First read this article in Adbusters entitled "Hipster: The Dead End of Civilization." I think it adequately sums up why hipsters are a bad thing and indirectly explains the difference between a true hipster and somebody who merely subscribes to modern fashions and wears tight pants. To summarize, it comes down to hipsters standing for nothing really except seeking authenticity through consumerism. Co-opting working class values and trends and spending lots of money doing it.

A lot of quote-unquote hipsters are really just artsy people who do cool things like sell street food in The Mission or make swimming pools out of dumpsters in Brooklyn. These people are not actually hipsters in my eyes. They are doing something and creating interesting things rather than buying something obscure and then ditching it when it isn't obscure or authentic enough for them anymore.

Again, great article, but I disagree with it where it draws a bright line between hipsters and punks...which brings me to the penultimate punk band, The Sex Pistols.

They declared their allegiance to the working classes and held mainstream society in contempt but really I think it's pretty safe to say they were just intellectually retarded nihilists consumed with image, self-indulgence and popularity. Sound familiar?

Sid Vicious was chosen for his attitude rather than his musical ability and they ended up becoming just as vacuous and rich as the ruling classes and cliched rockers they claimed to abhor.

Punk was sort of an interesting counter-culture moment and I see the value in bands like The Ramones and The Clash. I like the do-it-yourself attitude and the quesitoning of authority, but check out this quote from Johnny Rotten: "[The Ramones] were all long-haired and of no interest to me. I didn't like their image, what they stood for, or anything about them; They were hilarious but you can only go so far with 'duh-dur-dur-duh'. I've heard it. Next. Move on."

Newsflash...The Ramones were developing your sound while you were busy tearing holes in your Pink Floyd shirts and spending money on hair gel and red dye. Get over yourselves. Who cares how long their hair was?

Also, The Pistols (and pretty much all punks and hipsters) constantly talked about how much they hated hippies. The punk-hippie dichotomy really deserves to be explored fully in another post, but when you come down to it, they really weren't that different. The main difference I see is that at least hippies were trying to do something and change the world* while punks were consumed more with rebelling for the sake of rebelling and were ultimately a much more selfish group of blowhards. It's the same difference between a hiptser and somebody who isn't utterly worthless.

*That they failed and ended up becoming the big wigs they were rebelling against is irrelevant to me. At least they initially stood for something.

Wow

America's unjust DUI laws

Though the number of unjust laws in this country is staggering, the Economist zeroed in on one area recently and took on our Draconian sex offender laws. That's right, The Economist. This isn't coming from High Times or Harper's or Hustler or even the "liberal" (as right-wingers see it) New York Times. This is from a magazine that opposed the provision of aid to the Irish during the Great Famine.


The magazine makes a great point that the system lumps all "sex" offenders together and makes it harder to differentiate who the truly dangerous deviants are.

According to Human Rights Watch, at least five states require registration for people who visit prostitutes, 29 require it for consensual sex between young teenagers and 32 require it for indecent exposure. Some prosecutors are now stretching the definition of “distributing child pornography” to include teens who text half-naked photos of themselves to their friends.

The Economist argues that watering down the sex offender registry makes it actually less effective in preventing child abuse. And the registry will most likely only continue to become further watered down because politicians will only continue to make the laws tougher and tougher in order to not appear soft on crime.

Few politicians dare to vote against such laws, [let alone propose to reduce the harsh penalties] because if they do, the attack ads practically write themselves.

This article seems to sum up about sex crimes what I have been thinking for a while now about drinking and driving laws.

It seems that our society insists on gravitating further and further back to the time of The Scarlet Letter. I wouldn't be surprised if sex offenders have to start identifying themselves with some sort of giant S on their clothing (we're almost there with their houses), nor would it shock me if people convicted of DUI soon have to brandish their car with some sort of giant warning. Many already have conspicuous breathalyzer boxes in the cars. Why not require giant pizza delivery-esque glowing signs that say "Hey, I like to drive drunk!"?

To be certain, driving drunk (and the key word is "drunk") and committing sex crimes are terrible acts that deserve to be punished. So many families have been permanently damaged by the stupid and often selfish acts of men and women who took their lives and the lives of other people on the road for granted when they tried to make it home after a serious bender.

I belive to correct this problem, it's not as simple as make the penalties increasingly harsher and make the threshold lower to prosecute. Laws of this type should be more about protecting the public and less about generating revenue for the state or allowing the politician to appear for photo ops and generate material for his reelection campaign TV ads.

As usual, the politicians have missed the mark on how to truly benefit the most people. According to MADD, "In 2002, 2.3% of Americans 18 and older surveyed reported alcohol-impaired driving, compared with only 2.1% in 1997." So as the penalties were getting stiffer and the threshold BAC has been reduced to where people can have only a couple drinks be over the limit, drunk driving has not really decreased at all. One study has suggested that lowering the BAC has had an ambiguous effect at best. The bottom line is that people are still getting behind the wheel and people are still dying from alcohol-related crashes. And if 2.3 percent is the number reported, then there are lots and lots of people who are also lying on their drinking and driving surveys.

So how many ways has the government tried to reduce the deadly effects of drunk driving on our society other than increasing the penalties and generating more revenue and political capital for campaign ads? If you ask me, the answer is zero unless you count meaningless public service announcements.

Aside from the most progressive of cities, how many places actually try to get cars off the road? To me, if you want to curb drunk driving, you have to get people to focus more on the driving part than the drinking part of the equation. Build more public transportation, encourage urban planning that allows for more walking or taxi rides, partially pay for people's taxi rides after midnight, instruct police officers to do more than lie in wait to nab drunk drivers and get them to proactively assist intoxicated people make it home without driving.

People who drink lots alcohol generate tremendous amounts of tax dollars for cities and help keep urban districts alive. It's hard to imagine a thriving city center where there were no bars or nightclubs. Drinkers deserve to be treated with more respect than gotcha policing and thousands of dollars in fines and legal costs and mandatory education. They also deserve more options than compete with the rest of the drunken hoards for an expensive taxi, find a sober driver to hang out in a loud and crowded bar all night, walk until dawn, or drive drunk.

I repeat, drunk driving is a terrible burden on public safety, but so is text messaging and talking on a cell phone while driving. Some studies have suggested texting is even more dangerous than drunk driving. But do you see texters losing their licenses for a year and having big black boxes installed in their cars to breathe in? When it comes to oncoming traffic, I would much rather see a responsible driver heading home after two or three drinks than somebody with his/her face in a Blackberry.

It's time to start examining our laws and what roles they really play in making society a better place*. Big problems need creative solutions, not the same old dog and pony shows that politicians have been using to get reelected for centuries. Let's stop treating streakers like child murderers and let's stop treating buzzed drivers like involuntary manslaughterists.



*I'll save drug laws for another blog post.

[Mostly] Spot-on San Francisco Take

Sorry for the lack of posting. I wish I could say that I've had better things to do than to transcribe my ramblings, but the truth is that I've caught a raging case of the lazies when it comes to writing.

To tide all three of you over, here are Anthony Bourdain's thoughts on my current home. For the most part, I think he does an excellent job of describing it. Tune into the Travel Channel tonight to see the SF No Reservations.

I'm Not Angry
By Anthony Bourdain on August 9, 2009 11:57 AM Permalink

Let me come right out and say it. I love San Francisco. I am helpless and unwavering in my affection--in spite of every effort over the years to find fault, to dismiss, to sneer. And there's surely lots to sneer at, San Francisco and the Bay being pretty much the epicenter of so many of my most cherished aversions: political correctness, veganism, rich hippies, sanctimoniousness about food, food fetishism, animal rights terrorists, gastro-dogma, and loud locavores who actually get their produce flown in from Chino Farms in San Diego.

But at this point, I bore even myself railing against the above. Hell, I'm not even bitter about San Francisco taking the lead in banning smoking anymore. They won that battle long ago. Game over.

I guess it's like any love that's true--sooner or later you learn to accept the good, bad and silly all together. It's all part of the package when you know, without any question, that you want the package. It doesn't even matter if one's love is returned.

Okay ... it does still drive me berserko watching a blissed out St. Alice, burning up a few cords of firewood (in Berkeley no less!) to cook two eggs for an unusually credulous Lesley Stahl.

But in general, I got it all wrong, didn't I?

It may be the town of Alice Waters but it's also home to Dirty Harry. The Grateful Dead? Yes. But also the Dead Kennedys. The excrutiating and treacherous lite FM sounds of the Jefferson Starship? True enough. But also Blue Cheer, the Count Five, Big Brother, Sly and Family Stone and the greatest band that never was: the Brian Jonestown Massacre. None of these entities could have come from--or taken root--anywhere else.

I don't think you could have one San Francisco without the other. If the San Francisco area weren't the perceived headquarters of anti-foie gras forces, I doubt very much there'd be an opposing force doing something as crazy as developing a foie gras vodka. I don't know that a less crunchy community would require a stuck-joyously-in-time museum of beef like House of Prime Rib. It's like a yin and yang thing ... a balance, man, one thing creates a need for another.

San Francisco, underneath a gossamer thin veneer of granola is in fact, a two-fisted drinking town, a place of oversized martinis, silver zeppelins overloaded with bleeding slabs of meat, restaurants you could call "institutions" that defiantly refuse to suck, and in an ever tidier, cleaner, Disneyfied world--where even New York's Times Square looks like a theme park, still, a delightfully nasty, dirty, beautiful, carnivorous, vice-filled town.

And you can, apparently, recklessly careen around town at high speed in a rented Mustang (from whom we received, by the way, absolutely no money, consideration or thing of value), shooting guerilla-style, possibly without appropriate permits or safety precautions--and the local constabulary can be remarkably understanding. I doubt they would have been as tolerant of the impromptu filming of a car chase where I'm from.

Oh ... and I'd like to mention that though Swan Oyster Depot does not appear in the show (because we shot a segment there for the previous series), I ate there almost every day while shooting in town. Mopping fat and roe out of those Dungeness crab backs with sourdough bread and washing it down with a cold beer? Perfect happiness.

Pollan on the decline of cooking

Great essay in the New York Times from Michael Pollan on everything from how cooking has become a spectator sport to the new movie "Julie and Julia" to how a return to cooking could save your health. Like everything that Pollan has ever written, I highly recommend you set aside 20 minutes or so and take your time digesting what he has to say.

Ruhlman's post about Pollan's essay also makes a great point about the distinction between cooks and foodies, which is really quite a large distinction.

Nothing else really needs to be said. Read this stuff because it's a lot better than anything I've ever written. I'm not kidding, damn it. Read it.