America's health care system is still largely fee for service, which breeds independence and self-interest (and often profit) among different types of providers, with no better outcomes and greater cost to many patients and taxpayers. That has made figuring out a coordinated, outcome-based system difficult.
Perhaps, then, it's not surprising that America's farm policy and health policy are even less coordinated, if that is possible.
The Food and Drug Administration is one agency, with a mission to ensure the safety of both food and drugs, but that is about the extent of coordination.
The FDA is part of the Department of Health and Human Services. Farm policy is run through the Department of Agriculture.
There are plenty of big, but less-than-obvious factors. However, while the government promotes the consumption of fruits and vegetables, it spends much more money subsidizing the growth of corn, wheat, rice, soybeans and cotton. Part of the subsidized corn goes to feed cattle and pigs, which contribute cholesterol to the arteries of Americans. Even sugarcane production is supported by a nation whose biggest health problems are obesity, heart disease and type 2 diabetes.
Meanwhile, the National Institutes of Health gave out nearly $1 billion in 2012 to fund studies of drugs to treat type 2 diabetes after people are diagnosed, with some of that cash going to drug companies looking for a treatment. Merck's best selling drug, Januvia, is for type 2 diabetes.
"About 70 percent of health-care costs are from chronic diseases and for the most part they are caused by lifestyle problems liked bad eating and lack of exercise," former Congressman and Agriculture Department Secretary Dan Glickman said Monday with some frustration during a meeting with the Inquirer Editorial Board. "Our farm bill has nothing to do with our health-care legislation. It is a massive wall between the two."
Glickman was joined at the Inquirer by former Maine Senator Olympia Snowe. Both are senior fellows at the Bipartisan Policy Center in Washington. Founded in 2007 by former Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole and George Mitchell, the BPC says it is the only Washington, DC-based think tank that actively promotes bipartisanship and works to address the key challenges facing the nation.
The Bipartisan Policy Center is partnering with the National Constitution Center in Philadelphia for a Tuesday afternoon event that is part of the Commission on Political Reform’s series of National Conversations on American Unity. Tuesday's discussion is about public service.
Tickets were free, but they are all gone, according to the Constitution Center web site. Watching a web cast can be done at fora.tv.
The current farm bill fight is over whether to separate crop subsidies for farmer or agribusinesses from food subsidies for poor people. There is some debate about whether price supports, crop insurance and other subsidies are really necessary at all, especially when the money goes to big agribusiness and not the stereotypical family farmer. But the country's collective health and finances might be better off if there was more discussion about what crops are subsidized.
Groups representing U.S. fruit and vegetable grower have often declined subsidies, so they were freer to raise prices.
"One of the issues at the forum was how to integrate farm policy and health policy in a much better way," Glickman said. "That is a big issue. I suspect with limited federal dollars in the future and people's attitude about the farm program changing, that will be a bigger piece of future farm bills."