Bringing Wellness to an Insurance Fight

Twice now, when asked his position on single-payer health care or a public option, our congressman launched into a dissertation on the problems of junk food and childhood obesity, and how wellness must be part of any health care reform. [Full disclosure: I worked on his first campaign.]

The first time, it just seemed like a pretty odd segue. But okay, who can be against wellness or reducing obesity?

The second time wellness made an appearance, it was head-scratching strange. Constituents come to talk about insurance and end up hearing about fat kids and eating more fruits and vegetables. And personal responsibility. Who can be against personal responsibility?

So, what's going on? Why are we bringing wellness to an insurance fight?

The wellness meme has been circulating widely on Capitol Hill of late. It pops up with talking-point regularity in House and Senate hearings on health care reform, among insurance CEOs and among politicians in the habit of calling for “clean” bills uncluttered by side issues.

Some Democrats may hope wellness, prevention and personal responsibility elements will be the sugar that makes the reform medicine go down for Republican obstructionists. But they are also rather convenient distractions for health insurance giants eager to divert opprobrium from their bad habits – rescission, for example [1] – to their customers’.

“I’m sorry, Senator, but how can we agree to keep insurance costs down and not rescind cancer patients' coverage when our customers are fat? Do you realize that obesity in America is....”

Congress seems nervously eager to water down any form of public insurance option. Co-ops and triggers have been attacked as obvious gimmicks for sabotaging a robust public option. However, it is harder to find fault with promoting wellness and reducing obesity.

So, what could be wrong with encouraging Americans to eat more vegetables? Why not include wellness provisions in a health insurance reform bill?

For one, because the food industry is big business.

A recent Guardian article [2] profiled anti-junk food activist, MeMe Roth, and her one-woman crusade, National Action Against Obesity. But someone else provided the money quotes:

Marion Nestle, the author of Food Politics and professor of nutrition, food studies and public health at New York university, explains that "the basic problem is that if people are going to do something about obesity, they need to eat less, and eating less is bad for business. The food industry is a trillion-dollar-a-year business." Nestle tells me that 3,900 calories are produced per capita every day - roughly twice the average need. "We're talking about capitalism here," she says. "It was very difficult for the Bush government in particular - they couldn't tell people to eat less." Couldn't they? I ask. "Well, they could if they hadn't cared about getting elected."

Nestle also argues that nutrition and medical societies won't act because they are funded by the food industry.

To date, the health care reform fight has been mainly with the powerful, well-funded insurance and pharmaceutical lobbies. Add harmless-sounding wellness provisions to insurance reforms, however, and you invite the food industry to start throwing its money into the fight as well. Achieving the meaningful insurance reform that the public demands is going to be hard enough without inviting another family to the feud.

Promoting healthier lifestyles is good policy. But for the American people, passing health care reform is fundamentally about their health insurance. It should remain fundamentally about their health insurance. Passing a separate bill specifically designed to promote wellness and fight obesity would make a dandy encore.

Our elected leaders' first priority should be to make sure that all Americans can get health coverage as good as theirs. They can tackle problems like reducing Denny Hastert’s girth later.