Food Over Medicine (27 page)

Independent groups like Cochrane should be hired to conduct research on tests, drugs, and procedures to determine which are worthwhile. Congress and any bureaucracy susceptible to political influence should be kept out of the discussion. The National Institutes of Health at one point convened a panel that concluded that breast cancer screening should not be a blanket recommendation based on the evidence; Congress overrode the scientists and overturned the panel’s recommendations.
⁶
This should be unacceptable.

If we develop a system that relies on evidence, instead of confining our discussion only to who should pay for any test or intervention that any doctor orders or any patient wants, we could contain costs, which would free up enough money to provide scientifically justified care to all seniors. Doctors and hospitals have a financial incentive to preserve the status quo, but we know that the status quo is terrible health outcomes at unsustainable cost.

GM:
Are you optimistic that government will reform itself and make these kinds of changes happen?

PP:
No, but I think we can educate the public one person at a time, until so many people have dropped out of the system that the system does not exist in its current form. The only workable solution to our Medicare problem and our larger health care cost problem is to reduce demand for health services. The ways to do that are to create a healthier and better-informed populace and to demand that science, not a profit-oriented medical establishment, determines what is worth paying for.

GM:
Since we did such a good job of developing a plan for Medicare, let’s help balance the budget. We raise and kill more than ten billion land animals a year in America, and kill another fifty-three billion aquatic animals.
⁷
If we were to tax this carnage at an average of only about a dollar per animal—considerably more for the large mammals and considerably less for the sardines—with the tax burden shared by the producers and the slaughterhouses and the commercial fisheries, that would generate about $60 billion per year for the Treasury. Some of that money could then be dedicated to remediating the environmental damage to the land and rivers brought on by animal agriculture. Of course, the argument would be made that such a tax on producers would be passed along to the consumer. To the extent that that’s true, it would only increase prices on foods that are making Americans sick, thereby discouraging their consumption, and leading to reduced medical costs, a further savings to the government, and a boost to the economy generally. So, while I don’t believe it’s on anyone’s radar, theoretically a slaughterhouse and fisheries tax would be a superb way to raise revenues for a government awash in red ink.

PP:
I agree. Those who pollute the water supply and destroy the environment should be responsible for paying for it. And the price of animal products should have some bearing on the true cost of producing them, which includes this damage.

GM:
New York City Mayor Michael Bloomberg has been in the news in the last few years, first banning trans fats from restaurants, then banning sodas and sugary drinks larger than sixteen ounces from restaurants, movie theaters, and street carts. Some are attacking the mayor for acting like Big Brother. What’s your opinion of his initiatives?

PP:
We live in America, not China. I worry about who is going to make up the food police and what guidelines they are going to use. If we’re going to let Mayor Bloomberg decide the size of the soft drinks and whether or not trans fat is allowed … well, what if Mayor Bloomberg talks to Dr. Barry Sears, who tells him that baked potatoes are bad for you? Is that the next food we’re going to eliminate? The more government gets involved, the more messed up things get.

GM:
I grant your logic, but all the same, I support the mayor’s actions. It might not be the most sensible or ideologically consistent way to improve public health, but when you’re in a crisis of the proportions that we face, I appreciate that at least somebody in a position of power is trying to do
something
. More than a dozen other state and local governments have emulated Mayor Bloomberg’s ban on trans fats, and it appears to have changed eating habits in NYC, at least slightly for the better.
⁸
And while it seems silly to ban sugary drinks larger than sixteen ounces while allowing consumers to buy three eight-ounce sugary drinks, I’ll welcome it for the attention it brings to the issue.

PP:
I’ll continue to disagree. Growing the problem, as in more regulation, does not make it better. As Albert Einstein once said, “You cannot solve a problem with the same thinking that created it.” A major contributor to our health care crisis is government; let’s get it out of the picture, instead of rearranging it.

GM:
Personally, I wouldn’t object if Mayor Bloomberg were to really show some guts and tax cheeseburgers. They clearly cause even more damage to people’s health than giant soft drinks. In fact, I have a theory that Obama’s presidency was nearly destroyed by the cheeseburger.

PP:
I’m also very anti-cheeseburger, but could you explain that one?

GM:
Sure. When Obama first ran for president, I agreed with him on most of the issues, but I had one quibble: he kept eating cheeseburgers at his photo ops. Proof that he was a regular Joe, even if his name was Barack. Well, I certainly wasn’t going to let his dietary indiscretions keep me from supporting him, so I thought of it as a quibble without consequence. But it was indicative of his lack of understanding of health, and his tendency to conflate health with health insurance.

Imagine an Iraqi bureaucrat at the worst point in the insurgency in 2004, with car bombs exploding in markets all over Baghdad, and IEDs blowing up American Humvees. The bureaucrat surveys the carnage around him and has a “Eureka!” moment: “What this city needs is car insurance reform.”

That’s precisely how Obama has approached the atrocity that is the state of American health. Our real problem isn’t the large number of uninsured, lamentable as that fact may be. Our real problems are obesity, diabetes, heart disease, cancer, and all the other ailments that come from eating foods like the cheeseburger that our president is so delighted to chomp down on at photo ops. Obesity is so widespread that he apparently couldn’t find anyone to be surgeon general who wasn’t obese. So I realize now that what those cheeseburger photo ops really demonstrated is that the man knows nothing about health. And knowing nothing about health allowed him to believe that having health insurance is a matter of greater significance than having the real thing, health. The Affordable Care Act, his signature achievement, has nothing whatsoever to do with health.

PP:
I want to say first of all that it’s not entirely his fault. There is a tendency for the market to pay attention to who’s paying for health care versus whether there might be a way to obviate the need for those services in the first place. He’s caught up in a system that emphasizes who’s going to pay, instead of whether there’s another way to provide care, so it’s not entirely his fault.

What is his fault is that, in spite of public sentiment against it, the bill passed anyway. It’s very difficult to manage any situation that involves significant change with zero buy-in from the public.

GM:
As a Democrat, I agree with you.

PP:
I don’t find many who don’t. This is not a partisan issue; this isn’t Republicans against Democrats; this is practicality setting in. It doesn’t matter if you’re Republican or Democrat; if you have a simple grasp of economics, you’ll understand that if a breast cancer patient diagnosed yesterday pays her first $175 health premium today and then sucks up $50,000 worth of care, you can’t have a whole lot of that going on before it becomes unsustainable. We can’t print money at the insurance companies. So this is a bad piece of legislation that will eventually have to be dismantled, at least in part.

In government, we have to be very careful of the law of unintended consequences. We need to think through all the things that will happen as a by-product of a new law, outcomes that were never intended. The more people, and especially businesspeople, understand the Affordable Care Act, the more they will object to it. When that happens, the federal government will have to make more exceptions to keep disaster from happening. And that’s where all these exceptions come in—

GM:
Yeah, all these waivers to businesses to sidestep the law.

PP:
Oh, they will have to keep doing it. I read a survey recently where this polling company called CEOs to say, “We’re not going to use your name, but if this law stands, will you drop your health insurance?” And some alarming percentage of CEOs said, “We wouldn’t be the first but we would be a fast second.” In other words, all we need is one large company to drop coverage and the dominoes will start to fall. I think that the government cannot afford to have a major player say, “We give up. We’re not going to provide insurance at our company anymore.” So they’ve granted all these waivers trying to keep the ship from sinking and they can’t keep doing that but then again they have no choice.

GM:
It’s like getting special dispensations from the pope. It’s an absurd way to create national policy. And let’s not forget that while Chief Justice John Roberts upheld the mandate’s constitutionality as a tax, he also struck down the law’s enforcement provisions to effectively compel the states to expand the Medicaid program, the mechanism by which roughly 15 million more people were to obtain health insurance. So the law will not bring us anywhere near universal coverage, in spite of the mandate. I do approve of the law’s provisions for government-sponsored insurance (the preexisting condition insurance plan) for those who are refused coverage by private insurers, but that was a nice, simple provision that didn’t require a mandate. Unfortunately, it’s going to be replaced by the more complex exchanges in 2014.

The absurd mandate has been posited by almost every commentator in the media, with the notable exception of Lawrence O’Donnell, as the
sine qua non
of Obamacare. The truth is that it’s a sham and a mirage, a toothless response to the largely imaginary problem of people “gaming the system” by going to the emergency room for a cold. In fact, people don’t fail to buy health insurance because they want to “game the system”; they fail to buy it either because they can’t afford it or because they feel they don’t need it. There is no enforcement mechanism for the mandate. What happens if you don’t buy health insurance as mandated by the law? You get fined—$95 the first year, or 1 percent of your income. What happens if you don’t pay the fine? Nothing. There’s no penalty for not paying the fine. Here’s what the law says: “In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such payer.” So if the mandate is a violation of constitutional freedoms, as some passionately argue, it’s only a symbolic one; in a very real, practical sense, it’s merely an invitation to break the law. That doesn’t strike me as wise policy.

PP:
No, it’s not, but I’ll tell you what I think the take-home message is for anyone who is reading this book, regardless of her political convictions. Whether you are sick or healthy, whether you have health insurance or not, whether you are a Republican or a Democrat, the bottom line is the same. You have to take responsibility for your own health. You’ve got to get the information that you need to make informed choices about health care. It doesn’t really matter who’s going to pay for it; it doesn’t really matter whether Obamacare stands or doesn’t stand. If it got erased tomorrow, and we went back to the way it was two years ago, the person with coronary artery disease faces the same choice: he can either do what his doctors tell him, which is not medically warranted or scientifically supported, or he can take matters into his own hands and find his own solution. If you are perfectly healthy and you want to stay that way, you’re not going to stay that way listening to most of the authorities who you generally might seek out for advice about such things. You’ve got to drop out of the system and look for alternative options. And when I say alternative, I don’t mean “alternative medicine”; I mean alternatives to all traditional health care.

You can go visit doctors, do what you’re told, and keep eating what’s advertised on television and what’s served in fast-food joints and restaurants. Or you can drop out of all of that and take care of yourself. If enough people do that, we won’t have to worry about who’s paying for health care anymore because we’re going to get rid of so much of this health care cost that it’ll be a nonissue.

GM:
I confronted Michael Moore on this recently at a public event in Los Angeles. Again, I’m a left-wing guy and I’ve admired several of his films, but not
Sicko
, because, as I told him, he doesn’t understand anything about health. His overriding issue is that fifty million Americans don’t have insurance coverage and he made the point that fifty thousand people died last year because they couldn’t afford medical care. Now if that’s true, it’s of course indefensible.

PP:
It is, but more people died from too much medical intervention.

GM:
I pointed that out to him. Probably at least five times as many people died because they had excessive and unnecessary and bad medical care. He didn’t have a response to that. He was sitting on the stage, all three hundred or so pounds of him, arguing that we should have Medicare for all. So in other words, people should be free to eat hot dogs and pizza and cheeseburgers and then force us to do unlimited medical testing on them and provide unlimited surgical interventions, with the government picking up the tab.
That’s
the progressive solution? What exactly is progressive about bankrupting the country so that Michael Moore can have as many angioplasties as his cardiologist recommends? What’s progressive about bankrupting government so that it won’t have any money to spend on education, clean energy, infrastructure, the environment, and all of the other things that Michael Moore and I believe in?