The horizon is not so far as we can see, but as far as we can imagine

A fundamental cause of healthcare costs exploding

Is that Americans (and Westerners as a group) eat crappy food and don’t get enough exercise.

The author is entirely right that real healthcare reform would tackle these problems. Frankly, if it was up to me, I’d subsidize healthy food (so it’s cheaper than junk food) and heavily tax unhealthy food.  Exercise would be mandatory in all schools, and it would be real exercise, meaning every kid who could handle it would be getting a minimum of half an hour of cardio  3 days a week, and would learn how to use weights as well as being exposed to some form of skilled movement exercise, whether that be climbing, dance, yoga, tai-chi or something else along those lines.  Every kid, when graduating, would be able to put together an exercise program on their own, so that if they needed to in the future, they could.

No mortgage would be considered to be “conforming” for federal mortgage guarantees if the neighbourhood it was in did not have sidewalks, city centers would be off-limit to all cars, with only emergency vehicles allowed in during the day, and commercial vehicles delivering at night.

Etc…  Yes, this might infringe on the holy right of Westerners to be lazy, fat and sick, but so be it.


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  1. BDBlue

    In my opinion, you can’t really go after Americans for their crappy diets as part of any healthcare reform without combining healthcare reform with food policy reform (I don’t read your post as necessarily disagreeing with this premise). There’s a reason why hamburgers are often cheaper than salads and HFCS is in every product imaginable.

    Poor people eat what they can afford and thanks to our corporatist food policy what they can afford is mostly cheap, unhealthy calories. Anglachel had an excellent piece up pointing out how difficult it is for poor people to have healthy diets – here.

    We really have become a country where just about everything we do is based on optimizing corporate interests. How we’re born, how we’re buried, what we eat, what we read and watch, what healthcare we get, what power we use – damned near everything. It’s deeply unhealthy and not just in a physical sense, although that is certainly a large part of it.

    I agree with how the government could pursue policies that will help, but unless there is some corporation that’s going to make money off of it, I doubt anything will happen, at least not above the local level.

  2. beowulf

    This is America, we only accept big government when its related to national security. That Eisenhower was smart, his highway bill was called the Interstate and Defense Highways Act, his bill subsidizing public and private universities was National Defense Education Act and he justified his creation of the President’s Council on Physical Fitness by declaring that too many out of shape teenage boys were reporting for their Selective Service induction physicals.

    You want mandatory PE, then require mandatory ROTC (the Navy Sea Cadets program starts at age 11).

  3. Ian Welsh

    Yes, BDBlue – the cheapness of bad food and expensiveness of good food needs to be reversed.

    Beowulf: might work at that. As you say, everything has to be considered defense related.

    And I’m a big believer in giving everyone basic military skills. Concentrates elites minds if they know the entire population knows them.

  4. S Brennan


    Eisenhower was also aware that far two many men were unfit for service during WWII because of poor nutrition received in childhood…all this was known to those in charge of bringing the war to a successful conclusion.

    That is why we do not see a move away from New Deal Policies until suficiate numbers of the generation that had experienced pre-FDR 19th century economic policy died off. Friedmanism/Reaganism/Neo-Liberalism just more of the failed 19th century economic policy dusted off and given new names.

    The “Americans eat crappy food and don’t get enough exercise”. meme is a red herring, except for the elites. US citizens get very little choice in where they live, wage and price is always the driver.

    Ian, I totally agree on the Draft, except I have twist on it.

  5. Some of us are trying to keep people informed about how to get and stay healthy.

    Carolyn Kay

  6. BC Nurse Prof

    Here are Kunstler’s predictions for 2010. They agree with what Ian says, and add some detail.

  7. Ian Welsh

    I’ll probably do my predictions (if I bother) next week.

  8. Lex

    Actually, good food is not significantly more expensive than bad food. The problem is availability, and that arises from the collusion of government and big-Ag corporations…along with food retailers.

    Or course the generally accepted wisdom of fresh fruits and vegetables as good food (which they are) plays right into the hands of industrial agriculture too. There are very few places in the US where fresh vegetables can be grown year round. And in many cases, industrial produce is not worth the higher cost. A tomato doesn’t necessarily have X% of a nutrient and Y% of a vitamin, especially if said tomato is picked while hard and green to survive transport.

    But you all don’t want to read a Wendell Berry-esque essay from me here and now. It should suffice to say that agriculture does not work in the industrial model, and the costs of forcing agriculture into that model will only become more apparent. Fat, lazy and diabetic citizens are actually some of the lesser problems. The big ones can’t be fixed so easily.

    The easiest, most effective thing we can do, individually, is to join a CSA program (i’m gearing this advice to sub/urban dwellers), because there won’t be an abundance of healthy food until there is an abundance of healthy farms and the farmers who work them. Oh, and learn to sprout…it’s painfully easy, cheap and provides high-quality nutrition.

  9. Bwahahaha. Ahem. Excuse me. I was just thinking: “Yup. It used to be called ‘gym class’.”

    Some kids hated it. We had an hour or more of running around pretending we were playing soccer, or hockey, or basketball, or whatever. Sometimes we climbed ropes or did chin-ups.

    And then that all got cut to save money. I wonder, if you costed it out, how much all those cut gym classes have cost the country in medical bills, in the time of ‘soccer moms’ who had to do all the chauffering formerly done by school bus, and on and on and on.


    I couldn’t agree more: gym class needs to be improved and brought back!

  10. There’s no doubt that our lifestyles are affecting health care costs, but if you contrast them with the cost of private health insurance, the current obsession with that part of the problem still makes sense. There’s also nothing wrong with a separate bill that will attempt to address this problem.

    There have been several such articles over the last few months, and I have yet to read one that proves the point that getting Americans to change their lifestyles is more important than making it so that one third of the population isn’t getting the health care it needs. That they are often written by people with their own axe to grind – diet plans, etc., only adds to my skepticism.

  11. My gym classes all through school were useless, timewasting stupid group exercise nonsense. Dodgeball and other useless crap. My gym teachers ranged from inept to actively malicious, screaming psychotic thugs.

    I didn’t discover I actually liked working out until I was 26 years old as a result. Funny.

    While weight gains can be assigned some of the blame, I think our lousy health insurance model, massively overpriced drugs and exhorbitant spending on end of life care have more to do with it.

  12. Celsius 233

    We used to eat food by the seasons; which varied our diets in a very healthy way. We’ve lost a lot of knowledge about how to eat because we allow others to be responsible for our eating patterns.
    I see us as the new slaves who’ve been fooled into thinking we’re still free and individuals; when actually we do very little to determine the course of our daily lives. Yes, we’re in a period of neo-slavery.

  13. I think the key sentence is here: “The sad truth is that there is essentially no profit in helping people stay healthy and immense profit in managing their chronic diseases.”

    But the other major issue is end-of-life care. We simply don’t know how to deal with those very thorny problems.

  14. Ian Welsh

    Yes, gym was relatively worthless for me too. But we had mandated exercise after school 3 days/week and that was fairly serious, then I joined the cross country team (and track in the spring). That made me very very fit.

  15. Heh, my gym classes went beyond useless to actively harmful sometimes.

    Though it could be worse; my sister almost died in a gym class as a combination of Zero Tolerance drug policies and her gym teacher. They required my sister to keep her emergency inhaler in the school nurse’s office (why I cannot imagine; they don’t really do anything to healthy people). She wasn’t supposed to run outdoors due to her allergies/asthma; the gym teacher made her. So when she collapsed, unable to breathe, she didn’t have her inhaler. The teacher tried to stop her friend from going to the nurse to get the inhaler, and if she’d been successful, my sister would probably have died. And then of course, I’d have gone to prison for killing the gym teacher.

    Funny old world.

  16. Ian Welsh

    Wow, the fucking stupidity that implies is amazing John. Seriously, that’s beyond stuidity into insanity. But then, we keep reading about zero tolerance being used on things like fucking asprin, so…

    Seriously, Americans are insane. Batshit insane as a society.

  17. Google “zero tolerance zero brains” and you’ll come up with stuff like this:

    The first case told the story of six-year-old Zachary Christie of Newark, Delaware, who proudly brought to school a camping utensil that serves as a spoon, fork and knife. He intended to use the device, which he received after joining the Cub Scouts, at lunch – to eat food, not stab someone, obviously.

    But zero-tolerance on weapons at school means no knives – no matter the circumstances, age of the offender or intent.

    Zachary was suspended and faced 45 days in reform school until the decision was overturned a few days later by a unanimous school board, after public outcry forced the seven-member board of the Christina School District to reconsider the case.

    The second case wasn’t any better.

    It’s as though we think we’ll all do better if we just switch off our minds.

  18. Yeah, it was amazingly stupid. My mom and dad were rather upset when they found out. We weren’t sure it wouldn’t happen again at some point either; this wasn’t enough to change the drug policy, naturally, because somewhere, somehow, a person might sneak a pill into the school. Saints preserve us.

    I was… hmm. 15 I think, at the time, and I actually had a plan, if something had happened to my sister, to.. ‘deal’… with the aforementioned teacher. So the situation was pretty intense.

    In my experience, Americans regard gym class as a way to funnel tax money to the school’s sports teams. You exercise, if one can call it that, in a facility primarily designed for their audience. Any real equipment, weights, etc, is kept off-limits to the general population of the school, so that it can be used exclusively by the school teams. Most of the budget for these facilities goes to things like scoreboards and football field maintenance. The PE instructors are hired first and foremost as coaches, and everyone knows it. In none of the school gyms or PE classes I ever went to, in several states, did you have anything resembling a fitness center, a health club, etc. The fact is, they’re not designed with the health of the students in mind in any way. I have a better gym in my upstairs loft than I ever got to use in 12 years of American public school education, in that I have weights and an exercise bike, and am hoping to get a nice treadmill eventually.

  19. Lex

    It’s only getting worse. The US is bordering on dementia. We’re paranoid, psychopathic, more than a little schizophrenic, suffer from delusions of grandeur, prone to psychotic episodes, violent…and fuck me if i don’t feel like i’m missing a few important ones in that list.

  20. Bolo

    I need to get on the treadmill.

  21. Personally I think we’re no crazier than we’ve been for a good long time, it’s just manifesting in different and perhaps more inherently self-destructive ways. I mean, really, we were barking mad for half the twentieth century, poised to destroy the world at a moment’s notice. Nobody spotted it, of course, because much of the world was in the same condition.

    Now that we’re competing with saner, more sober nations, and nobody needs us to balance out the insane Soviets, we look nuttier by comparison, and are getting outmaneuvered.

  22. We ravens have it easy on diet and exercise.

    If we require more gym, we will discover that, “Those who can’t teach, teach gym.” (Shel Silverstein? Woody Allen?)

    Agribusiness has experts on getting people to overeat. As far as I can tell, much of why Americans are overweight and diabetic because agribusiness is fattening them up. Childhood obesity, in particular, seems to be a result of intense soft-drink marketing. There is some evidence that high consumption of high-fructose corn syrup is more troublesome than high consumption of sucrose (cane sugar.)

    Our cities are built in ways that make it difficult to maintain a healthy activity level without a great deal of extra effort.

    Shaming people for their weight doesn’t help.

    Pressuring sedentary middle-age people to exercise seems to mostly produces injuries and discouragement. Doctors and trainers don’t seem to know how to safely raise the activity level of overweight middle-age people.

  23. Ian Welsh

    Eh, I know trainers who specialize in overweight middle aged types, and seem to be able to get them fit. The key seems to be various gentle types of weights, and fairly vigorous calisthenics performed prone, so they don’t blow out their knees. Start by working on their stamina, lower back and abdominals. Once the core muscles are strengthened, move to more vigorous and heavy weights, to build muscle (since that increased resting burn rate), intersperse with cardio.

    And if weight loss is desired, they will have to change their diet. When you’re young, exercise is enough for a lot of people, when you hit 40, you need diet. The rules are fairly simple: no sugar, almost no simple carbs. Most people lose quite a bit of weight if they cut those two things out.

    Or, if they’re up for it and moderately flexible, stick them in yoga. Yoga gets pretty challenging after a while.

  24. To encourage more activity, the important thing is that people do something they enjoy, in which case they’re more likely to continue doing it. Consistency is more important than any other aspect of exercise.

    I have a real problem with so-called experts who try to teach people that there’s only one way to get fit or lose weight. The road to recovery from an unhealthy lifestyle isn’t a regimen enforced from the outside, at least that’s not how alcoholics and drug addicts recover. Those who do, recover because of an inner realization that it’s what THEY want to do, and that they must find their own way through the maze of techniques used by others who have been successful.

    I think most of the problems of American society are related to self indulgence. The wrong people are held up as role models. No one teaches the benefits of self restraint.

    I’m not saying we should go back to the imposed restraint of the 1950s, but neither is the “let it all hang out” culture of the 1960s and beyond the way to a satisfying life.

    Carolyn Kay

  25. Lex

    I’d put America’s descent into madness as beginning right after WWII, when Gen. LeMay and others concluded that the only way to secure their wartime budgets was to provoke mass hysteria. The historical record, bolstered by a lot of archive releases from Russia, strongly suggests that the USSR was never even close to being the threat it was portrayed to be.

    I’m a horrible person to be involved in discussions of weight since i have a metabolism run amuck. I simply cannot understand the situation. Then again, a day at work for me is an awful lot like being at the gym. It’s not uncommon for me to average 1 mph of walking over the course of a work day and innumerable weight exercises of various types. Body by wet soil and lumber. That’s good though, because i hate the gym.

  26. I tend to agree that there’s a lot of counterproductive shaming going on here. People would much rather blame others for the problem rather than the system, so it becomes all about ‘fatties’, and hence, their responsibility; if it’s their responsibility, you don’t have to do anything to change yourself.

    Yes, obesity causes health problems, and of course it should be addressed. But it’s obviously not the exclusive, or even predominant, cause of our particular national problem. I was looking at an EU report on obesity the other day showing that Greece, for example, actually has a worse obesity problem than the US, and many EU countries are beginning to approach US levels of weight control problems. Yet none of them spend 16% of GDP on healthcare while leaving millions uncared for entirely.

    A comprehensive approach is much easier when you have a government managed system because it’s easier to justify spending on things that have less short-term utility. One of the arguments I always make for, say, single payer, goes along these lines:

    We all know that preventative care reduces health care spending, but who pays for the preventative care? For a private health insurer, it’s a bad deal. Their next quarterly results look worse, and the benefits, which may or may not accrue (though they are likely), will be years down the road, at which point they can figure out a way to deny you care or dump you onto someone else. With a single payer system, or a strictly managed set of private insurers, that’s impossible. No matter what happens, your health is ultimately the government’s problem, so they have an undeniable interest in, say, getting you preventative care now in a cost effective manner. There’s no shiny short-term alternative, no way to maximize your take at the expense of your client, because their needs will come back to bite you eventually.

  27. It’s also in our own best interest to take preventive measures, not just from a cost standpoint, but also from a suffering standpoint.

    Carolyn Kay

  28. gmanedit

    Until I was laid off, I took daily ballet or Pilates classes. Will “wellness” programs pay for them? Where do I sign up?

  29. gosh, there’s a lot to respond to here.

    -i oppose a national draft. unless there is a true “peaceful service” component that does *not* include basic training military style brainwashing. i am a vet, and military service is great! for some people. during peace time. but we’ve officially shifted to a permanent war economy, and until that changes, i don’t want to see any more poor kids shoved into the maw than already are forced to go. being in shape and having good personal habits of discipline are useless to you when you’re dead.

    -without education, a lot of what y’all are talking about it useless. people aren’t educated about the basics of food, let alone complicated science about things like HFCS and chemical additives to food, and how those things have an impact on health. health science classes need to be comprehensive and mandatory. but of course we’re busy defunding education, so this is another librul pipedream for the near future.

    -gym class is usually a waste, but there are alternatives. my old high school had a “blue point” system. there was no gym class, but in order to graduate, every student had to join at least one athletic club or team each year, and the coach would assign your “blue point” value on the basis of how hard you worked out and tried on the team. quitters and whiners wouldn’t get a point if they were lazy. you’d be amazed at how motivating this was.

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