Eat, drink and be merry...

For tomorrow you may pay the penalty

A few days ago a friend said that she thought people who have

unhealthy life styles should not have their medical costs covered by insurance. Health insurance rates are sky-high, and it is unfair that people who live healthily have to pay for other people’s bad choices. While I see her point, loud inner voices were clamoring against this point of view, so I decided to check out some of the facts and look into the arguments for punitive measures and against them.

The facts are indeed shocking. Something like 20% of US health care costs are spent on obesity-related problems. Alcohol abuse costs the US economy more than $200 billion a year. Tobacco, drug addiction and risky behavior all take a toll as well, although smokers in the US apparently pay higher health insurance rates than do non-smokers.

Most of these costs are paid for by society, not only in high insurance premiums but also government health care and disability benefits. These are only the direct costs, with time lost from work, prevention campaigns etc. also adding up to hefty indirect expenditures.

In favor:

In light of these figures, it is understandable that there are several arguments in favor of making people with unhealthy life styles pay the costs of their choices. Lowering tariffs for the rest of the population is the most obvious. In addition, one argument goes, knowing that they would be out of pocket were they to end up in the doctor’s office or in hospital would have a motivating effect on getting these people to live more healthily. Most often encountered is the argument for moral individual responsibility. These people living carelessly are doing something wrong and they should pay for it.

Against:

There are, surprisingly, more arguments on the other side, i.e. that

everybody should be treated equally. Solidarity, for example, which is of course the philosophy behind insurance. Then there is the question of people who are addicted, who cannot be said to be choosing an unhealthy lifestyle, as do people engaging in risky sports, for example. From the practical point of view, people who give up unhealthy behaviors will probably live longer, thus costing society more in the long run when they reach old age.

Social inequality is cited as a reason against making people pay the costs of their unhealthy choices, for such costs would bite far more heavily into the budgets of the poor than of the rich. This argument is applied to the effect of indirect penalties such as higher cigarette taxes as well. Addicts barely managing financially will have to choose between their drug and having enough food, for example. For an addict, it is unlikely that higher taxes will have the desired effect, in any case.

From the purely practical point of view, it is often impossible to

prove that a particular individual’s medical problem stems from bad lifestyle choices. One envisions doctors having to make difficult judgment calls and court cases as a result, perhaps leading to the setting of arbitrary limits, for example the number of cigarettes smoked per day that divide the good from the bad. “Health police” would be a part of our vocabulary.

In thinking about “lifestyle choices” one sees a difference between those that are unhealthy and those that are risky. For someone in the ICU with concussion and multiple fractures after a parachuting accident, cause and effect are pretty obvious. But should parachuting therefore be classified as “risky behavior”? Boxing? Playing football or ice hockey? Bungee jumping? Even here categorization is difficult and would end up being judgmental.

It is perhaps just the judgmental, moralistic and socially unfair attitudes that rub us the wrong way. Insurance, based on solidarity, has been around for a long time and enjoys widespread acceptance. Perhaps we have to realize that those who live riskily or unhealthily are apt to suffer physically, mentally and emotionally at some point from their lifestyles, and that is punishment enough.

Let's eat....good food

In his book “Food Rules”, Michael Pollan sets out a number of rules to help one negotiate the myriad choices, good and bad, in the eating arena. He begins by saying “Eat Food”, which sounds obvious until he outlines the pretend food, junk food, additives etc. that masquerade as real food.

So what is real food? It runs a whole gamut, from the wild, the unwashed, and the uncooked  - berries picked from the vine on a walk - to the sophisticated creations of the cook’s kitchen. What one realizes when one starts thinking about real food is that it is often associated with memories that flavor it with nostalgia. Let’s take other wild foods, for instance. There are dandelion greens that I remember my mother gathering and cooking, the woodruff she put in white wine and that I have put in a Bowle, mushrooms that one gathers with a group in the woods, the plentiful wild garlic perfuming the woods here in Switzerland.

Then there are the old-fashioned sounding purslane, dock and sorrel, as well as linden, hickory nuts, watercress and wild game of all sorts. I remember homemade elderberry wine in Sweden, and wild strawberries remind me of jars of jam on a windowsill, with the light dazzling through the wonderful red color. Then there is the handsome wintergreen shrub and myriad fish, from crayfish on up to salmon.

Our ancestors ate all of the above, and at some point someone got the idea of domesticating some of these wild plants in a kitchen garden. Certainly easier to gather, so that one has time to do a bit of home processing, making the likes of chutneys, applesauce and pesto. A friend and I trade chutneys, hers made from her abundant figs, mine from the last of the green tomatoes in the fall. Applesauce and its further processing into cake belonged to my childhood. Little jars of homemade pesto nestle in my freezer for winter meals.

The kitchen garden spread out to the Saturday farmer’s market and then came its big brother, the supermarket, with its association with processed food. Not that processed food got its start there, basic processed food is as old as humanity. One thinks of flour, sugar and molasses, yogurt, cheese, dried fruits and legumes, cider, wine and beer, dried and smoked meat and fish, coffee and tea, soy sauce and tofu, sauerkraut and kimchi, all aimed at longevity not possible with fresh food.

Why, then, is the term “processed food” a bugaboo among those who want to eat healthily? What is the difference between these foods made by ancient processes and those lining the supermarket shelves? The most outstanding difference is that most of these old-time foods are made long lasting by such age-old processes as smoking, drying, the action of bacteria, fermenting, grinding; the foods themselves are still quite recognizable as their original selves.

But wait, what about soups and stews and casseroles, bread and baked desserts? Processed, right? Yes, by cooking, the application of heat, and now true domestic food is making its appearance. None of these common kitchen creations are long-lasting; they are meant to be eaten quickly. “Eat foods that will eventually rot”, as Pollan says!

Now let’s leave the wild, the kitchen garden, the age-old processed

food and the home kitchen and peruse the supermarket shelves. Here is rice, pasta, rolled oats – processed, therefore baddies? No, Pollan is helpful here when he says avoid food with ingredients you wouldn’t keep in your kitchen, “foodish” products like processed cheese and foods pretending to be something they are not.  I remember a breakfast at a friend’s that would fall into that last category. There was margarine and an artificial cream substitute that had never seen a cow, a vaguely orange-tasting chemical drink, dry cereal with so many ingredients that the grain – what was it? – got lost among the additives.

It is additives that are the less-than-healthy culprits in true processed foods. Most of them are unpronounceable, which is as good a way as any to identify them on the ingredient list. Azodicarbonamide, for instance, found in something like 500 bread products sold in the US, including “healthy” breads, has been linked to health issues. Tartrazine, a yellow dye, has been recently removed from a popular brand’s macaroni and cheese after buyers complained.

Then let’s consider propyl gallate, an estrogen antagonist, widely used to keep fatty foods from oxidizing. As most prepared food is either loaded with fat or with sugar, propyl gallate is to be found everywhere on supermarket shelves, even in mayonnaise. Strangely enough, the mayonnaise in my fridge, the product of a major Swiss company, contains no propyl gallate, and it keeps just fine.

Pollan’s food rules are simple; you don’t need to hunt through the 20 ingredients in a product to see if a no-no chemical is present, for example. Just give a glance at the number of ingredients, and do a quick scan to see how many of them are actual foodstuffs. My purchased mayonnaise, for instance, contains sunflower oil, vinegar, salt, mustard, egg yolk and a spice extract. All except the last would be ingredients in homemade mayonnaise.

By contrast, an instant pea soup with croutons has 21 ingredients, plus “natural aromas”. Of the 21, 8 would not be homemade pea soup with croutons. One is an antioxidation substance, the addition of which is probably responsible for the fact that this soup has a shelf life of a year. Is this necessary? Only if one is living in the wilds of Alaska or the back of beyond in Europe, it seems to me. The rest of us shop frequently. So who is really benefitting from these long-life foods on the shelves? The supermarket, maybe.

Writing about this has made me hungry for the fruits and veggies –

additive free - sold at the outdoor market in a nearby town; it will start up again in April. Of the variety on offer, the best are the seasonal produce, berries for instance, chanterelles, apricots. Or asparagus in May, locally grown. The seasonal treats that are the very opposite of stuff on the shelves that lasts approximately forever. I am counting the days.