Imagine that someone proposed a path to universal health care that would significantly lower the cost and provide the means to pay for the rest of it. One would think that politicians and the American people would jump at the chance. And yet. . . I had a parent who is a geologist speak with my students on energy policy this week, and among the things he reminded them is that there is no free lunch and everything is connected to everything else.
This diary is written as a result of two op eds in today's major newspapers. Neal Bernard, a nutrition researcher and president of the Physicians Committee for Responsible Medicine offer Neal Barnard: Another Way to Reduce Costs -- Get Healthier, and the Boston Globe's Derrick Jackson argues Soda Tax: It's the Real Thing
You should read both. I will explore both and offer some thoughts of my own.
Let's start with the Bernard. But first, let us recognize that in general diet is a major contributor to health problems. In his opening paragraph Bernard writes that
Collectively, we are sicker than we have ever been, and part of the blame falls on the government's own shoulders.
First Bernard presents some shocking statistics from the CDC on diabetes: the number of Americans with the disease has now soared to over 23 million, and another 57 million have pre-diabetes, which means that without serious lifestyle and diet changes they are at serious risk of developing the disease. Further, the CDC estimates that one in three born since 2000
will develop diabetes at some point in his or her life. Adding up the costs of doctors, hospitals, and medical supplies, our national bill for diabetes was $174 billion in 2007. That's one disease for just one year.
That's current costs, which will seem miniscule compared to the costs we will incur if the number and percentage of Americans with the disease (a) continues to expand significantly, and (b) occurs far earlier in life.
Bernard also informs us that 74 million have high blood pressure, and 17 million have coronary artery disease, two diseases expanding greatly the cost of doctors' visits, hospitalizations, and prescription drugs. Then comes the key part of Bernard's piece: these statistics are a direct result of governmental policies that subsidize practices in agriculture that lead to our unhealthy diet and the resulting poor health. Let me offer the end of his piece for you to ponder:
Between 2003 and 2005, the federal government spent more than $20 billion subsidizing corn, soybean, and sorghum, mainly for animal feed, and an extra $1.3 billion for dairy subsidies. Among other things, the Department of Agriculture buys up hundreds of millions of dollars of meat and dairy products, aiming to boost farm income, and dumps them in school lunches and elsewhere.
These purchases push our cholesterol levels up and our waistlines out. The natural result is that the government then needs to find ways to pay for diabetes drugs and supplies, cardiac surgery, and antihypertensive medications related to our unhealthful diets. Sadly, every administration in recent decades, including the current one, has been caught up in a system that not only tolerates ill health, but encourages it.
Let me note that addressing these causes will not be easy. Remember the words of my student's geologist parent, that everything is connected to everything else and there is no free lunch. We could cut the subsidies to farmers, but there would be an immediate impact on farmers and upon farm communities. And politically that is not an easy path to take, even though much of funding for those subsidies goes not to family farmers, but to agribusinesses. Still consider only this - we are subsidizing production and consumption of food that is unhealthy, not to mention how often it is destructive of the environment.
And as regularly readers of progressive blogs should know by now, subsidizing of corn contributes directly to one of the most damaging changes in our diet, consumption of high fructose corn syrup, which is something our bodies have not yet evolved to process properly, and which contributes greatly to the diabetes about which Bernard write. It is also perhaps the major contributor to the kind of serious dental problems such as those I saw in Wise Virginia at the Remote Area Medical Mission in July, and which I will encounter again in two weeks at a similar event in Grundy VA. HFCS is heavily consumed in soft drinks. And that leads to Jackson's column.
Jackson begins by quoting Coca-Cola CEO Muhtar Kent speaking in opposition to taxes on soda as socialist:
Kent told the Rotary Club of Atlanta that proposals to tax sugary drinks and trash food were "outrageous’’ because "I’ve never seen it work where a government tells people what to eat and what to drink.’’ Kent added, "If it worked, the Soviet Union would still be around.’’
Here I want to interrupt my exploration of Jackson's column to note what Kent fails to mention: we have long had taxes on alcohol and tobacco. Perhaps originally these were intended primarily as a source of revenue, but there is no doubt that part of the approach on tobacco has been to discourage consumption of a product whose use imposes heavy medical and social costs upon the rest of us. By that logic, a tax on overly sugary foods and beverages would not be something new. States have increasingly used their revenues from cigarette taxes to help pay medical costs that are higher than they might be without cigarette consumption. A similar approach on HFCS-loaded sodas thus would have a strong precedent.
Coke's Kent is scared because of remarks by our President:
...Obama, in the current issue of Men’s Health, said soda taxes should be explored. "There’s no doubt that our kids drink way too much soda,’’ Obama said. "And every study that’s been done about obesity shows that there is a high correlation between increased soda consumption and obesity.’’
Obama recognized that the soft-drink industry would resist such a tax, but
"If you wanted to make a big impact on people’s health in this country, reducing things like soda consumption would be helpful.’’
Jackson offers us some statistics that should be sobering:
Coke and the other soft drink makers (this includes sports/energy drinks) have seduced Americans to double their daily intake of calories from sugar water since the late 1970s, fueling a tripling of obesity among youth 12 to 19, according to the Centers for Disease Control and Prevention.
Meanwhile CEO Kent wants to boost Coke's global sales to 8 billion units a day. Kent argues that our life expectancy may by 2020 increase by 5 years , while ignoring a 2005 report in The New England Journal of Medicine that warned that
that unchecked obesity trends could slash up to five years off American life expectancy, the first sustained drop in modern times.
I am not going to recapitulate all that Jackson offers, from various sources whose expertise should not be doubted: the Institute of Medicine of the National Academies, UCLA health policy researchers, and the New England Journal of Medicine. The aforementioned federal agency
recommended steps echoing those taken against tobacco: Advertising and marketing bans near schools; zoning restrictions for fast food joints near schools and playgrounds; overall community limits on the density of fast food restaurants; and promoting candy-free checkout aisles
and an article in the current volume of the Journal argues that a 10% rise in the price of soda would lead to a 10% drop in consumption.
And Coke's response? Not unlike what we have been seeing from the health insurers:
Lobbying by Coca-Cola, about $1 million a year from 1998 to 2006, zoomed to $1.7 million in 2007, $2.5 million last year and was at the $1.2 million mark halfway through this year, according to the Center for Responsive Politics.
Jackson also cites a similar increase in spending by the beverage industries trade association.
Much of the discussion about the crisis of health care has focused on those who lack coverage and the exploding rate of increase of cost. And yet our discussions do not often enough explore the reasons for the explosion of costs. Diet and lifestyle are major contributors. Look again at the figures on the expansion of diabetes and of obesity, and consider the costs each of those imposes on a health care system already under stress. It is illogical to attempt to fix the problem only downstream, after the damage to the bodies and thus the health of our people has already occurred.
We limit access to tobacco and alcohol by age. There are many reasons for that, including questioning whether younger people have the judgment to use either product responsibly. By that rationale, one could well argue for similar limitation on HFCS drinks, sodas and "sports" and "energy" beverages. Of course, that won't happen.
What should happen is to bar their presence in schools. That would be fairly easily accomplished: the Federal government could impose as a condition of aid for receipt of school lunch money that there be no such beverage machines accessible to students. Of course, many school districts would complain, because in a time of exceedingly tight budgets the revenue they obtain from those and the accompanying junk food machines is moneys they are unwilling to forgo. And yet, by allowing and effectively encouraging students to buy from such machines they are damaging the health of their students. They are contributing to diabetes, obesity, dental caries; they are facilitating destructive behavior that costs all of us, and may be shortening and is certainly restricting the future lives of those we entrust to their care.
Perhaps people will resent soda taxes the way they resent gasoline taxes. We pay the latter for the use of the roads they help produce. We tax alcohol and tobacco not only as a source of revenue, but also to help control their consumption, and increasingly to help pay for the costs they impose upon society. It is not clear why soda should be exempt from a similar approach, except perhaps because of the political influence and massive contributions that industry can exert.
I have been teaching since the 1995-96 school year. I can visibly see the difference in the percentage of obese young people in our schools. As I look around me in stores and on the street, I am also seeing it among adults, although as yet not as dramatically as I see in school. It is irresponsible of us not to address this ongoing - and burgeoning - crisis. And as Bernard notes in his piece, there is much we can do elsewhere in our governmental policy to prevent some of the health problems and the costs they impose from happening.
Merely raising taxes to pay for costs that should not be happening is neither sensible medically nor sustainable economically. Yes, we do need to pay for the increased costs, and a tax on sodas should certainly be part of that. We also must act aggressively to change the behaviors that are causing so many of our health problems. We might not want to go so far as to outright ban consumptions of foods that are unhealthy, but we can certainly cease subsidizing their production and consumption, as Bernard notes.
And as to Coke and its objections, I will let Jackson have the final words, from his final words:
Coke wants to double global beverage servings as American teen obesity has tripled. This is now a wanton attack on the health of children. Taxing Coke is not communism. It is common sense.
Peace.