What the President Didn't Say

By Neal Barnard, M.D.
This opinion piece was printed on Sept. 20, 2009, in The Washington Post.

In his health care speech to the joint session of Congress, President Obama outlined his goals for three key areas: helping the insured to have the best possible coverage, helping the uninsured to get coverage, and reducing unnecessary waste.

But in that congressional chamber was a 400-pound gorilla that the president never once glanced at: The entire debate about health care is driven by the fact that Americans need so much care. Collectively, we are sicker than we have ever been, and part of the blame for that costly problem falls on the government's own shoulders.

Take diabetes, for example. The number of Americans with diabetes has soared to 23.6 million in recent years, according to the Centers for Disease Control and Prevention. Another 57 million have pre-diabetes, meaning that, barring changes in their diet and lifestyle, they too will end up with the diagnosis. Looking ahead, things get even uglier: The CDC forecast that one in three children born since the year 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.

High blood pressure affects 74 million Americans. Coronary heart disease affects 17 million. As patients line up at pharmacy counters, doctors offices, and hospital registration desks, the cash registers ring up the costs of these diseases—well into the hundreds of billions.

What neither the president nor Congress wants to admit is that, even while our government is struggling to cover the cost of illness, it is also spending an enormous about of money causing the epidemics we are plagued with. 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.

The U.S. 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. On July 31, agriculture secretary Tom Vilsack announced another $243 million in dairy purchases, saying in a press release, "The Obama Administration is committed to pursuing all options to help dairy farmers."

These purchases push our cholesterol levels up and our waistlines out. The natural result of these ill-considered bailouts is that the government then needs to find ways to pay for the diabetes drugs and supplies, cardiac surgery, and antihypertensive medications related to our unhealthful diets.

If the president could not look the gorilla in the eye, it was because the current administration, like its predecessors, sees the farm vote as essential to its survival. Even if the steak and cheese produced on American farms foster health problems, our government rallies behind agribusiness all the way to the emergency room. Sadly, every administration in recent decades has been caught up in a system that not only tolerates ill health, but encourages it.

We need health care reform. And even more, we need health. And that should be front and center in the president's plan.

Neal Barnard, M.D., is a nutrition researcher and president of the Physicians Committee for Responsible Medicine.