Everybody knows obesity is a problem, and that it's inflating medical costs that are gradually bankrupting our nation. But I think most people have a misguided sense that obesity is the result of fast-food using poor-quality ingredients and somehow tricking people into eating them. For example, I saw this article on BoingBoing talking about the uproar over the high calorie count in McDonald's new oatmeal.
Basically, it has "as much sugar as a Snicker's bar and as many calories as a hamburger". That sounds really alarming, but it made me wonder: how many calories does oatmeal normally have? What could McDonald's have possibly done to take something good and make it bad? So I did some research on oatmeal, only to eventually find that the BoingBoing commentators had done a lot more.
To make a long story short, the McDonald's oatmeal is totally fine. The oatmeal itself is mostly normal, and most of "extra" calories really come from them adding a bunch of dried fruit (which is hardly an atrocity) and adding brown sugar and cream by default (which is commonly done at home anyway). So... false alarm.
Again and again I think people overreact when it comes to the "quality" of fast food. Yes it's made fast and in high volume, but even with the freshest possible ingredients on hand I think the results would come out looking, tasting, and nourishing about the same. For example, In-N-Out arguably uses the freshest ingredients of any fast-food burger joint, and to compare:
McDonald's hamburger = 100g serving size, 250 calories, 9g fat
In-N-Out hamburger = 243g serving size, 310 calories, 10g fat
(Incidentally, the standard In-N-Out burger comes with a spread that adds another 80 calories and 9g of fat. But I'm going with the mustard/ketchup option to compare more equally to McDonald's.)
So the McDonald's burger has 2.5 calories/g, while the In-N-Out burger has only 1.3 calories/g. But both have about the same fat. What gives? My sense is the difference has nothing to do with the quality of the ingredients, and everything to do with In-N-Out putting heavy, water-filled veggies (lettuce, onion, tomato) on while McDonalds doesn't. I don't have the data in front of me, but I bet if you took all the veggies off the In-N-Out burger (or added an equal amount of veggies to the McDonald's burger) -- basically assembling them the same way -- you'd get largely the same results.
In other words, both use more or less the same quality ingredients, with essentially the same nutrition, despite McDonalds being demonized as the culinary antichrist while In-N-Out being some kind of organic savior.
In my opinion, the problem with McDonald's (or any other fast food chain) isn't that their food is so much higher calorie than if you were to fix it yourself. Rather, the problem is they cater to a customer base who is actively looking for high-calorie, high-fat food. Said another way, given a fully-stocked kitchen (and the willpower and expertise to actually cook), I wager most people would basically fix something as bad or worse than McDonald's, intentionally.
This is somewhat reinforced by this study that suggests that NY's "label the calories as big as the price" plan is failing to produce results. I'll admit, I thought the plan was a good one, and I'm disappointed it didn't work. This suggests people know they're eating crap food (even if composed of reasonable-quality ingredients), but simply don't care.
So where am I going with all this? I think the solution can't just demonize the quality of fast food ingredients (because they're fine) or emphasize how many calories people are buying (because they don't care). And it's not enough to highlight the long-term effects of those decisions; those are already pretty apparent and non-motivational.
Rather, we need some way to identify people who are on a bad long-term path and create short-term consequences. And by "we need" I mean "given that our country is being bankrupt by vast medical insurance programs with out-of-control cost increases driven by health epidemics such as obesity, taxpayers should demand" that something be done to prevent people from taking actions that leave us on the hook for massive medical bills down the road.
Similar to how people with good driving records and safe-driving courses get lower insurance premiums, I think we should do the same for Medicare/Medicaid. Create programs where people can earn better care by making healthy choices. Granted, healthy people need less medical care so it doesn't make sense to give them *more* of it as a reward for needing *less* of it. But what if healthy people got tax credits and prioritized non-emergency care. Shorter waits, nicer rooms, more choice. Everybody still gets the same quality of medical attention (for better or worse), but people who actively maintain healthy lifestyles are rewarded with status, convenience, and comfort.
Furthermore -- and this is the most important point -- it should be made very clear to you which "service tier" you're in at all times, creating an *immediate* positive consequence for healthy actions that normally only have long-term effects. So everybody who does nothing is lumped into the "standard" tier; you needn't do anything special. But you should be constantly encouraged to upgrade to the "premium" tier by just demonstrating healthy decisions. How exactly that is done is obviously a big question, but some ideas:
- Get credit for healthy-eating, healthy-lifestyle training courses
- Demonstrate participation in preventative care programs
- Get regular checkups to certify you haven't been abusing drugs
- Wear an electronic patch that measures caloric intake and expenditure
- Join a gym and hire a certified trainer who reports activity to your doctor
And so on. Every problem has a ton of complications, don't get me wrong. And it'll be a horribly political process to decide what's "healthy". But perhaps something like this can start to gradually steer us in the right direction?
Admittedly, that won't be enough. Not even remotely close to what's needed to actually get things under control. But it might be a step in the right direction of preparing people to resume individual accountability for their health given we probably have little choice but to vastly scale back coverage (perhaps starting with reducing end-of-life care, which is estimated to take roughly 30% of Medicare's budget), followed by probable rationing of key medical resources. (Read here for a hyperbolic freakout session about kidney rationing, which obscures a few good ideas under a heap of total garbage.)
Ultimately, I'm all for reducing government involvement in a lot of things. But it will mean *reducing*, not eliminating. I think we should provide a *minimum* level of universal healthcare, recognizing that it's simply not possible to give maximum care to everybody. And we should eliminate barriers that prevent private insurance health plans from operating at maximum competitive effectiveness.
At the end of the day, very expensive or end-of-life treatment is a luxury for the rich, just like helicopters and fast cars. Whether we like it or not, that's just the way it is. But like helicopters and fast cars, they're terrible investments on which only the rich should waste their money. Instead, we should focus on expanding coverage of inexpensive, early-life care to everybody because it's an investment in society that's returns dividends to us all. And that's what the government is there to help us do.
-david
