The Health Care Bill and Health

The bill has more or less passed. The reconciliation bill will be taken up shortly by the Senate and many seem confident it will pass here as well. Considering the major elements of the bill include things like ending discrimination against individuals with preexisting conditions, ending limits on lifetime spending, allowing adult children up to age twenty six to be included on their parents’ policies, ending premium disparity between men and women, and subsidizing affordable policies while taxing cadillac plans, it seems to be more of an insurance reform bill than a health care reform bill. The bill doesn’t include things like reforming measurements of service delivery, moving from quantity to quality or tort reform to decrease defensive medicine practices concerned more with legal liability than the health of patients.

And what about preventive care? Not much beyond what many state health departments already offered. The implied benefit is that with the promise of insurance, more people will take advantage of doctors’ services before the issue becomes a crisis. But there was one, minor attempt to consider preventive care in the bill. And it reveals that within Congress, there may be a dim recognition that our food system has something to do with our health. The Wall Street Journal blog “Washington Wire” posted an article Monday about a provision within the bill “requiring restaurant chains to disclose calorie information on menus.” Because these requirements first have to go through the FDA, menus won’t see changes for a few years. Of course, reactions from the restaurants are mixed but the movement to get information into the hands of the consumer isn’t new. And in fact, it seems, it isn’t helpful. An article by The New York Times published last October reveals “Calorie postings don’t change habits.” The study was conducted by professors at NYU and Yale to test the impact of labeling laws in New York City and found, “that people had, in fact, ordered slightly more calories than the typical customer had before the labeling law went into effect, in July 2008.” So, the provision is headed in the right direction but going about it in the most delicate way. The thinking seems to be, leave it up to the consumer and do as little damage as possible to the private food industry. But, as the study shows, we don’t understand the consumer. Human beings are not rational actors, food is not just a matter of calorie counts, and the “consumer” is not a neutral actor with equal access to all products. If we want to address the connection between health and food, it cannot be done through this minimalist philosophy of intervention that imagines a simple surgical incision can heal the whole body. Calories, cost, convenience, familiarity, marketing, information, etc. all factor into our relationship with food. Slow Food embraces the recognition that the most important information about food is hardly its calorie count. Health is not a numbers game. It is not a matter of converting individuals to a lower intake level. Health happens on the scale of the community and we need provisions that recognize this.

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