Medicare for All is a Bailout for the Food Industry
On the difference between health and healthcare
This draft was born a few weeks after the UnitedHealthcare CEO assassination, but last week’s confirmation of RFK, Jr. as the newest Secretary of Health and Human Services helped me find the words and motivation to get this piece across the finish line in order to share with you. I suspect that this piece will make a number of people uncomfortable, but I hope that you’ll bear with me.
Introduction
Medicare for All was probably the last grand policy aim of the Left as some attempted to consolidate under Bernie Sanders during the 2016 election season. While Medicare for All became a rallying cry that resonated across class and party lines, the Left that we got instead was the one Obama wanted. This version of the Left was rejected by American voters in 2016 with the election of Donald Trump (much to the surprise of the chattering classes), and was rejected again even more decisively with Trump’s re-election on November 5th, 2024. [1]
However, with the high profile assassination of UnitedHealthcare Group’s CEO Brian Thompson almost a month after the election [2], the topic of the American healthcare system came back into the news in a big way. The proliferation of both elite and pedestrian discourse about healthcare once again highlighted a guiding reason for why I continue to oppose Medicare for All as a desirable policy aim, even as I’m also critical of private payer systems as well.
While Medicare for All seems to offer a solution for a deep-seated and bipartisan frustration in our society, it nonetheless puts the consequences of corporate and regulatory decisions on the taxpayers’ bill. The people who grow our food, who manufacture chemicals for growing our food, who process our food, and who regulate what goes in our food are some of the most important inputs for health in this country, and Medicare for All subsidizes the effects of this population level poisoning which has been progressively taking place for decades.
Medicare for All amounts to something like a biological version of the 2008 bank bailouts — private organizations enjoy the profits of risky decisions, and then socialize the consequences.
Many people miss this because they really are out here thinking that the healthcare system is the provider of a resource called “health.” This misunderstanding, and the debilitating mindset which accompanies it, drives some of my deeper nopposition to the Medicare for All proposal. I read some words in an internet pundit’s analysis of the UnitedHealthcare killing, and it captured this misunderstanding so perfectly that I just had to share:
“UnitedHealthcare and its peers make their money not by providing access to healthcare, but by rationing a resource without which none of us can stay alive.” [3]
The notion of health which underlies these words shines through if we have the eyes to see it. The author believes that health is a “resource” which the healthcare system possesses, but which insurance companies are “rationing.” Without this resource, “none of us can stay alive.” He really thinks that without constant treatment from the healthcare system that he cannot have health. He sees health as something which can be accumulated or distributed by an institution. If someone cuts off our access to this system, we will shrivel up and die because we can’t access something called “health.” This is the mindset of the “disabled subject” which Ivan Illich worked to describe and combat.
A theoretical excursus on medicine and health
Contrary to popular belief, life does not have a health bar with health points like in a video game where you can simply buy and drink some potions to regain your stamina. It’s obvious that this is not how health works. Let’s be clear — health is an activity, not a state of being or something which is possessed. Health is created, achieved, and renewed at every single second by the successful operation of an organism. In truth, only you can give yourself health through increasing the energies and function of your body and soul. Health is you being fully alive, doing what alive things do.
So, what does the healthcare system deliver then? I think a more precise term for the product which healthcare delivers is “treatment.” The healthcare system provides “cures” in some cases, although even these cures often come with interesting side effects, but in many causes the best that the healthcare system can achieve is some amelioration of symptoms through a type of treatment.
Western allopathic medicine mainly excels at keeping you from dying. If you have a deadly disease, we’ve got antibiotics. We can keep your fluids replenished, your lungs pumping air, and your wounds clean. We can run diagnostics tests to monitor your condition, and even look inside your body. We can also achieve absolutely incredibly things with surgery, things that previous generations of humans never would have dreamed would be possible. Do you need a new heart? We can just take out the old one and put in a working one.
But when it comes to chronic conditions or questions of optimal function, we’re fumbling around in the dark. You have long term chronic pain? Alright, let’s cycle through various pain medications to find the best way to numb it. You have an auto-immune disorder? Yeah, we don’t really know what causes it, and the scientific community disagrees on what exactly it is, so we’ll just prescribe you a lifelong treatment of drugs which basically nuke your immune system so it doesn’t act up. You are obese? Okay, here, take this pill which will mask your hunger cues so you can lose weight (and apparently is now making people blind?). And so on and so on.
Allopathic medicine can probably save your life, but it cannot make you healthy. Health comes from the right inputs — eating real nutrient-rich foods, drinking clean water, regular physical activity, sleeping, regulating your hormones, and having your social and emotional needs generally satisfied. Doctors are aware of this (are you exercising?, they ask) and public health officials push vague advice to this effect (stop smoking! eat fruit! avoid fentanyl!), but these health inputs are never viewed as medicine. They are never viewed as the essence of the cure.
There is a saying that “food is medicine.” We have narrowed the idea of medicine down from anything we consume to the smaller set of ‘chemicals produced by certain companies.’ But Hippocrates, the father of Western medicine, would agree that food is medicine — his writings emphasize that medicine is about figuring out what to feed a sick human in order to help them to regain their health. Hippocrates understands that the body is healing itself, and the doctor’s job is to partner with the body in that healing journey by giving the body what it needs and nothing that it doesn’t. Ultimately, it will be the patient who heals themselves, or not at all.
The strange thing about illness is that a sickly creature will have lots of individual problems — trouble sleeping, inflammation, indigestion, headaches, irregular bowels, stiffness, random aches and pains — but treating any one of these will rarely the solve the others. However, if you instead focus on the right health inputs and achieving a higher state of function, the whole panoply of problems will generally vanish together. Individual dysfunctions can often resolve when a whole system begins to function more optimally.
Population Effects
Alright, but how is this relevant to Medicare for All as a policy? Do we just revert to the grumpy old libertarian line of saying that we don’t want to foot the bill for other people’s health choices, or do we go all in-on on the diet and health food industry telling people to eat their greens and cut carbs as an empowering alternative in the face of a dehumanizing capitalist system?
This is not a diatribe about pulling yourself up by your own bootstraps. We have to take a structural view on the issue, without also adopting a victimhood mindset which denies our own agency. A key tension which I’m constantly exploring in my work is how the social influences which encourage us to optimize our behavior at an individual level often serves as a way of compensating for structural dysfunction. The social costs of decisions made by those who benefit at the top often get pushed down to those on the ground.
I suspect that most people in our country more or less consciously act on the belief of the commentator earlier in this essay, namely, that “health is a resource monopolized by the healthcare industry and rationed by the insurance industry.” I think this view derives some of its intuitive sense from the commonplace experience of how sick we are as a population. If your baseline is illness and dysfunction, then it would not be unreasonable to assume that the power to be healthy lies not within us, but rather outside us, in the powers of experts and technology to confer it upon us. Under such conditions of general unwellness, the problem would be how to access this expertise so that we might receive health from its exclusive purveyors.
I want to avoid this section devolving into me just rattling off a litany of poor health outcomes we’ve been experiencing in our country, and how they have been worsening, but I want to lead by saying that while Americans are not dying from malaria, we’re experiencing something more akin to endemic levels of chronic conditions, pain, and bodily dysfunction at a population level.
For instance, we’re seeing more people than ever, but especially young women, suffering from auto-immune disorders, such as Crohn’s or Hashimoto’s. Gluten and lactose intolerance have become widespread. Our bodies are constantly undergoing low-level inflammation from the presence of seed-oils, processed ingredients, pesticides, and more in our food. Our grocery stores are filled with processed foods, and synthetic additives are included in even the most mundane products (try finding a carton of heavy cream without guar gum, xantham gum, or carrageenan in it. Good luck). We also eat many genetically modified grains and vegetables, many of which are sprayed with chemicals to kill pests. Oh, and did you know that your brain might have a spoon’s worth of plastic in it right now?
One thing we do know is that many chemicals and food additives which are banned in other countries are permitted in the US. Many people report effortlessly losing weight in Europe despite eating more grains and eating to satisfaction when they are there. This is even true of other Asian countries — my wife was diagnosed with an auto-immune disease, and often experienced severe gut issues, but she found that when she lived in Japan she could eat anything she wanted without any symptoms. Unfortunately, the very first meal she ate when she arrived in the US re-ignited her symptoms (it was a tortilla).
On their way out of office, the Biden Administration’s FDA issued a ban of red dye #3 in food, even though this additive had already been banned in Europe, Australia, and New Zealand for decades (they only permit it to be used in cocktail cherries). The research linking it to cancer in mice had been known at least since 1990 when the FDA prohibited red dye #3 from being used in topical medicine or cosmetics. Think about that — it was banned from being put in products for your skin, but it took 35 years to get it banned for things you will ingest? This is the state of our regulatory framework, and corporations having been taking advantage of this lax enforcement to push cheap synthetic products in our food.
This isn’t new. Business’ have always been trying to get away with diluting food with additives in order to reduce costs and make their product go further. An odd little book I quite like called The Good Old Days—They were Terrible! uses archival material from old newspapers to highlight terrible things about the past that we don’t generally have to deal with today, and have consequently forgot. In the ‘Food’ section, the author Otto Bettman highlights things like the rancid state of meat, the spread of disease via vegetables, or how butter in America during the Gilded Age was filled out with casein, water, calcium, gypsum, or gelatin fat, Many people could only afford to purchase ‘bogus butter,’ a slop made from unidentifiable animal parts processed with bleaches. Milk was typically diluted with water, and the poor quality of the milk was masked with chalk or plaster of Paris. In fact, testing by New York City’s health commission in 1902 uncovered that 52% of all milk being sold in the city was adulterated. Of course, perhaps you’d take that milk over the common ‘swill milk’ which came from sick cows fed solely on old whiskey mash, causing their milk to even make babies drunk.
The food and ingredients which makes up our nation’s food supply are largely the result of decisions made by individuals at private corporations, advocated for by lobbyists and trade unions, and all in concert with regulators at government agencies. The health of a people is not simply a function of individual willpower about what to eat or not, but that it also depends on the type, quality, and safety of the ingredients in food and chemicals in their environment. We have to realize too that regulators often come from private industry or end up taking powerful positions in private industry once they leave, so there persists a deeply incestuous relationship between these profit-seeking organizations and the agencies which exist ostensibly to regulate them for the safety of the consumer.
For what it’s worth, I by and large don’t blame farmers for these outcomes, as most of them are at the mercy of the demands placed on them by an increasingly consolidated food industry. Monocropping, using GMOs, using pesticides, etc are all “best practices” pushed by the industry and supported with subsidies, so farmers as self-employed entrepreneurs are just following the incentives. Much of what is produced, packaged, and sold in our country is making us as ill at both the individual and population level, and the market mechanisms which cause these outcomes are primarily influenced by the three groups I mentioned above — corporations, lobbying groups, and regulators.
In closing
This brings us back around to why I oppose Medicare for All — an unhealthy food supply is one major contributing factor to rising levels of illness in our country. To those who believe that health is a resource stewarded by healthcare, this rise in illness looks like an access issue. Certainly there are people who need treatment but cannot afford it or they have received treatment which became financially ruinous for them. This is also a social evil. But I want to advocate for reforming the inputs of our health as individuals and as a population rather than increasing the amount of public funding which we put towards treatment of the issues which arise after the fact. That is socializing the consequences of corporation’s profit-driven decisions (and the inadequate action taken by governmental agencies to curb corporate power and to protect people).
If we continue down the path that we’re on where we socialize medicine in our country without reforming our food and pharmaceutical industry, we’ll create a situation where sickness and chronic illness will continue to rise, symptoms will proliferate without the root causes being addressed, and healthcare will balloon as it demands more and more resources. This also creates perverse incentives for private industry where the sicker we become the more public money they can access by charging the government for bandaids for precisely the issues they contributed to causing in the first place.
Let me close by noting that none of what I’m about to say should be taken as a defense of the current healthcare system. I would hope that this is obvious by now, but this rant isn’t some “best of all the worst possible systems” nonsense like the stuff that conservatives spout about capitalism. Everything about healthcare in our country is deeply dysfunctional, and we need to change because our lives are quite literally at stake, but we won’t be able to untangle this rat’s nest of private moneyed interests without decisive political intervention (which is probably why so many people reflexively sympathize with the killing of the UnitedHealthcare Group CEO — they feel powerless).
We need to change healthcare in this country, but I’m arguing that Medicare for All is not the solution we are looking for. It’s a moral hazard that doesn’t address the underlying causes of sickness, and instead foists the consequences of private moneyed decisions onto the public’s back. The people always pay twice for the mistakes of the rich — first in personal ruin and then again in taxes.
I do not support or advocate for Medicare for All, because I’m convinced that this policy would let corporations and regulators get away with making us sick. We would be better served instead by pushing for sustainable farming practices, tighter regulations on food ingredients, more scrutiny on medications, more impartial studies of pesticides and everyday chemicals, replace lazy and complicit regulators, close the revolving door between the private sector and the regulators, and ruthlessly punish food and chemical companies who profit from poisoning our food and polluting our environment.
Make corporations and regulators face the music, and let’s start getting healthy together again. That will be the first and most meaningful step towards true healthcare reform.
Thanks for reading, and don’t worry — this publication will never be one of those insufferable health influencer accounts. Frankly, I like to drink and smoke. I’m not planning on giving those up anytime soon, and I do also personally struggle with keeping my weight down and getting in enough physical activity. My wife too has a chronic illness, which has forced me to become more conscious of the food industry in our country. I know it’s controversial to say in many circles, but I’m excited to see what RFK, Jr. might be able to achieve in terms of disciplining the private sector and rooting out corrupt regulatory practices in the food and pharmaceutical industries.
[1] Obama’s punishment for scuttling the will of the people, both in elevating Hillary over Bernie and in anointing Kamala without consulting voters, ultimately gave us two terms of President Donald Trump. One wonders how different history would have looked if the Bernie vs Trump contest had been permitted by Democratic party leadership back in 2016.
[2] Just wanted to note down here that I’m still not 100% convinced that it was Luigi Mangione who committed the killing. Some details still don’t match up, and this whole business has all the classic hallmarks of a psyop, but I’m not working on developing any sort of coherent theory about this. I’m just expressing some mild skepticism about the official narrative that is circulating. That’s also why I’ve chosen to simply refer to the killing or the incident, rather than attributing anything to Mangione (everything remains alleged).
[3] From an editorial note by Spencer Ackerman, editor of FOREVER WARS, appended to the piece “Exiting Luigi’s Mansion” by Sam Thielman.