March 2, 2009 — In our apparently endless debate about health care reform, we have lost sight of the fact that what is being debated is not really “health” or even “health care,” but proposals to modify — slightly — the American system of access to health care insurance. Period. To date, the discussion is only marginally related to the fundamental question of America’s ill-health.
The United States should, most emphatically, follow the lead of every other civilized nation in the industrial world and adopt some form of universal health insurance. But let’s not fool ourselves. We could create a universal health insurance program tomorrow – and guarantee universal access to health care – and we would still be facing a health crisis in America. It might not be quite as critical or pervasive as the crisis we face today, but it would still be a crisis.
Why? Because neither universal health insurance nor universal access to health care would greatly effect the two biggest problems in American health: chronic disease and obesity.
The two are not unrelated. America is the land of chronic progressive diseases for reasons that include our diet and a lifestyle that manages to be both sedentary and stressful. Do we really believe that universal health insurance is going to stop us from overindulging in fast food or spending several hours a day sitting in traffic or in front of a TV or computer screen?
No. And so universal health insurance will do little to curb health care costs, which are being driven in large part by the need to treat the growing number of Americans suffering from those above-mentioned chronic illnesses, like type-2 diabetes, cardiovascular disease, cancer, and auto-immune disorders.
We could, as Michael Pollan and others have pointed out, realize a rapid improvement in national health – and do so while saving lots of tax money – by simply eliminating the federal subsidies for corn and soybean production.
Those subsidies benefit only one segment of our society – giant food processors; in turn, those same subsidies have led to widespread environmental degradation and, by artificially depressing the price of these commodities, have flooded our food supply with artificially cheap, mostly empty calories. If we had to pay the real cost of a can of Sprite – a cost that reflected the price of fuel, fertilizer, soil erosion, water pollution, and long-term health effects – we’d be sipping the stuff like a rare Burgundy, not guzzling it by the six-pack.
Of course, cutting off those subsidies is not going to happen. Too many powerful oxen would have to be gored. Instead, even though we are supposedly believers in free market capitalism, one of whose axioms is that raising the price of a commodity will reduce demand for it, we will continue to settle for public-service announcements and other forms of moral suasion about the need to eat less and exercise more. Both are good ideas, but the whole tenor of the discussion is focused, as it usually is in our country when it comes to questions of the common good, on purely individual responsibility, never collective or, God forbid!, corporate responsibility.
And when it comes to personal responsibility for obesity and inactivity, hectoring, shaming, and lecturng overweight individuals ignores the fateful link between obesity and human evolution. Far from being weaklings unable to control their appetite, the overweight and obese among us are living testimony to one of the primary mechanisms that ensured human survival during the thousands of generations of the Pleistocene.
That epoch favored individuals genetically predisposed to seek out and consume as much fat, salt, and carbohydrates as they could lay their hands on – none of which was abundantly available in those days – and then to be able to use calories with optimum efficiency, which is to say by storing any calories not immediately burned off as body fat. We are, in short, the descendents of ancestors who were able to live to the age where they could reproduce and care for their young during extreme cycles of feast and famine.
Take a species that evolved in this kind of environment, plunk it down in a country in which its present-day members are constantly bombarded with the sights, sounds, and scents of high calorie foods, throw in a lifestyle that all but precludes physical exertion, and you will end up with precisely what we have in America: a population in which two-thirds of adults are overweight, and nearly 20 percent are obese.
Universal health care? Absolutely. Universal health? That’s going to take a revolutionary approach informed by an understanding of human evolution.