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Why national health care is necessary for a viable food system


And, of course, we can see that other states are leading the way here - most notably California, which plans to resolve its budget crisis not by legalizing pot or releasing non-violent drug offenders, by stripping benefits from children, the disabled and the elderly. But California isn’t alone - children’s health care is threatened or there are pushes to curtail it in nine other states, and I suspect it is only a matter of time before more states make the push to cut health care programs for children and the working poor.


In _Depletion and Abundance_ I included a chapter on health care - on the ways that could keep national lifespans up and spend much, much less than we do now - half as much or even less than that. It involves a great deal of system triage and difficulty, but it is possible - and IMHO, in the end, as long as we imagine that the goal of national health insurance is not keeping infant mortality low and lifespans high, but the serving of people accustomed to a large range of drugs and interventions with as may drugs and interventions as possible, we are facing trouble.

And yet, we need national health care desperately - we already have a tiered class system in the US where those who are poor and lack health insurance get sicker, die younger and suffer more. We already have a lifespan pathetic in the developed world - we are 44th, and lifespans are declining in many poor counties in the US.

We need national health care because otherwise we will see that class division, and the differences in lifespans and infant mortalities between rich and poor grow and grow. We need it because our current system is too costly and devours too many resources in every sense. We need it because it is a basic issue of justice, and because having the crappiest medical care system in the developed world is not an honor. We need it because we already bear the costs of medical care for the uninsured in our society, both directly and indirectly - we all pay for the poor mother who takes their daughter to the ER in the middle of the night for an ear infection that could have been handled with a ten minute office visit. We already pay for the people who age into Medicare with uncontrolled diabetes and high blood pressure, whose medical costs are double the costs they would have been if they’d had basic preventative care. We already pay - the question is whether we pay honestly and directly, or inhumanely and dishonestly.

But we need national health care for another reason as well. We need it because we need sustainable food systems, and national health insurance is the key to ensuring that we can have the Nation of Farmers we so desperately need to be. Because one of the things preventing people from farming, one of the things small farmers off their land is the cost of medical care.


Among younger small farmers getting started, I’ve watched many of them struggle with the insurance conundrum - they start out young and healthy, and often are willing to forgo health insurance because they truly and honestly want to do something good. But farming pays poorly, and the first serious injury can be a disaster - and working outside all day, you get hurt sometimes. Or perhaps they have a child - even those able to take on a homebirth find that the cost of having a child is a few thousand dollars or more - on a small household income. Those who must have a hospital birth or more interventions can find themselves rapidly indebted. Soon, finding a job with health care coverage starts to look awfully good - and there goes the farm, or it goes down to a part-time venture.

Farmers who experience a major injury or illness risk losing their land to bankruptcy - while losing your home is always traumatic, there’s a big difference between losing the house you love but that mostly provides shelter and a good school district, and losing the land you use to make your living. Up to 10% of all agricultural bankruptcies are linked to illness and injuries - mostly among the uninsured. Once the land is lost, it is gone - most farmers once out of agriculture, are out for good.

Without a national health care system, we can become a nation of hobby farmers and victory gardeners, but that won’t resolve the grain production problem, and it won’t feed our cities. A lot can be done by home scale agriculture, and I am an ardent proponent of it - but we need professional, full time farmers as well, and without insurance, the lure of any other work that covers the child’s asthma medication or the husband’s heart pills will always drive agriculture. What parents wants their child to go into a profession that leads in so many ways to heartbreak and loss at so many levels - including the fact that one medical crisis is the end.

We have spent four trillion dollars bailing out the banks already, and committed another 9 trillion at last estimate. Now whether you are a fan of big central government or not (and I’m not for many purposes), I think there can be little debate between honest people on the left and the right that the money would have been better spent serving the needs of people in need than bailing out the banks. And we simply cannot allow our venal foolishness in subsidizing the rich to allow us to forget that we can and should take care of the basic needs of the population.

It is certain that there will be costs and losses in whatever system arises - in _Depletion and Abundance_ I strive to acknowledge that we cannot do all the things we do at present, and that will hurt some people. That said, however, enormous cuts could be made in the costs we incur at critical times in our lives - for example, 1/3 of all medical interventions take place in the last 3 years of life. Some of that is inevitable - someone who gets cancer, has major interventions, but then dies two years later will fall in that category. But an enormous number of those interventions operate simply to draw out the process of death and add to suffering - my great-aunt, visibly dying, was pressured into having open heart surgery a few months before she died, simply because no one would say “you are dying, it is time to talk about relieving your pain.” My husband’s grandmother was pressured into giving her dying husband medications to prevent a heart attack that caused him great discomfort - at a point where a heart attack was the most benign and merciful sort of death possible.

Even if we were simply to radically cut back our interventions at the time of death and birth - for birth too is radically overmedicalized, and many nations successfully demonstrate that the safest form of birth, barring medical complications that affect only a small percentage of the population, is home birth with a midwife - and shift our emphasis not to treating disease, but to preventing it, we could afford health care that would keep lives long and infant mortality low, that would minimize suffering and allow us to keep our farmers farming and every other useful person engaged in subsistence and cottage industry business going, doing what we desperately need - increasing the self-sufficiency of our nations, states and communities.

Few of us think of the debate on health care in terms of food security and our agriculture - but we are on the cusp of a great shift in our food system, mostly driven by demographics. The average age of US farmers is approaching 60 years old, and there are not enough young farmers to follow them. If we do not make it possible to go into farming a profession - if we make it only the province of the young, the healthy, the childless, we risk facing a national food crisis far more acute that the one shadowing us due to other causes. The reality is that all of us have a real investment in our country’s continuing to produce sufficient food, and the right kind of food - and that investment requires that it be possible to become a farmer without sacrificing your health.



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