Is food system reform on the horizon?

Jack Rutherford

Michael Pollan’s recent editorial in the New York Times (Big Food vs. Big Insurance — 9/10/09) did more to galvanize my thinking on the relationship between the childhood obesity epidemic and health care reform than anything to date. In short, Pollan suggests that until food system reform figures into the national conversation about health care reform, the government will inadvertently continue to encourage America’s fast-food diet and thus fuel the obesity problem in this country. Pollan calls the American way of eating the elephant in the room in the debate over health care.

Let’s look at this connection. According to the Centers for Disease Control and Prevention, 75 percent of health care spending now goes to treating “preventable chronic diseases.” With the notable exception of smoking, many, if not most, of them are linked to diet. We currently spend $147 billion to treat obesity, $116 billion to treat diabetes, and many times more than that to treat cardiovascular disease and the many types of cancer that have been linked to the Western diet. A recent study estimated that one-third of the increase in health care spending over the past 20 years can be attributed to higher rates of obesity.

President and Mrs. Obama have alluded to food system reform recently; the President talked about putting a farmers’ market in front of the White House and Michelle Obama planted a vegetable garden on the South Lawn. The President has also floated the idea of taxing soda.

But thus far, food system reform has not been targeted in the conversation about health care reform. Why not? Pollan believes it’s because reforming the food industry is politically even more difficult than reforming the health care industry. At least in the health care battle, a large corporate segment of Fortune 500 companies have concluded that the current system is unsustainable.

Unfortunately for our nation’s waistline, cheap food will remain popular as long as the environmental and social costs of that food are charged to the future. As Pollan indicates, there’s lots of money to be made selling fast food and then treating the diseases that they cause. But the rules could change if, for the insurers, preventing chronic diseases became good for business. Imagine if health insurers were required to take everyone at the same rates and provide a standard level of coverage regardless of their health. There would be no more “pre-existing conditions” and no such thing as “underwriting.”

If that were to happen, health insurers would quickly realize that reducing rates of obesity and the accompanying chronic diseases linked to diet would become good for the bottom line. For example, a person with Type 2 diabetes costs more than $6,600 a year and more than $400,000 over a lifetime in health care costs. Suddenly, every can of soda or French fry would become a threat to future profits.

When health insurance companies are forced to absorb the cost of treating the collateral damage of the American diet, the movement to reform the food system will gain traction. They will represent a powerful ally, and everything from farm policy to school lunches could be affected. For example, our current system of farm subsidies makes fast food cheap and healthy food more expensive for consumers. The health insurance industry would then take on agribusiness in Congress in an effort to get legislation passed with the public’s health interests firmly in mind.

This could happen much in the same way that the health insurance industry ardently campaigned in the war against smoking.

Recently, a group of planners from M.I.T. and Columbia was asked by the foundation of the insurer UnitedHealthCare to develop an innovative systems approach to the battling the childhood obesity problem in America. Their idea was surprising; a “foodshed” — a diversified, regional food economy — could be the key to improving our nation’s diet.

This suggests that health care reform must be passed in order for us to take a first step towards food system reform. If it were to pass, it would force the industry and government to take a good look at the elephant in the room and take steps to slim it down.