From the White House garden to his picks for top health jobs, Obama is telling America’s McDonald’s-loving, couch-dwelling, doctor-phobic populace that things are about to change.
Don’t be fooled by the presidential burger runs. Obama and Congress are moving across several fronts to give government a central role in making America healthier — raising expectations among public health experts of a new era of activism unlike any before.
Any health care reform plan that Obama signs is almost certain to call for nutrition counseling, obesity screenings and wellness programs at workplaces and community centers. He wants more time in the school day for physical fitness, more nutritious school lunches and more bike paths, walking paths and grocery stores in underserved areas.
The president is filling top posts at Health and Human Services with officials who, in their previous jobs, outlawed trans fats, banned public smoking or required restaurants to provide a calorie count with that slice of banana cream pie.
Even Congress is getting into the act, giving serious consideration to taxing sugary drinks and alcohol to help pay for the overhaul.
To some, it smacks of a “nanny state on steroids” — but for others who fret that America is turning into one big Overeaters Anonymous meeting, Obama’s prescription is like a low-fat dream come true.
“He has expressed more interest in preventing diseases and promoting health than any previous president. It is not a breath of fresh air. It is a tornado,” said Michael Jacobson, executive director of the Center for Science in the Public Interest. “That contrast is breathtaking. This is really a rare opportunity to make progress on so many issues.”
Still, Obama needs to strike a balance between fashioning himself an advocate of clean living and coming across as a public scold or a killjoy. That’s precisely how some people view Jacobson’s group, which has denounced movie popcorn, Chinese food and other indulgences that many Americans — including Obama voters —enjoy. Clean living in balance is an appealing notion, but finger-wagging moralism may not play so well in some precincts of Middle America, where voters may decide government commentary on the size of their beer gut or that plate of nachos isn’t such a good idea.
The public health community has worked intensively in recent years to build a body of evidence in support of the very initiatives Obama and lawmakers are now embracing. They frame the issue as one of money: Chronic diseases account for 75 percent of the nation’s $2 trillion in medical costs, according to the Centers for Disease Control and Prevention. And if the government encourages healthful lifestyles, it could slow the rising cost of health care, though the exact savings are debatable.
Obama has been leading the charge. He secured $650 million in the economic stimulus package for prevention programs, and brought corporate executives into the White House last month to highlight their success at lowering insurance costs by investing in wellness.
“All this [is] designed to save taxpayers money, save businesses money and ultimately make the American people healthier and happier and make sure that we’re getting a better bang for our health care dollar,” Obama said after the meeting.
Then there is the first family itself.
Barack and Michelle Obama sweat through a morning workout before most Americans step out of bed. They receive almost as much attention for their toned bodies as they do for their policies, which for the first lady includes an early concentration on healthful eating. She made headlines worldwide for planting a vegetable garden. And they marked their first Easter at the White House by organizing an Egg Roll that focused on exercise.
Former President George W. Bush was equally devoted to fitness but never gave it as prominent a role in policymaking as public health experts expect from Obama.
“I was always struck by President Bush, who was in terrific shape. It was a lost opportunity on his part,” said Kenneth Thorpe, an Emory University public health professor and leading advocate of chronic disease care. “President Obama is very physically fit, and this is very much part of his personal philosophy, and he has made it a centerpiece of health care reform.”
The whole situation has libertarians craving a basket of onion rings and a beer.
“If you care about the sorts of things I do, then you are going to be losing big-time for the next four to eight years,” said David Harsanyi, a Denver Post columnist and author of the book “Nanny State: How Food Fascists, Teetotaling Do-Gooders, Priggish Moralists and Other Boneheaded Bureaucrats Are Turning America Into a Nation of Children.”
Don’t get them wrong, critics such as Harsanyi say — they like broccoli and they lift barbells and they have no particular beef with a healthy president who was once described by his physician as having “no excess body fat.” They just don’t like it when government becomes the messenger and the enforcer.
The appointment last month of New York Public Health Commissioner Thomas Frieden as director of the CDC really made the libertarian-minded nervous.
Frieden is a big part of the reason New Yorkers no longer smoke in bars or eat trans fats at restaurants and find calorie counts on their menus. Frieden once said that when anyone in New York dies at an early age from a preventable disease, “it’s my fault.”
His groundbreaking approach to curbing chronic disease — heart disease, diabetes, cancer — has been mimicked in cities across the country, including Baltimore under Joshua Sharfstein, now the deputy commissioner at the Food and Drug Administration. (One example is Sharfstein inaugurating a Salt Task Force last year to study the “impact of excessive salt intake in the city.”)
“Frieden’s stick-over-carrot, for-your-own-good approach to public health is no longer confined to the Big Apple,” the industry-backed Center for Consumer Freedom wrote on its blog. “Get ready, because the ‘nanny state on steroids’ is going national.”
An administration aide said it was too early to tell what approach Frieden would take at the CDC, where he started Monday. In announcing the appointment, Obama said Frieden’s “experiences confronting public health challenges in our country and abroad will be essential in this new role.”
But other skeptics have critiqued the healthier-is-happier approach with the numbers. An article this year in the journal Health Affairs concluded that prevention measures usually add more to medical costs than they save.
Louise Russell, a professor of health and economics at Rutgers, examined hundreds of studies over the past four decades and found that policymakers needed to make “careful choices” about how to invest in prevention. She did not look at savings such as added workdays that might be realized outside health care spending because, she wrote, “the issue under debate is what happens to medical costs.”
Yet Democrats are looking to ease the way toward more preventive services by eliminating co-payments and deductibles. Members of the Senate Health, Education, Labor and Pensions Committee want a federal Prevention and Public Health Council to “develop a national strategy with public health goals and objectives for the nation to achieve,” according to a committee briefing paper.
“People do want to be healthy. It is just hard,” said Sen. Tom Harkin (D-Iowa), a leading proponent of prevention policies. “When you walk into places, the fastest, easiest food you can get is the saltiest and highest in fat, highest in calories. I want something quick, but I want it low in all this stuff. I want to give people choices so that they know, so when you put it on the menu board, they know. I think most people, if they knew, they would take better care of themselves.”
The bill released Tuesday by the Senate Health, Education, Labor and Pensions Committee orders chain restaurants with 20 or more locations to disclose calories on the menu board and make more nutrition information — fat, cholesterol, sodium — available upon request.
Republicans are no less on board. Some of the most conservative members of the House and Senate, as sponsors of the Patients’ Choices Act, want to prohibit junk food under the federal food stamp program and reward seniors who adopt healthful behaviors with lower Medicare premiums.
“This isn’t about telling people what to do,” said Nick Papas, a spokesman for Health and Human Services Secretary Kathleen Sebelius. “It is about giving people the tools they need to live longer, healthier, happier lives.”
Whatever the case, libertarians like Michael D. Tanner, director of health and welfare studies at the Cato Institute, aren’t looking forward to it.
“At the very least,” said Tanner, “we are going to get nagged a lot.” Carrie Budoff Brown