Low Hanging Fruit - With No Sugar Added
I believe that most issues in health should first be addressed through prevention, followed by finding and fixing root causes if necessary. And while it’s tremendously important to get everyone covered by insurance, the current focus on different definitions of “Medicare for All” presented by Democratic presidential candidates while Republicans cry “Socialism!” ignores an enormous yet addressable health crisis growing while we focus on payment systems. What if we could drop 10% - 15% of our nation’s total annual medical bill largely through lifestyle changes in one area alone? Shouldn’t we spend some energy on that? Consider:
· Health insurance is not health care. (We should probably call our system “disease care” – that’s where most of the money goes.) Private health insurance, often subsidized by employers, various government programs such as the VA for veterans or Medicare for elders (yes, that’s me), high-deductible catastrophic policies, self-insurance, relying on emergency rooms, and other approaches are all methods of paying for disease management and health services and products.
· We spend far more per capita than all other first-world countries to achieve mediocre-to-average results. Yes, we can point to great technology, drug development, leadership in treating uncommon diseases, and fantastic emergency and acute care, but most deaths now result from chronic issues. 40% of our adult population is obese, along with 18.5% of our children (Source: CDC Obesity Statistics), and 100 million – about 1 in 3 – have diabetes or pre-diabetes (CDC Report July 2017). Estimates of the annual economic cost of obesity-related diseases range from $147 billion to $210 billion; over 20% of our nation’s annual medical bill is spent on obesity.
The great nutritional experiment of the last 60+ years – no fat (especially saturated fat), eat more grains and other carbs, avoid meat, etc. - has very clearly not worked. We should not continue to repeat and subsidize this failed experiment as a matter of policy, hoping for different result, when a number of lifestyle changes have proven to be highly effective in reversing obesity and Type 2 diabetes.
Public policy should focus on this low-hanging fruit, attacking the obesity epidemic at its root. Just one example: we currently pour gas on this fire (maybe I should say ethanol…) through subsidies that make high fructose corn syrup inexpensive. We should allow it to float up to a market-based price and subsidize organic leafy green vegetables instead! And in the name of public health and lower healthcare costs, don’t forget some hefty taxes on added sugar, especially in drinks. (Did you know most of those lovely little juice boxes we give kids are packed with added sugar?) This revenue could support programs to help implement the often-difficult transition to a healthier lifestyle. Note that taxes on tobacco use have helped decrease cardiovascular disease and various cancers tremendously.
We surely waste billions with our payment systems and exclude tens of millions from access, but let’s also set a high priority on decreasing costs while making one-third of our population healthier.
What can we do? Here’s just one idea: support the Nutrition Coalition in their efforts to educate the public and influence policy to be based in science. Right now, the US Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) are jointly selecting 15 nutrition experts for the next panel to determine dietary guidelines for 2020 – 2025. The last panel was packed with biased advocates of nutritional belief systems (11 of 14 had published papers favoring a vegetarian diet). The result? The 2015 recommendations called for 7 – 8 servings of grains per day, 55% of calories from carbohydrates, and low-fat milk – for everyone. The guidelines not only inform the general public but end up in rules and regulations for the military, school lunch programs, hospitals and in myriad other places.
See the sample letter you can send to Secretary Perdue of the US Department of Agriculture on the Nutrition Coalition site here. And if you’d like to see my personal version, just send me an email and I’ll forward it to you. They are selecting the panel right now, so please act now if you are so inclined.
P.S. If you use Twitter, you can follow the dietary reform policy issue through the Nutrition Coalition here. And if you’d like to read an excellent short book on reforming our whole system that is not focused on insurance, get a copy of Chris Kresser’s Unconventional Medicine.