The election of President Obama has done at least one thing to improve the political climate, and that is to put health care front and center as an issue. That’s fortunate, because we have been ignoring multiple parallel crises in the American care system for decades, and the consequences are becoming deadly serious. We spend more than any other country on health care, and we get less for our money than any industrialized nation.

The first problem is under-participation. The AMA has estimated that more than half of Americans do not have their own Primary Care Physicians.  Add to that, of course, the more than 50 million Americans with no health coverage at all, and you can see that more than 150 million people in this country are not getting regular checkups, do not have the medical care they do receive coordinated by anybody, have no central store for medical records, have no way to manage the risk of pharmaceutical interaction, are not detecting disease early and are not treating it effectively. We can see the consequences when more than ten percent of our health care costs stem from one disease: Diabetes. Since most diabetes is Type 2, the vast majority of these costs are preventable through early risk identification and lifestyle changes. Instead, we are spending hundreds of billions of dollars to treat people who should never have been sick.

The second problem is the role of profit in the health insurance industry. It’s not simply that thirty percent of our extravagant spending goes to profit and the recision and denial mechanisms necessary to protect it, but the profit motive of employer-based care produces perverse incentives. Care is denied whenever possible. Early intervention is denied to minimize “medical loss,” even though it would reduce future outlays, because insurers do not know if they will cover the patient when they get sicker. They have no incentive to reduce their future costs by eliminating deductibles and co-pays for diagnostic and preventive care. Thus the financial incentives of insurers are perversely related to the health outcomes of their policyholders. Insurers are profitable while Americans become sicker every year.

The third problem has been the least-discussed: the subsidized corn sugars and soy oils that are killing us. The modern epidemics of obesity and diabetes are directly related to the late twentieth-century surge of subsidies into factory farms that produce little but empty calories. Our foods contain steadily diminishing quantities of vitamins, anti-oxidants and amino acids as a giant biochemistry experiment engulfs its third generation. The health consequences of our fast-food culture are so severe that life expectancies are actually beginning to drop.

So, we’re facing a fifty trillion dollar Medicare iceberg at the same time we’re spending tens of billions a year to subsidize the foods that are killing us. But conservatives choose to blame poorly educated working class families with little money and less time for patronizing the businesses these same conservatives spend their time fighting for. The hypocrisy of it would be startling were not hypocrisy the operating standard of the conservative movement. On the one hand, the mounting data linking modern factory food to every form of chronic disease is dismissed as liberal “culture war” against good old-fashioned American food. On the other hand, people who uncritically consume this fare are blamed for the diseases that result. Don’t they know this stuff is bad for you?

All too often, they don’t. Industrial food is huge business in the United States, spending billions of dollars a year to market their products, targeted specifically at younger, poorer people who do not know about the link between the epidemics of diabetes and obesity and the food they are eating. Fast food outlets are located where poorer, less-educated people work, shop and live. Two-income families working three or four part-time jobs with little control over their working hours lack the ability to get together for a home-cooked meal. Even if they could make the time, they find that the fresh fruits and vegetables they need to stay healthy are not subsidized, not as available in their neighborhoods and require a struggle to get small children to eat, a struggle they no longer have the time or energy to undertake. So they get the fried chicken or the Happy Meal and stave off hunger for another day, frequently unaware that these foods are not just vaguely unhealthy but specifically deadly to precisely the kind of poorer, less-educated families the companies that sell them target with their advertisements and store placement.

So, minimum wage workers must show “personal responsibility” but food industry and health insurance executives are allowed, no, required, to cut any corner, tell any lie, spare no expense, walk away from any number of sick and needy people, to make profits that enrich them and their shareholders. If one were to wake up and say to herself “I make money from human misery and basic human decency demands that I stop,” she would be treated as mentally ill and possibly face tort action.

Capitalism is a vital part of modern society and I wouldn’t live in any country without it, but if there are no other values in a society save those of the marketplace, that society is in crisis. We have to stop arguing about the obvious and we have to stop treating corporate interests as if they were inviolate. Our physical and economic futures depend on it. Let’s put single-payer back on the table and justify it by pointing to the fiscal crisis in Medicare. And let’s stop paying Cargill, Monsanto and ADM to make us sick.

Tags: diabetes, factory food, health care, profit, reform