5 minute read
OPINION: Can RFK Fix Healthcare?
By Robert H. Lustig, MD, MSL
There’s no denying it. The U.S. healthcare system is broken. We spend the most (as demonstrated by percent of GDP, at 17.3%), and get the least (lowest life expectancy, highest infant mortality, and 93% of Americans with some form of metabolic dysfunction) of any developed country. And let’s be truthful – covering up symptoms of chronic disease with medications (e.g. statins, oral hypoglycemics, antihypertensives, GLP-1 agonists) does not treat the actual metabolic dysfunction, which is at the root causes of these diseases. Those diseases are still there, which continue to spiral the healthcare system out of control.
Who benefits from such a system? The food industry’s gross profit margin was 17.3% in 2023, with $1.5 trillion in sales. The pharma industry’s gross profit margin for 2023 was 65%, with sales of $318 billion. And now with the Biden administration greenlighting Medicare and Medicaid coverage of GLP-1’s, who knows how high that might rise.
How about the health insurance industry? For decades, health insurance followed the casino model — 1) pay to play, and 2) set their own rates. In this model, the industry was glad when people were sick. As long as there was enough money in the till, and as long as the players anted up, the House couldn’t lose. But then came Obamacare, and the industry had to take 32 million sick people onto the rolls, with a cap at 15% profit. Now the US healthcare industry’s gross profit margin is 2.2% and falling every year. All of a sudden, insurers want their subscribers to be healthy. But they can’t, because of chronic metabolic disease, which has only gotten worse, and they don’t know how to fix it. Here’s the inconvenient truth: you can’t fix healthcare until you fix health, you can’t fix health until you fix diet, and you can’t fix diet until you know what’s wrong.
Here’s the rub: the U.S. healthcare system spends $4.1T per year, of which 75% are diet-related chronic metabolic diseases, and of which 75% are preventable. That means $2.3T per annum is wasted on preventable health care. Way more money wasted than both the food and pharma industries’ gross profit together. Yet 52% of the U.S. population is afflicted with some form of chronic metabolic disease requiring chronic medication (driven by ultra processed food, and specifically sugar). And it’s not their fault, because they didn’t pay to play; the sugar was put there by the industry for its own purposes. And since the amount of money wasted on healthcare ($13,500 per capita) is way above their food budget ($5,235 per capita), this constitutes a policy crisis as well. And of course, it’s the one subsidized by the U.S. government. So, we pay for it twice. We pay for the food subsidies, and we pay for the ER visits. No wonder health insurance is in trouble.
RFK is now HHS Secretary-Designate, and Trump said “I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines.” Will this help health insurance? Only if it helps health. Our group at UCSF modeled out what the savings from lowering U.S. consumption of sugar by 20% or 50%. A huge reduction in mortality and huge savings; but those improvements would only manifest after 3 years of sugar reduction. Even if RFK fixed the Farm Bill (which he can’t, that’s Congress), and even if he got soda out of SNAP (which he can’t, USDA is a different Department), and even if he fixed the NIH, CDC, and FDA to align them with chronic disease prevention, those incremental gains will come painfully slowly, and not realized in this next administration. So, it’s either draconian cuts or fixing the ultra-processed food epidemic now. The good news is that the health insurance industry wields a lot of clout in Washington. It’s time to use it. It’s time to “go wild” on healthcare.
Here’s the inconvenient truth: you can’t fix healthcare until you fix health, you can’t fix health until you fix diet, and you can’t fix diet until you know what’s wrong.
Dr. Robert Lustig is Professor of Pediatric Endocrinology at the University of California, San Francisco. Dr. Lustig has become a leading public health authority on the impact sugar has on fueling diabetes, obesity and metabolic syndrome epidemics, and on addressing changes in the food environment to reverse these chronic diseases.
In his New York Times best-selling books including Metabolica, The Hacking of the American Mind, and Fat Chance: Beating the Odds Against Sugar, Processes Food, Obesity, and Disease, Robert documents both the science and the politics that have led to the current pandemic of obesity and chronic disease. In the Fat Chance Cookbook, Robert provides practical examples for applying healthy eating principles with recipes by Cindy Gershen.
Dr. Lustig has authored 125 peer-reviewed articles and 73 reviews. He has mentored 20 pediatric endocrine fellows and trained numerous other allied health professionals. He provides endocrinologic support to several protocols of the Children’s Oncology Group. He is the former Chairman of the Ad hoc Obesity Task Force of the Lawson Wilkins Pediatric Endocrine Society, a member of the Pediatric Obesity Practice Guidelines Subcommittee of The Endocrine Society, a member of the Obesity Task Force of the Endocrine Society, a member of the Pediatric Obesity Devices Committee of the U.S. Food and Drug Administration, a member of the Bay Area Board of Directors of the American Heart Association, and a member of the Steering Committee of Health Foods, Healthy Kids of the Culinary Institute of America. He also consults for several childhood obesity advocacy groups.
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