WICHITA, Kan. - As President Obama prepares for the bipartisan healthcare summit on Thursday, and in light of the increasingly uncertain future of current healthcare reform efforts in Congress, I thought it might be worthwhile to point out two policy areas that, while not seeming to be directly connected to healthcare, would, were they to be dealt with effectively, have a substantial impact on healthcare costs and effects in this country. We could call this, "how to deal with healthcare without dealing with healthcare."
The first is food policy, and the second is transportation policy. The relation of these to healthcare is evinced by a recent Newsweek article on heart disease, in which both were mentioned. I would venture to say that with the exception of quitting smoking, no two factors would have a larger impact on heart disease than these.
The background on this, as any acolyte of Michael Pollan knows, is that since the Nixon administration, food policy has supported making food as cheap as possible, so corn and soybeans and meat heavily subsidized, with the result that a calorie derived from one of these foods is much cheaper than a calorie derived from fresh fruits and vegetables.
The only thing I hear about food policy in my Twitter and Google reader universe is coming from the First Lady's office. Last summer she tried to lead by example by establishing the White House garden: "In three short months, Michelle Obama had accomplished what other food advocates could only dream about. Good food was no longer just virtuous. It was cool."
Moving from good example to public policy, here's what the article in Newsweek recommends:
Subsidize whole grains, fruits, and vegetables in the food-stamp program. The underprivileged tend to have disastrously unhealthy diets, and no wonder: $1 will buy 100 calories of carrots--or 1,250 calories of cookies and chips. The government should offer incentives for buying produce. The Wholesome Wave Foundation has shown the way in 12 states, providing vouchers redeemable at farmers' markets to people in the SNAP program (the official name for food stamps). "We've seen purchases of fruits and vegetables double and triple among recipients," says president and CEO Michel Nischan.
Poor people are much more likely to get more of their "nutrition" from junk sources because of the price issue. Putting these foods into the food stamp program would address this, making it cheaper to eat healthier for the people who are most likely to have negative health effects of an unhealthy diet. It also probably could be done by executive action rather than legislation.
Of course, as with healthcare reform, climate legislation, and anything else, any attempt to redress this situation meets with resistance from a combination of ideological opponents and entrenched corporate interests, in this case Big Agro - the farm and ranch lobby - meaning it's unlikely that the misguided farm subsidy system that underlies the issue will be addressed anytime soon. This is probably why the issue is being handled rather sotto voce by the first lady. After her garden last year, she's undertaken an effort to get healthier food into the schools, relying primarily on voluntary efforts on the part of "school food vendors, food manufacturers and beverage makers."
The second issue is transportation policy. Lack of physical exercise is a major reason for the growth (so to speak) of obesity in America, with all the health repercussions that entails. As I know from my own experience, not everybody likes to go to the gym; people would be more likely to exercise if short trips and commutes of short distances could be done by foot or bike. Yet because of the dangers of walking and biking in the car-crazed United States, Americans use their cars for 66% of all trips up to a mile long and for 89% of all trips between 1 and 2 miles long.
Here's the pertinent paragraph from the Newsweek article:
Require that sidewalks and bike lanes be part of every federally funded road project. The government already spends 1 percent of transportation dollars on such projects. It should increase the level to 2 to 3 percent. When sidewalks are built in neighborhoods and downtowns, people start walking. "The big win for city government is that anything built to a walkable scale leases out for three to five times more money, with more tax revenue on less infrastructure," says Dan Burden, executive director of the Walkable and Livable Communities Institute. He recommends a "road diet" in which towns eliminate a lane or two of downtown traffic and substitute sidewalks. "When roads slim down, so do people," he says.
In other words, addressing the safety issue so as to increase the use of biking and walking even a couple of percentage points would have a huge impact on some of the most expensive and pervasive healthcare issues the country faces.
Again, given the hyper-partisan opposition to anything Obama suggests, and the stranglehold that corporate lobbyists have on Congress, the possibility of major overhauls of transport policy through legislation appear slim right now. (There is even ideological opposition to this sort of thing among "libertarian" sorts, on the basis that the market has spoken and people like McDonald's and cars, so why should government intervene? This ignores, of course, the huge amount of government intervention there has always been on these issues over the years through tax policy and subsidies.)
Maybe it will be possible to get the revisions in road project funding through in some sort of omnibus highway bill that no one wants to vote against. There should also be some places where changes can be made through executive action. In any case, again, a small investment in this approach would bear large dividends in healthcare costs and impacts, even in the absence of overhaul legislation.
Let me conclude by stating that I support efforts to overhaul the healthcare system, and I'm aware that subsidizing whole grains with food stamps isn't going to get anyone health insurance who doesn't have it. What I'm trying to point out is how interrelated some of these issues are, how addressing one thing can have a substantial impact on something else that doesn't seem (at first glance) to be related, and - perhaps - how to address some of the underlying issues that we must deal with in this country even in the face of determined partisan and corporate opposition.