Big meals and big costs

Now what?

Some of you will remember I had the privilege of attending a couple of meetings in Seattle week before last following a few days in New York City in July. I also made it to Minneapolis and Kansas City earlier this year so I have eaten out a lot this year already.. I could not help but notice our meals are getting humongous in this country. Doesn’t seem to matter where one goes, food in large proportions is accessible to most of us.

And we all like to seem happy about that if cleaning our plates is evidence of approval.

I understand that is we like getting our money’s worth out of things but we always, always, ALWAYS seem to assume more is better when it comes to food.

Buffets have always been a big deal in America. The pandemic seemed to curb our appetite for them somewhat but we did not stop craving these enormous portions now served at tables or bars or in take away containers.

French fried potatoes, those seemingly ubiquitous savouries from the starch family rather than our friends across the pond, overflow on plates already laden with sandwiches well over 16 ounces of hamburger, deep-fried fish, or Kansas City burnt ends. It’s notable when a vegetarian burger coexists with a salad as the preference is most definitely for that heaping joy of fries.

Oh, and it is a given that everything will have cheese. For vegans or lactose-intolerant, this is frustrating but one learns to adjust. People simply buy the argument that that cheese will fix their decaying bone density with lots of calcium. This disputable but restauranteurs respond to the common demand for cheese.

Even salads which our parents’ generation probably saw as a vegetable-centric small bowl with greens, reds, whites, and perhaps purple (cabbage) invariably now also have the added option of adding something to make it a yet another enormous entree. Servers are crestfallen if you decline when they suggest, ‘You do want to add a protein, don’t you?’. They have no understanding that greens, reds, whites, and purples actually already have protein, too.

I am hardly one to criticize others since weight has been my biggest obsession for my entire life. Growing up thinking I was a failure if my body did not look like the 1960s original Barbie doll (no, I assumed that was what an average person looked like even if I did never seen anyone who looked like my doll). I have done every single diet that existed except the one that actually achieved the Barbie look; somehow, my body always failed to mirror the doll. Funny about that.

I raise this observation about the size of our meals, however, in conjunction with the health care expenses that are consuming us as a nation. We currently spend 18.3 cents of every federal budget dollar on health care with expectations that number can only climb significantly as dementia becomes more common, diabetes continues spiraling, and arterial disease remains the single greatest cause of death in the nation. Cancer in its many horrible forms is terrifying and expensive but does not rank as high as heart disease on the charts of death-inducing conditions.

We have come to rely on remediation rather than prevention. That is fine but expensive. There are also arguments, I know, that heart disease, diabetes, high blood pressure, stroke, gallbladder disease, blah blah blah blah blah are genetic so the patient is innocent. Perhaps that is the case but it seems the medical researchers are still fighting that fight.

What is clear, however, is that we spend billions of dollars on medications to remediate conditions that lesser amounts of food might help, specifically lesser amounts of saturated fatty foods. The effects of our love for these foods are costing us an awful lot of money.

Other options?

The Biden administration announced negotiating lowering costs for 10 frequently-prescribed drugs which Medicare patients require such as blood thinners, insulin, anti-inflammatories, and blood cancer medicines. According to the Associated Press, between 1 June 2022 and 31 May 2023, Medicare paid more than $50 million for those prescriptions alone. Biden says he will help consumers but making the drug companies lower their costs.

I predict, regardless of intent, this will join the queue of topics that somehow goes to court. Or a successor administration could toss the negotiations altogether.

As the RAND Corporation pointed out in 2020, those with health care problems but lower incomes find the challenge of drug costs more painful in the United States than do the wealthier among us. One often hears about seniors forced to choose between paying for heat during particularly harsh winters versus paying for their medically-prescribed remediations under our system. I cannot say how common that problem is but those on fixed incomes certain would find it hard to stretch their dollars in Texas, for example, where sustained heat demands this summer must have eaten into some of their fiscal resources.

President Biden is appealing to those lower income voters, many of whom are in states which voted for his opponent in 2020, as well as aiming to change a public policy condition of a Medicare system spending ever increasing amounts without receiving greater contributions. Concerns about the system’s solvency (ability to pay for incurred medical costs for the millions of people on its rolls) and sustainability (paying with the formula it currently uses for mandating the various levels of required individual contributions) require regular infusions of cash from Congress as Republicans threaten to slash the social safety nets of the past ninety years. Negotiating lower drug prices would help but certainly not solve one of the system’s most fundamental challenges.

Tying of this together means that eating more may be increasing our costs for Medicare (and likely private health care as well). Is there nothing we can do?

No, there are always options but the crux of the question is whether anyone wants to exercise them. What are they?

We could raise taxes on all sorts of things such as taxes on consuming more food. Not likely but many cities do take baby steps towards holding the food providers accountable by mandating calorie counts on menus and on display where consumers buy their prepared foods. It wouldn’t be too far a step to tax say a meal with 3500 calories (yes, there are many meals that large today). That sort of tax could drive down consumption but likely would also drive down honesty about calorie counts.

We could as individuals exercise more control over our eating habits but we tend to glorify eating as one of the greatest social, personal, and stress-reduction events in our lives. Personal responsibility also abuts evidence that diets simply don’t work in 95% of the cases for biological as well as willpower reasons.

We could increase contributions to Medicare by raising taxes. Ask the Bush family how that tax things went in 1990 for George H.W. Bush. I am not aware of too many (any?) Republicans who have supported tax increases since. Democrats are not wild about that solution, either.

We could outlaw certain types of food, particularly that which contribute to the most common medical conditions requiring these drugs that are so expansive along with various interventions such as angioplasty, heart replacement, etc. America’s history with Prohibition and illegal drug consumption does not indicate outlawing behaviour works well but we did incentivize seat belt wearing in the 1980s so perhaps there is an incentive in n our future on this topic?

We could fund massive amounts of funding for medical research to a find cheaper ways to address these health problems. Unfortunately, a layman’s read of what gets published indicates this stuff is so complicated that single-causal solutions, as most scientific research is done, would probably either take forever or never accomplish what we need.

We could change eligibility for Medicare. Means-testing, or deciding that someone with an income over a set amount, is able to pay for her or his own care so that person is not eligible nor required to sign up for Medicare, might help. Possibly but do you recall Illinois Representative Dan Rostenkowski harassed by seniors when he advocated de facto for means testing another program in 1989? Elderly of all income levels seem to expect equity in contributions and access so that likely would discourage this.

Or we see our system continue bumping along. This likely is the outcome but can it be the path for sustainability? What is the root of the problem the cause of the effect? Is there even a problem? Any reason to look for a solution?

What I have laid out here is one of those Actions Create Consequences concerns that strikes me as important but likely politically insolvable. One of the issues we always teach in strategy is that many potential approaches to addressing a problem are utterly and completely infeasible which invalidates those approaches, regardless how brilliant or needed they are. The incredibly intricate questions of weight, food, size of meals, health care links, and everything else is just that—way way way complicated and complex.

Perhaps there is no need to solve it at all. One of the loyal readers of this column said to me almost 40 years ago, with her background in health care, that genes are our destiny so perhaps we really have nothing we can do and it was all predetermined at birth.

That is not generally the American way as we think we can fix most things. She is British, interestingly, so perhaps the NHS and health care professionals there see it differently. But, it certainly is a notable problem for us right now as we aim to fix things but can’t wrap our arms around this one.

I truly would love to hear your suggestions!

Thank you for reading Actions Create Consequences. Thank you especially as paid subscribers. Be well. FIN

AP, ‘House Panel Leader Jeered by Elderly in Chicago’, Newyorktime.com, 19 August 1989, retrieved at https://www.nytimes.com/1989/08/19/us/house-panel-leader-jeered-by-elderly-in-chicago.html

The RAND Corporation, ‘Burden of Health care payment is greatest Among Americans with Lowest Incomes’, 27 January 2020, retrieved at https://www.rand.org/news/press/2020/01/27.html

Tom Murphy, Amanda Seitz, and Chris Megerian, ‘10 Drugs Targeted for Medicare Price Negotiations as Biden Pitches Cost Reductions’, apnews.com, 29 August 2023, retrieved at https://apnews.com/article/medicare-prescription-drug-negotiations-biden-inflation-2bf6775c3431111a2cd03fd033caefa7

Rebecca Pifer, ‘Medicare go-broke date pushed back to 2023’, healthcaredive.com, 3 April 2023, retrieved at https://www.healthcaredive.com/news/medicare-trustees-report-solvency-2031/646627/