Calorie labeling: aw jeez

So Ezra Klein points out one of the "prevention" provisions of our shiny new healthcare bill, as is is job, wont, and duty:

One of the bill's provisions is a menu labeling proposal for chain restaurants with more than 20 locations. The proposal requires chains to post the caloric content of each item (and the total calories of combo meals) next to its listing on the menu, the menu board, and even the drive-through menu kiosk. This goes into effect next year, and will be one of the most visible effects of the health-care bill. You can read the provision here (pdf).

The early evidence on menu labeling has been undeniably mixed, but this is good information for people to have. In 20 years, I think we'll be baffled that there was a time when it wasn't easily available to us.

So here's my thing. The immediate parallel, to my mind, is the nutrition facts labels on food products. I know I have a hard time imagining buying prepared foods, whether that means orange juice or microwavable Indian food, without being able to see what-all's in 'em.

But the difference is you have a choice. I can pick up, buy, unwrap, and eat a candy bar without ever looking at the calorie count or the saturated fats percentage or the nature of the carbohydrates locked within it. When that number is splashed big and loud and in red on a menu--a menu that in some situations will be the equivalent of a poster--that is a whole different story. Furthermore, nutritional information gives you much more than the bare number of calories. At least it gives you information that you can use to manage your diet in the way that works for you, if you so choose.

I understand that its inescapability is the point of the provision. But my god, what about the eating disordered in this country? Many will be perversely overjoyed: no need to privately estimate calorie counts, round up wildly to be "safe," google around for others' tallies. But many will also be terrified. They will be terrified that if they consistently pick the lowest-calorie option when obliged to eat out at a chain restaurant, their friends and family will notice; and they will be terrified that on the occasion that they venture, manage, or feel obliged to pick a higher calorie option, someone--anyone who knows what they picked, whether a dining companion or a server or a bystander, will be thinking, "what is that fatass doing eating anything but naked lettuce." Fat people who want to be left alone to eat a goddamn meal will face even more detailed commentary and well-intentioned, yet ultimately hurtful advice from friends, family, and random strangers than they do now. "Normal" people (i.e. those not included in the previous two categories) will find themselves competing with themselves or others to limit their calories while restaurants compete to offer the lowest calorie options (with no incentive to do so with regard to nutritional content or to provide customers with the ability to consider nutrition, rather than calorie-counting, themselves).

This is not to mention three larger points: 1, not all calories are created equal; 2, weight loss is not health. It is not necessarily not-health, and I am not saying that this provision is the only mechanism in the bill (lord knows if it were Ezra would be singing a much different tune), but I would really like to see some work on urban food deserts, for example, before we start giving ourselves even more tools for public body and diet shame.

Finally, 3: in many ways one of the biggest issues around food and health for Americans is that our culture can't conceive of food as food. It's all calories and good fats and bad fats and antioxidants. Having to intellectualize and moralize the shit out of everything we eat is not good for us. It leads to deprivation/binge cycles, depriving ourselves of things we need because they're "bad," sometimes relying on companies or fads to figure it all out for us (read: diets). Many of these diets are not very nutritionally sound, and almost none of them promote healthy relationships between mind and body--which is really one of the bases of health.

I think this further standardization and commodification of food into points which are good or bad but ultimately to be conquered will do nothing to help this pathologization of food and plenty to further it.

Compare:

MeMe Roth: "We’ve gotten ourselves to the point where we’re behaviorally and neurochemically dependent upon food."

Michael Pollan: "Eat food. Not too much. Mostly plants. That, more or less, is the short answer to the supposedly incredibly complicated and confusing question of what we humans should eat in order to be maximally healthy."

Our culture, sadly, is much more in tune with the former sentiment than the latter. I don't think putting calorie counts on menus nationwide will help.

Well said, sir

"America cares about the fact that you can get all the health care you need as long as you don't need any."
--Rep. Alan Grayson (D-FL)

If this isn't the healthcare reform soundbite the Dems have been looking for, I don't know what is.



Now someone get that man a white shirt and a better tie.

Targets

Ezra Klein reports that a consensus goal for healthcare reform seems to be emerging: "to slow the annual growth rate of spending by 1.5 percentage points." There's lots of very Reassuring and Serious chatter about how 1.5 percentage points may sound small, but it's going to be very difficult to achieve and would represent a great accomplishment.

Ezra is generous, to my mind:

What you can say about an annual slowdown of 1.5 percentage points is that it would be a magnificent achievement given the political difficulties of health reform, but it's quite a bit lower than could be achieved absent those constraints. [...] But though it's true that this new definition of success is ambitious given what we're likely to achieve amid a broken political system and a powerful health-care industry, it's probably quite modest given what could be achieved in more straightforward circumstances. And that's worth keeping in mind.

The kicker, though, is that 1.5 percentage points happens to be exactly the goal that the healthcare industry voluntarily offered for itself.

This puts me very much in mind of Susan Greenhalgh's Just One Child, which examines the conception, development, and implementation of China's one-child policy from the framework of an anthropology of policymaking. It's a fascinating read and I highly recommend it. In it, she notes that a particular goal--constraining the population at 1.1 billion--was arrived at by a particular set of policymakers based on computer models designed for missile control that were not equipped to consider concerns that social scientists would have thought paramount: demographics, the varying economic needs of rural vs. urban families, etc. This goal, enshrined in a highly technical report that won definitive status almost immediately due to very impressive and impenetrable math, political connections, and the privileging of "hard" science over social science under Mao, quickly became the unquestioned aim of population control policy in the Deng government, despite protest from social scientists that the goal was too ambitious and would harm rural families as well as women. (1.1 billion advocates retorted that it was better to aim too high, in case of falling short.) The result was the often punishing policy we know today.

I should hope the analogy is fairly obvious. In both cases a numerical policy goal was nominated based not on the most rigorous, inclusive, and pragmatic analysis possible, but rather based on other considerations and due to disproportionate political influence. It seems the target of 1.5 percentage points is well on its way to becoming an authorless, Reasonable number that everyone will endorse. The healthcare industry will be pleased, healthcare reformers farther from the centers of power--but often with better information about the effects of policy on the ground--will protest to little avail, and soon we shall have the healthcare policy that became inevitable when this number became The Number.

Policymaking is tricky business, and it has a tendency to turn into a sort of Rube Goldberg Machine (see below) where the final effect seems to have almost nothing to do with the original force even though the chain of cause and effect is there; it's just wended its way through a dizzying array of objects, people, offices, departments, obstacles and pathways.


Best Rube Goldberg Ever - Watch more Funny Videos

The final policy outcome of lowering costs by 1.5 percentage points (assuming policy is effective) will probably seem to have nothing to do with the industry by the time it is realized, or if it does this will be only because they, as Knowledgeable Businessmen with Experience, were wise.

However, that the number came from the healthcare industry is, as Ezra says, worth remembering.

Update: Also see DDay on the way healthcare can die.

Tiller links

George Tiller needs more than candlelight vigils

Why Clinic Violence is Obama's Problem

The Murder of Dr. Tiller, a Foreshadowing

Voices of Choice: Dr. Tiller

From the last, in Tiller's own words:

It is my fundamental philosophy that patients are emotionally, mentally, morally, spiritually and physically competent to struggle with complex health issues and come to decisions that are appropriate for them.

This should not be a radical idea.

Peaceful, legal means

Hilzoy has an eye-opening post on what exactly Operation Rescue got up to through "appropriate channels." Why nobody has ever sued them for stalking and harassment is beyond me.

Newman and his small staff of zealous pro-lifers are buzzing with the news that the clinic's office manager has quit -- a result, they believe, of their name-and-shame campaign. The manager had been accosted by a neighbor in a grocery store who recognized her from an Operation Rescue flier that featured her photo. "You're that baby killer!" the neighbor screamed at her. Then Newman, through investigative methods he'd rather not reveal, discovered where the woman's husband works. "We think that's what clinched it," he says. "He probably realized we were going to picket his workplace. I imagine he's the major breadwinner in the family, and he didn't want to risk his job."

It gets worse. We're talking cruising people's houses at night, stealing and going through their trash, paying others to spy on them. Tiller drove an armored car.

Furthermore, the disregard for the lives--yes, lives--of the patients involved is staggering. From the Rolling Stone article Hilzoy quoted:

Newman and his staff have spent months compiling a list of more than 200 "abortion collaborators" -- companies that do business with Women's Health Care Services and its employees. They plan to approach every firm on the list -- from the guy who mows the clinic's lawn to the cafe that sells Tiller his morning latte -- and lobby them to stop doing business with the facility. At the top of the collaborator list is Wesley Medical Center. Wesley is vital to Tiller's clinic: It's where his patients are taken if there is a medical emergency. Newman has written to Wesley's board of physicians to request that they retract hospital privileges for Tiller's patients. If they refuse, Newman plans to expose them as Tiller's accomplices: "We're thinking of taking out an ad in the local newspaper, naming Wesley's physicians and accusing them of supporting a baby killer."

And then what will happen to those women--and fetuses--who are in the midst of medical emergencies? Not to mention the utter lack of respect for the Hippocratic Oath. Whether abortions of the type performed at Tiller's clinic are freely chosen is debatable, but no medical professional worth the title can turn away a patient in crisis from emergency care. What did they think they were playing at?

I don't think I can answer that

Via digby:

I hardly know what to say. What’s worse: A healthcare system where someone is so desperate, he’d blow up buildings to pay for his brother’s treatment, or homeland security that thinks nothing of setting people up so they can claim they caught some “terrorists”?

Interesting

Daschle withdrew. I didn't think it would happen, honestly.

I started to write a post yesterday about how Daschle's lapses didn't seem that big a deal to me. In the course of listing my caveats and "on the other hand" clauses, I convinced myself that actually there was a much stronger argument against him than there was for letting it slide, so to speak.

But I can't seem to get riled up about it on a gut level. I don't know.


At any rate, having gone through that exercise and now reading the NYTimes on his health care industry connections, I'm content with the withdrawal of his nomination.

Frankly, I think it's ridiculous that Geithner got a pass and Killefer got axed, given that Killefer owed less than a thousand dollars and Geithner owed tens of thousands, but I guess Geithner got there first and used up the one free pass that was available this time around.

Finally, to echo Hilzoy, what the hell is going on with these people and their taxes? And how much tax revenue is going unpaid by people who aren't being vetted for Cabinet posts? And how is it that you can discover you owe huge amounts of back taxes and then just go on not paying them without any sort of enforcement by the IRS? How much taxpayer money are we losing here?

...Perhaps a better way to put it would be that I can't get riled up about it in relation to his eligibility for HHS. It would appear that I can, in fact, get riled up about it in itself.

A very important point.

Okay, I'll be honest. Normally Kos (of Daily Kos) pisses me well off; most of the commenters there even more so. There are a couple of regular front page posters I like and every once in a while you get a great diary, but mostly I read it for the poll data.

However, this is one of those times when they manage to come up with a rose.

The point of this article is that for the past 30-40 years (i.e. the conservative movement, which started with Nixon) Republicans, small-government beliefs aside, have deliberately obstructed any real government solutions because people would then gravitate to the Democrats. This is because one of the fundamental principles of the conservative ideology is that government cannot. Government cannot solve your problems. Government cannot provide any workable solution to anything. Government offers you no hope. So don't try.

The post goes on to suggest that the rise of idiotic nonissues (flag pins, etc) has largely been as a result of the spread of this belief. If government can never solve your health care problems, it really doesn't matter what the two candidates say or plan to do; neither of them will ever make a difference. So you might as well vote on who you'd like to have a beer with or who has a funny name.

I have always staunchly believed that good government should fundamentally be about helping people (see John Dewey in The Crisis of Liberalism and, you know, the New Deal), and I have always considered that to be a bastion of liberalism and (in theory) the Democratic party. I have always felt, sometimes on a nonverbal level, that the right is about "freedom from" and the left is about "freedom to", and I know which one I prefer.

However, it never quite occurred to me in this way that Republicans would deliberately stop government from improving people's lives in their own self-interest. Not because they genuinely believed that, say, healthcare reform was impossible through the government and so those dollars should go to letting people buy their own, but because they knew it would probably work and decided that was bad for them. The former is called a disagreement--a disagreement with potentially huge ramifications, but nonetheless a debate in good faith. The other is called craven and shortsighted, a corrupt and self-perpetuating machine to no good purpose.

If you don't believe this is possible, follow the link at the top. Oh, and something to keep in mind--the man who wrote one of the memos that most nakedly demonstrates this? William Kristol. Op-Ed columnist for the New York Times, which is of course a DISGRACEFUL BASTION OF LIBERALISM.

TK is teh osm

I am really proud to have Ted Kennedy as my (former? native?) senator right now. Yes, I know, shady events in the past, yada yada, but the man has been an amazing advocate for health care throughout his career.

http://www.thecarpetbaggerreport.com/archives/16148.html#more-16148

Despite his recent brain cancer diagnosis and current treatment, he flew into Washington against doctors' advice IN SECRET to be the 60th vote (meaning no more filibusters) on a really important Medicare bill. Basically, Medicare was scheduled to cut the pay of doctors who practice under the program, which would have led to disastrous cuts and reductions in Medicare care. The Democrats had sponsored a bill canceling the cut, allowing doctors to continue at current rates. It passed the house and got filibustered by Republicans in the Senate (seriously, is there ANYBODY whose lives the Republicans care about besides fetuses?). The American Medical Association has been going nuts about this, running ads and targeting Congresspeople while the government postponed the cut to give the Senate time to work something out.

Kennedy, who has been out from work lately due to, you know, a brain tumor, flew in in a move that was fabulously sneaky (read the link for details) to be vote number 60 to invalidate the filibuster. When Republicans saw they were beaten, 9 of them switched their votes (cute). The response of Senators from both parties to Kennedy's appearance, as well as the description of his entrance and his statement, honestly made me get a bit teary-eyed.

One of the last great statesmen in Congress, as far as I can see. Chris Dodd is definitely another, for the record.


Oh, and since I didn't mention it, Congress passed the FISA bill and we're all fucked. Just a heads up.