Big food: the elephant in the living room

In his September 9 New York Times article, "Big Food vs. Big Insurance," Michael Pollan makes some interesting observations about why American health care is so expensive, and how reformed insurance companies may help to lower health-care costs. (If you haven't yet read Pollan's The Omnivore's Dilemma or In Defense of Food, this is the day to look for them at your library or bookstore.)

1. American obesity has a lot to do with American health-care costs. "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," Pollan writes. "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."

2. But "reforming the food system is politically even more difficult than reforming the health care system," Pollan notes. We Americans may hate the health insurance companies that deny us coverage, but we love our burgers and fries--and we heavily subsidize farmers who produce our now-omnipresent corn syrup. (If you wonder why we are so in love with food that is so bad for us, read David A. Kessler's The End of Overeating, or at least my review of it here.) "There’s lots of money to be made selling fast food and then treating the diseases that fast food causes," Pollan cynically observes.

3. A reformed health-insurance industry will almost surely put pressure on the powerful food lobby. When health insurers are required to accept everybody and keep everybody, they "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," Pollan believes. He writes:

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.

Wait a minute--why should Congress debate what I eat? Isn't my diet an individual choice?

Yes it is, but choice implies a set of options, and most of our options today--heavily subsidized by the U.S. government--involve too many sugars and fats, too few whole grains and fresh fruits and vegetables. What if Congress stopped propping up King Corn? Or what if it directed subsidies away from the foods that may make us sick and toward the foods that could keep us healthy? What if the most nutritious foods were also the cheapest?

Meanwhile, of course, it's a good idea to keep one's weight in the healthy range, even if doing so requires more time, more money, and more attention than we'd rather spend. One third of us do this already. If Pollan is right about insurance reforms, help for the other two thirds may be on the way.