On Friday, June 19, our younger son graduated from high school.  As I listened to the various speakers and the roll call, I thought back to my own high school graduation in 1966 from a Catholic high school in Rochester, New York.  Many thoughts came to me during our son’s two-hour ceremony.

I was angry and disappointed that I was not selected as valedictorian.  The school had consistently manipulated and changed grading rules to give the advantage to my rival, who actually was a lifelong friend of mine.  They did so because he had gone well beyond any other student, including me, in supporting the school and his classmates, and deserved the award as the award criteria should have been designed. However,  the school had locked itself into a set of rules in which the valedictorian was the person with the highest grades.

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In the Saturday-Sunday Wall Street Journal,  for June 20, there is a lengthy article entitled “The Myth of Prevention,” by Dr. Abraham Verghese of Stanford University.  It is a very thoughtful article with many good insights, but one comment captured in two separate sentences is worth a great deal more commentary:

“…a dollar spent on medical care is a dollar of income for someone. ..It may be the single most important fact about health care in America that you or I need to know.”

I experienced this when I was advocating postal reform.  Everyone understands that we need to reduce the number of retail post offices, postal processing centers, and, probably, the number of postal employees doing what they are doing today.  However, no elected official wants to sit idly by and let a postal facility close in his or her district, state, city, or county, because people will lose jobs or income.

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At a time when businesses are trying to reduce costs to continue to be profitable when revenues are either declining or flat, it is tempting to reduce spending on government advocacy, especially if a business believes that it is adequately represented by trade associations or coalitions.  Nothing could be riskier.  Let me illustrate my point by discussing the evolution of health care legislation.

Contrary to what is sometimes reported in the popular media, large, self-insured employers want to continue to control and manage their own health plans for their employees, and are unenthusiastic about the “single payer” system, which would take control of health care costs away from them, and place it with a government-owned organization.  While some employers think a single payer plan will reduce their health care cost outlays, this is probably not the case, and, more likely than not, they will pay more, except that it will be in the form of one or more kinds of taxes.  In fact, when I hear the comment that Toyota has an advantage over GM because Toyota does not have to pay health care costs, I am astounded that any intelligent person accepts this argument uncritically.  Someone, whether it is Toyota or another category of Japanese taxpayer, pays for the health care costs of Toyota employees.  While a single payer system spreads the cost over a larger population, the real driver of health care costs is not who pays, but how much is paid, based on usage and cost-per-unit.

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•       Successfully combating obesity is simply a matter of controlling calorie consumption relative to the calories burned off through exercise and other daily activities.
•       In addition to controlling overeating, good eating includes having a diet that includes the correct balance of proteins, complex carbohydrates, fat, and minerals and vitamins.
•       Overeating is partially a result of a combination of the great success food companies have had in finding the “sweet spot” in the palette of eaters in which they are attracted to an optimal combination of sugar, fat, and salt.  Over time, food producers, restaurants, and grocers have gotten better and better at marketing the pleasurable aspects of food.  Historically, people stopped eating when they were full, and were constrained from overeating by the combination of the high cost of food, the unattractiveness of much of what they were eating, and the fact that their body signaled that they were full.  Today, unhealthy food is lower cost than healthy food, unhealthy food often tastes better than more attractive options because of brilliant product development efforts, and because there is a delay between when someone has eaten too much and when they feel full.
•       Combined with the brilliant product and marketing efforts of food producers and marketers is the environment in which unhealthy eating is almost inevitable.  Dr. Wansink’s book, in particular, identifies opportunity and disparate availability of good and bad foods as the reason why many people unconsciously overeat unhealthy foods. Many lower-income neighborhoods are “food deserts,” which means that they lack healthy food that is affordable, available, abundant and attractive.  Many public health officials have zeroed in on this problem.  For example, in a great report entitled Life and Death from Unnatural Causes: Health and Social Inequity in Alameda County,  the Alameda County Public Health Department states on page 97, “A lack of healthy food outlets and overabundance of liquor stores are part of the legacy left behind by several decades of systematic disinvestment in low-income neighborhoods.”

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