8 ms·

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. The argument I've heard smarter, better informed peop

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. The argument I've heard smarter, better informed people than me make is: If healthcare were nationalized, it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. When the government subsidizes farming corn on a massive scale, and all these corn-derived products make people obese and give them diabetes, it becomes counter to the government's own goals if its charter includes providing affordable healthcare to all. If we don't stop subsidizing liquid sugar, it'll continue finding its way into everything possible. What kills me is people proposing taxing products w/added sugar... talk about the American way; spend people's tax dollars on subsidies producing the sugar, then tax them again for consuming the thing you made cheap with their taxes! smh

DoreenMichele 6y ago
My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. That's only one factor. Another is car dependence and lack of pedestrian-friendly built environments. There is a lot of research on just how much harm it does us to sit all day, every day. We sit in a car to make a long commute to work. We sit our desks. We sit in the car again. And hitting the gym occasionally doesn't fully compensate for living like that. Urban planners used to configure cities to help promote physical health and we don't do enough of that anymore. It's nigh impossible to escape a sick outcome when trapped in a sick system that makes healthy choices largely out of reach for most people.
- qserasera 6y ago
  Our metabolism increase from walking 5-15 minutes every day is significant. With individual car transportation there is little want or little ability to do so. Many schedules do not allow for daily 60 minute exercise routines at the gym which take 10-15 min to get there by car. Every day US citizens waste hours life with transportation. I do believe in cars but I also believe we need to reshape how we live. If the US government allows our time to be wasted repeatedly by a variety of lobbies building infrastructure for a variety of interests it shows how little our leadership values the time of our citizens. I almost find it more egregious that government wants to waste the time of our citizens than wanting to eventually kill ourselves with emissions. The US currently has an oversupply of labour and I suggest the US does something with it to reshape infrastructure to be less energy reliant. The world should look into outfit and create houses with manditory natural cooling/heating, increase density in cities and towns to reduce habitat distruction and sprawl, reduce emissions of high GWP chemicals, and create a global political situation to reduce reliance on a failing economic system that incentivizes people to hide pandemics.
  - u801e 6y ago
    > Many schedules do not allow for daily 60 minute exercise routines at the gym which take 10-15 min to get there by car. You can get that 60 minutes of exercise/physical activity if the transportation to various destinations is changed into a form of exercise for all or some part of it. In the case of a bicycle, it does require that destinations are less than 10 miles (16 kilometers) away, otherwise it would take too much time.
cortesoft 6y ago
I think you are misunderstanding the incentives that drive politicians if you think extra health care costs would make them change their subsidy policy. They subsidize because the recipients are powerful donors who want them. It isn’t because it is sound fiscal policy.
- roenxi 6y ago
  Adding to this; there is also no evidence that the US's politicians care about financial incentives as applied to the US government. If it affects them personally then they'd jump like a cat on a stove; but if it only affects the budget they aren't going to respond to any incentive. If the US was being influenced by financial incentives it wouldn't be doing many of the things it does. Like tax cuts or spending more money.
  - neutronman 6y ago
    The monetary policy of the USA is insane these days. Tax cut and spend is here for the moment. Taxes will go up but so will spending...
- Aeolun 6y ago
  Then fix that? Powerful donors should not exist.
- MattGaiser 6y ago
  Yes, because cheap food is not something that would otherwise interest lots of people... Increasing corn production also does not play to a crucial constituency in the Presidential elections... This obsession with “rich donors” ignores that voters will also get mad at politicians for the consequences of eliminating those subsidies.
  - jyounker 6y ago
    The smaller your donor base, the fewer people you have to make happy. My personal belief is that this is why income inequality is inversely correlated with democratic representation.
briandear 6y ago
> it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. It would also incentivize the government to restrict all manor of activities in the name of “health.” Want to go rock climbing? Pay a tax. Want to ride a motorcycle? Pay a tax. Want ice cream after a hard running workout? Pay a tax. Don’t exercise enough? Pay another tax. Allowing the government “incentives” creates incentives for the government to restrict the risk management autonomy of citizens. And “liquid sugar” isn’t a problem. People choosing to consume too much of it is. I am perfectly healthy, normal weight, plenty of exercise and I like to drink Coke. Should I have to pay a tax or higher prices because some fat-ass makes the choice to drink it like water? Perhaps instead of taxing food, we instead tax obesity. Put the responsibility on the individual.
- NicoJuicy 6y ago
  > Perhaps instead of taxing food, we instead tax obesity. Put the responsibility on the individual. You probably have better genes than my family. Lookup endomorph body type or reasons of reduced metabolism. Evolution has inversed survival of the fattest, so it seems ;)
  - mlavin 6y ago
    >endomorph body type Somatypes are an ancient pseudoscience, while caloric intake relative to TDEE doesn't lie.
    - msla 6y ago
      Think it through a bit more: If obesity were taxed, there would be pressure to put loopholes in those taxes. Somatypes and "thrifty genome" and so on would be perfect hooks to hang those loopholes on. Result? Questioning that science becomes politically untenable, at least in some universities and research labs. After all, "the grants just follow the illiction returns", as the poet once said: https://www.thecrimson.com/article/1987/9/29/borking-up-the-wrong-tree-pbtbhe/ https://www.thecrimson.com/article/1987/9/29/borking-up-the-...
    - 6y ago
ArkVark 6y ago
Cut out the middleman - fund national healthcare directly with a tax on air pollution and sugar. The idea that nationalized healthcare (paid for by the middle class) will encourage politicians to tax the unhealthy food of the lower classes is fantasy - this has not manifest itself in other Western countries which do have nationalized healthcare systems.
evan_ 6y ago
What if the money collected for the theoretical tax on sugar-containing products went directly to subsidize the sugar producers? Then again just ditching the subsidies would get the same thing done with less paperwork...
- deleted 6y ago
  [deleted]
pm90 6y ago
Growing food and subsidizing farmers that produce food is more for the National Security angle: without enough food, there will be rapid social instability and riots and a complete breakdown of society. It’s absolutely essential to produce much more food than can be possibly required by the populace.
- frank2 6y ago
  True in general (well, except your final sentence), but the topic is the US, which has never failed to produce enough food to feed its population and is unlikely to to start failing now.
  - pm90 6y ago
    It doesn’t produce that food magically. A certain section of society needs to be dedicated to growing food and supported with subsidies if they can’t grow food economically.
    - frank2 6y ago
      Even in the absence of government subsidies, the US probably would'nt've experienced a shortage of food. I'm not saying that it is impossible for the US to experience a food shortage or even that smart people in and out of government shouldn't worry about that eventuality. I am saying that current and past US programs to subsidize farmers probably do not do / have not done much to reduce that risk and that most of the group collectively deciding to continue the subsidies probably know or strongly suspect that. In my experience, the elected representatives and other influencers arguing for the subsidies don't even use food security as an argument. (Again, like others in the thread, I am restricting myself to US food policy.) Instead, they argue that the family farm is a producer of particularly virtuous individuals, and it would be a shame if all the family farms were to be driven out of business by large corporations. The US Midwest has the largest tract of arable land in the world and twice as large as the second largest. If the people of the world were redistributed among the countries so as to equalize the probability of famine among the countries, the US would probably end up with a population over a billion.
baix777 6y ago
Canada is similar to the US in terms of food consumption, and yet Canada has much better health care outcomes and lower health care expenditures. I'm not saying food isn't a factor, I'm just wondering how big a factor it is compared to universal access to health care.
- bluedino 6y ago
  It’s the food. The USA has 40% obesity rate vs 15% of Canada. We just eat more here, and we eat more garbage. Funny enough, if you chopped off the fattest 5-6 states, the USA would compare more favorably.
  - Aeolun 6y ago
    Anecdotally, coming to the US from Europe/Japan. The food there is ridiculously fat/large. At least as long as you want to spend less than $30/meal.
  - nolangerner 6y ago
    Where are you getting your numbers? Canada is at ~29% and the US is at ~36%. Sources: https://en.wikipedia.org/wiki/List_of_countries_by_obesity_rate https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r... https://ourworldindata.org/obesity https://ourworldindata.org/obesity https://worldpopulationreview.com/country-rankings/obesity-rates-by-country https://worldpopulationreview.com/country-rankings/obesity-r...
    - knubie 6y ago
      That's interesting, the CDC lists 42.4% for the US. https://www.cdc.gov/obesity/data/adult.html https://www.cdc.gov/obesity/data/adult.html
  - kevin_thibedeau 6y ago
    Or it's not the food and people have just adopted a lifestyle where all energy expenditure is minimized. That is self evident in social behavior. Your theory is just an easily trotted out bogeyman.
wisty 6y ago
The US government already spends an absolutely incredible amount of healthcare, comparable to Canada or the UK (per capita). Medicare (old people), Medicaid (poor people) and VA, funds for people who don't pay emergency rooms. It's actually a huge amount of total spending, and while the government gets discounts (like health insurers) it's not radically more efficient. The problem is, I think, often one of over-treatment. If hospitals are paid per procedure (as they are in the US) they are encouraged to do procedures that are actually bad for patients. Insurers can try to reign in over-treatment (to the horror of people who think that more healthcare is always a good thing), but regulators and customers (and activists) fear they do so targeting costs, not patient outcomes. It's all just a mess. Here's a few issues: * Over-testing is the most innocuous problem, but even tests aren't "free". At best, it's annoying and makes you not want to go back to see the doctor unless you know it's urgent (especially if it's costing you money or time). Tests might also the emphasis away from immediate treatments (both things that the doctor can do, and things the patient needs to do) as it becomes more of a "wait and see" game. * Drugs. Obviously they cost money, and they can have side effects. Over-prescription is widely recognised as a major issue. * Cesareans when they're a bad idea. * Heart surgery when it's a bad idea. * Aggressive treatment (especially of cancer) that statistically decreases the quality-adjusted life years a patient has, but hey you have to do something right? I could go on, but there's really a ton of things where a hospital should do nothing, but has a lot of pressure (from patients and profit motives) to act. While insurers can try to control this, I think it goes without saying that they're also not entirely the good guys, and giving them too much power to reject treatments is also a bit worrying. Confrontational systems might work in the legal system, but it's too slow and expensive to work in healthcare. Let's look at the special interests the US has (it's not just corn syrup!): * Caps on doctor training spots. Obviously this is not unique to the US, but a free market solution is hardly going to work when you cap supply. * Existing players (insurers, hospitals) want high overhead (regulations, admin) to create a moat. * Drug companies in the US want high drug prices. Australia will subsidise drugs, but only if the drugs are priced right (which creates an incentive for companies to offer deep discounts in Australia). In the US, this kind of bargaining doesn't happen to the same degree. People online keep telling me that the spending on drugs is good though, because it's driving research (it's fine with me if Americans want to spend all their money subsidising the rest of the world).
mensetmanusman 6y ago
It doesn’t matter what you eat if you don’t move your body. People have to realize that the wealth America gained post WW2 was poured into making life comfortable and easy (institutionally and economically). This had the unintended consequence of making Americans (on average) some of the unhealthiest humans in the world.

DoreenMichele 6y ago

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. That's only one factor. Another is car dependence and lack of pedestrian-friendly built environments. There is a lot of research on just how much harm it does us to sit all day, every day. We sit in a car to make a long commute to work. We sit our desks. We sit in the car again. And hitting the gym occasionally doesn't fully compensate for living like that. Urban planners used to configure cities to help promote physical health and we don't do enough of that anymore. It's nigh impossible to escape a sick outcome when trapped in a sick system that makes healthy choices largely out of reach for most people.

qserasera 6y ago
Our metabolism increase from walking 5-15 minutes every day is significant. With individual car transportation there is little want or little ability to do so. Many schedules do not allow for daily 60 minute exercise routines at the gym which take 10-15 min to get there by car. Every day US citizens waste hours life with transportation. I do believe in cars but I also believe we need to reshape how we live. If the US government allows our time to be wasted repeatedly by a variety of lobbies building infrastructure for a variety of interests it shows how little our leadership values the time of our citizens. I almost find it more egregious that government wants to waste the time of our citizens than wanting to eventually kill ourselves with emissions. The US currently has an oversupply of labour and I suggest the US does something with it to reshape infrastructure to be less energy reliant. The world should look into outfit and create houses with manditory natural cooling/heating, increase density in cities and towns to reduce habitat distruction and sprawl, reduce emissions of high GWP chemicals, and create a global political situation to reduce reliance on a failing economic system that incentivizes people to hide pandemics.
- u801e 6y ago
  > Many schedules do not allow for daily 60 minute exercise routines at the gym which take 10-15 min to get there by car. You can get that 60 minutes of exercise/physical activity if the transportation to various destinations is changed into a form of exercise for all or some part of it. In the case of a bicycle, it does require that destinations are less than 10 miles (16 kilometers) away, otherwise it would take too much time.

cortesoft 6y ago

I think you are misunderstanding the incentives that drive politicians if you think extra health care costs would make them change their subsidy policy. They subsidize because the recipients are powerful donors who want them. It isn’t because it is sound fiscal policy.

roenxi 6y ago
Adding to this; there is also no evidence that the US's politicians care about financial incentives as applied to the US government. If it affects them personally then they'd jump like a cat on a stove; but if it only affects the budget they aren't going to respond to any incentive. If the US was being influenced by financial incentives it wouldn't be doing many of the things it does. Like tax cuts or spending more money.
- neutronman 6y ago
  The monetary policy of the USA is insane these days. Tax cut and spend is here for the moment. Taxes will go up but so will spending...
Aeolun 6y ago
Then fix that? Powerful donors should not exist.
MattGaiser 6y ago
Yes, because cheap food is not something that would otherwise interest lots of people... Increasing corn production also does not play to a crucial constituency in the Presidential elections... This obsession with “rich donors” ignores that voters will also get mad at politicians for the consequences of eliminating those subsidies.
- jyounker 6y ago
  The smaller your donor base, the fewer people you have to make happy. My personal belief is that this is why income inequality is inversely correlated with democratic representation.

briandear 6y ago

> it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. It would also incentivize the government to restrict all manor of activities in the name of “health.” Want to go rock climbing? Pay a tax. Want to ride a motorcycle? Pay a tax. Want ice cream after a hard running workout? Pay a tax. Don’t exercise enough? Pay another tax. Allowing the government “incentives” creates incentives for the government to restrict the risk management autonomy of citizens. And “liquid sugar” isn’t a problem. People choosing to consume too much of it is. I am perfectly healthy, normal weight, plenty of exercise and I like to drink Coke. Should I have to pay a tax or higher prices because some fat-ass makes the choice to drink it like water? Perhaps instead of taxing food, we instead tax obesity. Put the responsibility on the individual.

NicoJuicy 6y ago
> Perhaps instead of taxing food, we instead tax obesity. Put the responsibility on the individual. You probably have better genes than my family. Lookup endomorph body type or reasons of reduced metabolism. Evolution has inversed survival of the fattest, so it seems ;)
- mlavin 6y ago
  >endomorph body type Somatypes are an ancient pseudoscience, while caloric intake relative to TDEE doesn't lie.
  - msla 6y ago
    Think it through a bit more: If obesity were taxed, there would be pressure to put loopholes in those taxes. Somatypes and "thrifty genome" and so on would be perfect hooks to hang those loopholes on. Result? Questioning that science becomes politically untenable, at least in some universities and research labs. After all, "the grants just follow the illiction returns", as the poet once said: https://www.thecrimson.com/article/1987/9/29/borking-up-the-wrong-tree-pbtbhe/ https://www.thecrimson.com/article/1987/9/29/borking-up-the-...
  - 6y ago

ArkVark 6y ago

Cut out the middleman - fund national healthcare directly with a tax on air pollution and sugar. The idea that nationalized healthcare (paid for by the middle class) will encourage politicians to tax the unhealthy food of the lower classes is fantasy - this has not manifest itself in other Western countries which do have nationalized healthcare systems.

evan_ 6y ago

What if the money collected for the theoretical tax on sugar-containing products went directly to subsidize the sugar producers? Then again just ditching the subsidies would get the same thing done with less paperwork...

deleted 6y ago
[deleted]

pm90 6y ago

Growing food and subsidizing farmers that produce food is more for the National Security angle: without enough food, there will be rapid social instability and riots and a complete breakdown of society. It’s absolutely essential to produce much more food than can be possibly required by the populace.

frank2 6y ago
True in general (well, except your final sentence), but the topic is the US, which has never failed to produce enough food to feed its population and is unlikely to to start failing now.
- pm90 6y ago
  It doesn’t produce that food magically. A certain section of society needs to be dedicated to growing food and supported with subsidies if they can’t grow food economically.
  - frank2 6y ago
    Even in the absence of government subsidies, the US probably would'nt've experienced a shortage of food. I'm not saying that it is impossible for the US to experience a food shortage or even that smart people in and out of government shouldn't worry about that eventuality. I am saying that current and past US programs to subsidize farmers probably do not do / have not done much to reduce that risk and that most of the group collectively deciding to continue the subsidies probably know or strongly suspect that. In my experience, the elected representatives and other influencers arguing for the subsidies don't even use food security as an argument. (Again, like others in the thread, I am restricting myself to US food policy.) Instead, they argue that the family farm is a producer of particularly virtuous individuals, and it would be a shame if all the family farms were to be driven out of business by large corporations. The US Midwest has the largest tract of arable land in the world and twice as large as the second largest. If the people of the world were redistributed among the countries so as to equalize the probability of famine among the countries, the US would probably end up with a population over a billion.

baix777 6y ago

Canada is similar to the US in terms of food consumption, and yet Canada has much better health care outcomes and lower health care expenditures. I'm not saying food isn't a factor, I'm just wondering how big a factor it is compared to universal access to health care.

bluedino 6y ago
It’s the food. The USA has 40% obesity rate vs 15% of Canada. We just eat more here, and we eat more garbage. Funny enough, if you chopped off the fattest 5-6 states, the USA would compare more favorably.
- Aeolun 6y ago
  Anecdotally, coming to the US from Europe/Japan. The food there is ridiculously fat/large. At least as long as you want to spend less than $30/meal.
- nolangerner 6y ago
  Where are you getting your numbers? Canada is at ~29% and the US is at ~36%. Sources: https://en.wikipedia.org/wiki/List_of_countries_by_obesity_rate https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r... https://ourworldindata.org/obesity https://ourworldindata.org/obesity https://worldpopulationreview.com/country-rankings/obesity-rates-by-country https://worldpopulationreview.com/country-rankings/obesity-r...
  - knubie 6y ago
    That's interesting, the CDC lists 42.4% for the US. https://www.cdc.gov/obesity/data/adult.html https://www.cdc.gov/obesity/data/adult.html
- kevin_thibedeau 6y ago
  Or it's not the food and people have just adopted a lifestyle where all energy expenditure is minimized. That is self evident in social behavior. Your theory is just an easily trotted out bogeyman.

wisty 6y ago

The US government already spends an absolutely incredible amount of healthcare, comparable to Canada or the UK (per capita). Medicare (old people), Medicaid (poor people) and VA, funds for people who don't pay emergency rooms. It's actually a huge amount of total spending, and while the government gets discounts (like health insurers) it's not radically more efficient. The problem is, I think, often one of over-treatment. If hospitals are paid per procedure (as they are in the US) they are encouraged to do procedures that are actually bad for patients. Insurers can try to reign in over-treatment (to the horror of people who think that more healthcare is always a good thing), but regulators and customers (and activists) fear they do so targeting costs, not patient outcomes. It's all just a mess. Here's a few issues: * Over-testing is the most innocuous problem, but even tests aren't "free". At best, it's annoying and makes you not want to go back to see the doctor unless you know it's urgent (especially if it's costing you money or time). Tests might also the emphasis away from immediate treatments (both things that the doctor can do, and things the patient needs to do) as it becomes more of a "wait and see" game. * Drugs. Obviously they cost money, and they can have side effects. Over-prescription is widely recognised as a major issue. * Cesareans when they're a bad idea. * Heart surgery when it's a bad idea. * Aggressive treatment (especially of cancer) that statistically decreases the quality-adjusted life years a patient has, but hey you have to do something right? I could go on, but there's really a ton of things where a hospital should do nothing, but has a lot of pressure (from patients and profit motives) to act. While insurers can try to control this, I think it goes without saying that they're also not entirely the good guys, and giving them too much power to reject treatments is also a bit worrying. Confrontational systems might work in the legal system, but it's too slow and expensive to work in healthcare. Let's look at the special interests the US has (it's not just corn syrup!): * Caps on doctor training spots. Obviously this is not unique to the US, but a free market solution is hardly going to work when you cap supply. * Existing players (insurers, hospitals) want high overhead (regulations, admin) to create a moat. * Drug companies in the US want high drug prices. Australia will subsidise drugs, but only if the drugs are priced right (which creates an incentive for companies to offer deep discounts in Australia). In the US, this kind of bargaining doesn't happen to the same degree. People online keep telling me that the spending on drugs is good though, because it's driving research (it's fine with me if Americans want to spend all their money subsidising the rest of the world).

mensetmanusman 6y ago

It doesn’t matter what you eat if you don’t move your body. People have to realize that the wealth America gained post WW2 was poured into making life comfortable and easy (institutionally and economically). This had the unintended consequence of making Americans (on average) some of the unhealthiest humans in the world.