Ending the 'Sick Care' System

Kids get these little packages [in the program]—apples, oranges, broccoli and baby carrots are already sliced for them. In the current farm bill, I fought very hard and I got $1 billion for this program. Within five years, we'll be able to get close to 90 percent of all the elementary-school disadvantaged kids a high level of free and reduced-priced lunches. These kids are now eating fresh fruits and vegetables. 

People get their taste preferences when they're young, so if we can get kids enjoying healthful foods like that when they're young, they're much more likely to do so when they're older.
Absolutely. A lot of these kids getting these fresh fruits and vegetables at schools are going home and asking their parents to get them. I was at a fourth-grade class, mostly poor kids, and they were having fresh oranges, and there were kids who had never had a fresh orange in their life. 

As you know, many of the subsidies in the farm bill are perverse, making it significantly cheaper to eat fat, salt and sugar than fresh oranges.
Well, we're changing that. For the first time ever, I got fruits and vegetables included in the farm bill. We spend a staggering $2 trillion annually on health care, more than any other nation in the world, yet the World Health Organization ranks U.S. health care only 37th among nations. Thirty-seventh! We are 20th out of 21 industrialized nations in the quality of health care for children. When I look at these statistics, it seems as though we have lost our capacity to be shocked or outraged. Just how much evidence do we need that America's approach to health care—or should I say sick care?—is not working? 
 
The only state that mandates physical education in schools is Illinois. That's another approach that red states and blue states can get behind: getting exercise back in our schools. As you know, exercise and better nutrition improve academic performance as well.
Exactly. I'm looking at tying reimbursements for school meals to schools that have a physical exercise program, and/or giving bonuses to schools that have an exercise program.

The Robert Wood Johnson Foundation [a philanthropic organization dedicated exclusively to health and health care] has shown that when you change public infrastructure, it really does change behavior.
I put an amendment in the last highway bill that said that any state or local government that gets federal money for highways, bridges or streets would have to incorporate in their planning bike paths and walking paths. It lost, but part of my wellness initiative is to use the finance committee to put out tax incentives to workplaces that offer comprehensive wellness programs. Allocate more Medicare dollars for early diagnosis and prevention with no copays—if you have a colonoscopy, there shouldn't be a copay; there shouldn't be a deductible. We waste so much money in Medicare. For example, Medicare will not pay for any kind of diet or nutrition counseling if you are pre-diabetic.

But they'll pay to amputate your foot …
… After you get diabetes. It's just nuts. So these are the things we've got to change. A robust emphasis on wellness is about saving lives, saving trips to the hospital and saving money, and it's the only way we are going to get a grip on skyrocketing health-care costs. To date, prevention and public health have been the missing pieces in the national conversation about health-care reform. It's time to make them the centerpiece of that conversation. Not an asterisk. Not a footnote. But the centerpiece of health-care reform.

© 2008