November 20, 2015

Food for Thought Friday: Pay the Farmer Now, or Pay the Doctor ... When, Exactly?

When well-meaning acquaintances mock us for spending more money than they do for food, those of us who take pride in buying, cooking, and eating whole, unprocessed, real foods are fond of saying, “Pay the farmer now, or pay the doctor later.” Meaning, if people don’t pony up a little extra cash for better quality food now, they’ll end up paying even more in the future, in the form of medical bills. But is this actually true? If people spend decades putting garbage down their pieholes and end up with some of the “diseases of civilization,” do they really end up all that much worse off, financially?

For the sake of keeping this post to a somewhat reasonable length, let’s stick solely to the financial burden of diet- and lifestyle-induced illness, and we’ll table the “cost” of missed work time, fatigue, illness, chronic pain, and overall reduced quality of life for another time. (But let’s go ahead and acknowledge that these other issues are arguably more important than one’s bank account balance.)

Okay. Before I jump into today’s Food for Thought rant reflection, let me clarify what I mean by “better quality food.” I try to make it clear on this blog that while I favor buying as much food as possible from small, local, family-owned and operated farms, and patronizing your local farmers markets, I am completely sympathetic to budget concerns, and I absolutely believe that we can attain optimal health eating foods from the big chain supermarkets. As I said a while back in my podcast interview with Jimmy Moore, regarding my e-book about Alzheimer’s disease, if all you can afford is what’s on sale at your neighborhood grocery store, you’ll be fine. The real bang for anyone’s buck when it comes to the influence of food on health, is sticking with the aforementioned whole, unprocessed, real foods. That means meat, poultry, seafood, eggs, dairy, non-starchy vegetables, and natural fats, plus fruit and starchy foods as they fit within your individual carbohydrate tolerance. (With a little room for wine, chocolate, and other treats for good measure…and sanity.) If the meat is grain-fed and from a feedlot, and the eggs are from hens  (or pigs!) given “vegetarian” feed and kept in cages, and the produce is grown conventionally, with pesticides not used in organic farming, and your dairy products are made from the pasteurized milk of grain-fed cows, you are not going to die a horrible early death and rot in food sin hell for all eternity. I promise. (But don't quote me on that, just in case...)

So when I say “better food,” just know I mean real foods. Foods without ingredient lists that are 50-words long, 35 of which you can’t pronounce. I’m talking about animal and plant foods you can easily identify, regardless of their provenance.

Okay. Now that my usual (and probably unnecessary) setting the stage is complete, let’s get back to the issue at hand: the question of whether many years of not eating real food will come back to bite someone in the brain-fogged, heart-diseased, metabolic-syndromed, chronically-fatigued butt, financially speaking.

I don’t think it does. The truth is, assuming you have decent health insurance, if you don’t pay the farmer (or grocer) now, you won’t end up paying the doctor later.

“Assuming you have good health insurance?” Whoa. Looks like we need another quick sidebar regarding insurance in the U.S. I know I have a bunch of readers in the UK, Canada, Australia, NZ, South Africa, and Latin America. (And at least one Japanese person. こんにちは, Yuuji!) I can’t speak to what the healthcare systems are like in those places. Frankly, I can barely speak about the American one, since I have been extremely fortunate to always have jobs that came along with insurance, and I have been healthy enough to just about never need a whole lot from that insurance. (Since quitting my day job, however, I will soon be launching into the world of private insurance, and that will be eye-opening, no doubt. As a military veteran, I can get free run-of-the-mill checkups and such through the Veterans Administration [VA] medical system, but I will definitely be getting a catastrophic-only plan outside of that, since I’m pretty sure the VA wouldn’t cover the astronomical expenses that can be incurred overnight through a freak accident.)

Okay. Leaving aside heated political and economic discussions about the Affordable Care Act and whether it’s humane that anyone in the United States of America in the 21st Century should run the risk of going bankrupt if they get cancer or get hit by a drunk driver, just play along with me for now, and, for argument’s sake, let’s assume that everyone has decent medical coverage.

Let’s look at a hypothetical example of the guy next door. We’ll call him Jim.

Decent medical coverage means that a typical doctor’s visit might cost Jim somewhere in the neighborhood of $10-$20, in the form of a copay. If Jim has a great job, which provides him with a suped-up fancy-schmancy plan, maybe there’s no copay required at all, and the visit is actually free. Maybe Jim’s got some stuff going on “under the hood,” as Robb Wolf says, and he’s on a prescription drug…or two or three. (Remember RW and his car analogy. We’ll come back to it in a bit.) Maybe Jim has copays for those meds, on top of the visit. Maybe those copays are $5 per prescription, or maybe they’re $10 or $15. Whatever his copays are for the visit and for his meds, they’re likely far less than the actual price of those transactions, the services rendered, and the goods provided. The entity that bears the brunt of the expense for Jim’s healthcare in this scenario is his insurance company. (Granted, Jim pays premiums that are intended to cover some of this, but you know what I mean. Overall, the vast majority of payment for his healthcare does not come out of his own pocket.)

Have fun with that, Jim!
Now, let’s imagine that Jim does not have insurance. Let’s say that, paying full price, Jim’s statin costs $100/month. And let’s say he’s on insulin, too, and that costs another $100/month. While we’re at it, let’s throw in a prescription antacid, an antidepressant, and a prescription pain reliever. This isn’t too far off the mark, right? Most of us know plenty of people—old and not-so-old—who are on a host of drugs for all kinds of issues. (Never mind the discussion of the absolute insanity that passes for modern medicine, and whether they even need the statin, the insulin, the antacid, the antidepressant, and the pain reliever. Let’s just play devil’s advocate here and pretend that Jim does need them. Let’s pretend that these are lifesaving medications that he absolutely must take because of the state of his health.) Let’s go easy on Jim and say the antacid, antidepressant, and pain reliever are “only” $85/month, each. So the total for all his meds is $455/month.

Furthermore, let’s say the quarterly visits Jim makes to his cardiologist, endocrinologist, and psychiatrist cost $200 each. That’s an additional $600 per quarter, on top of the $455 per month, for a quarterly total of $1965, or an annual total of $7860—just for Jim. Never mind if his spouse or kids have any medical issues (or orthodontia!) his family needs to pay for in addition to just his. Could he afford all that? Could he afford to be as ill and debilitated as he is?

The thing is, again, assuming decent medical coverage, he doesn’t have to be able to afford this. Everyone else paying into the system—including all taxpayers, collectively, plus everyone with private insurance—have his back, whether we want to or not. He doesn’t have to “pay the doctor.” Many people have absolutely no clue how much their medical care actually costs, because they can scoot by paying nothing but relatively low copays for decades and decades. They have no idea how much it costs the system as a whole for them to be such health trainwrecks. (Never mind why the costs are as high as they are. Why the costs of medical care in the U.S. are so astronomical is a separate issue that I have neither the desire nor the expertise to delve into here. [Please, it’s hard enough to understand nutrition; I'll leave economics to people who are far better at math than I am.] Bottom line: we all probably agree that healthcare costs are ridiculous, and healthcare in the U.S. is basically the dead opposite of a “free market” wherein supply and demand, healthy competition, and other market forces determine costs.)

Taking our thought experiment a bit further: what would things look like if health insurance were more like car insurance?
This is what insurance is for—the big stuff, 
not the everyday maintenance you, 
as a responsible owner, are supposed to 
take care of, yourself.
I promised we’d come to back to Robb Wolf and the car analogy. Here goes. I mention Robb because he is the first person I heard talk about health insurance in the following way: Health insurance is not like car insurance. Car insurance doesn't pay for a new set of wiper blades, nor a new set of tires, nor for every oil change you get. Car insurance is intended to pay for catastrophic events only. It is your responsibility, as the car owner, to keep up with routine maintenance so that you don’t have catastrophic things come up out of the blue. You do those periodic oil changes, you get your air filters changed, you have the brakes/shocks/transmission inspected once in a while so you can repair or replace things before they’re completely destroyed. Because your car insurance only pays for the big things, it behooves you to take good care of your car. Pay a little bit upfront, in the form of regular maintenance and good stewardship so that you have as few of the medium-size expenses as possible. Because maybe new brake pads, or shocks, aren’t cheap, but they’re not as expensive as a new car, and the only time your insurance kicks in is when something grave enough has happened to the car that you’re pretty close to needing a new one. So you pay for the little (and medium) stuff, but if/when the automotive sh*t really hits the fan, that’s when your insurance kicks in.

THIS, dear readers, is how I feel health insurance should work. We should pay out of pocket for doctor visits and “routine” medication, and insurance should be there for the really catastrophic stuff. The stuff that costs zillions. If people had to pay out of pocket for their statins, insulin, antacids, antidepressants, anxiolytics, pain relievers, beta-blockers, and more, they would probably work a lot harder to not need them, no? (Believe me, I’m no Polyanna. I’m not so naïve as to believe that everyone would put more effort into eating better, getting more sleep, getting out in nature more often, and doing other things that we currently believe lead to better health, but I’m not so jaded as to believe that no one would.)

If people were faced with the true, full financial costs of their health scenarios, I’d like to think that a significant number of them would get serious about making whatever changes they needed to in order to reduce those costs. Because they couldn’t afford to be sick. Hence, the crux of this post: it falls flat to say, “Pay the farmer now or the doctor later,” because many people won’t pay the doctor later. Only in my imaginary scenario, where people are faced with the full cost of their list of medical woes, would they wake up to their health reality. (I say this knowing that my own family would absolutely have gone bankrupt if we’d had to pay the full price of my mother’s medical care over the years—and that’s before she passed away from cancer and all the expenses associated with that tallied up. She was on insulin, a statin, an antacid, a diuretic, and more. Never mind that her doctors were complete freaking morons, and she likely shouldn’t have been on anything at all, except a goddamn low-carb diet. But I digress. Sorry about that. I get very angry about this.)

Let’s revisit the $655/month total from earlier. ($7860/year divided by 12.) If Jim couldn’t afford $655/month for all those doctor visits and meds, maybe he could afford $40/month for a gym membership. Or a couple hundred bucks for a set of adjustable dumbbells and barbells he can buy at the big box discount store and use in his basement for decades, having laid out the initial expense just once. Maybe he can afford less than $5.50 per pound for a mix of grassfed beef, pastured pork, poultry, and eggs from free-range hens.

‘Cuz he can get a new car, if need be. (Even if he has to take out a big loan to do so.) But he can’t get a new body. And until people really understand the full cost of their ailments—so many of which are the direct and indirect results of things that are completely within their control—they will have no sense of responsibility for the care and feeding of their own bodies.

I think we are in need of a sea change in healthcare in this country, not just regarding insurance, but with the practice of medicine, itself. After all, maybe if patients—having to pay the full price of their meds out of pocket—admitted to their doctors that they flat-out couldn’t afford the statin/antacid/pain reliever/antidepressant, then the doctors would actually have to, oh, I dunno…freakin' help people get well, instead of “managing” their illnesses. And they might actually have to remember back to anatomy & physiology, and biochem 101, and think about how the human body works, and what that tells us about the kinds of foods and the type of lifestyle activities that do and do not support health. And they might not all magically arrive at something that looks like the ancestral health paradigm, but FFS, it would probably be pretty close.

P.S. As I have shown many times, “real food”—even the best quality stuff—is sometimes far more affordable than processed junk anyway! For example, $12/pound for sugary oatmeal and $12/pound for Cheez-Its versus the aforementioned <$5.50 for grass-fed beef, pastured pork, and free-range eggs from a local farm.
P.P.S. When I talk about having to pay for insulin, I am, of course, referring to type 2 diabetes. Type 1s will basically always require insulin. (However, with a good low-carb diet, they can manage their T1 with far, far less insulin than on a high-carb diet.)

Remember: Amy Berger, M.S., NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition.


  1. Oh, the slack I have gotten from my own Primal-type blogging 'friends' over not eating ONLY grass-fed beef. It's RIDICULOUS. Seriously. Thanks for shining your sun on that alone. Now off to read the rest. LOL

    1. Right on. I have no patience for holier-than-though food purists and "food provenance shaming." In the end, we're all on the same side. And if someone has such a charmed life that they have the privilege of worrying aboout (and commenting on) what someone *else* eats, well, there's probably a soup kitchen somewhere that could use a volunteer! ;-)

    2. Do not disagree with a lot of what you write, except the slack, holier than comments. I am reminded of Shakespeare's "Thou do protest too much' and The Farmer Poet Burns, 'Oh that we wad see ourselves as others see us, it wad from many a blunder free us'.
      Food and health is a huge, complicated subject, made so by humans educated to believe that nature can be subjugated to mind over matter, yet the whole truth is hidden in full sight. These self evident truths are revealed as we become aware that partial truths, spun as whole, become revealed through diligent enquiry and as events unfold.
      In my healthy 70's, except for a decade+ in the Roman Wall Country of Northern UK, in Police service with almost a decade as Detective Investigator, I have spent my life in grassland and animal husbandry. As such I certainly know how to follow my nose and arms length commendation for perspicacity. Using these skills I have come full cycle from grass fattening the domesticated beasts of a thousand hills, through the full gamut of grain fattening, hormone and artificial fertilizer/chemical use and back to grass/greens fattening.
      Knowing that Britain was the Beefeater Nation at its healthiest mid Victorian era and believing that Caesar from his writings on 54 BC Invasion, had invaded for the Milk and Meat diet of the indigenous tribes of superior size and stamina, and that old men of my youth believed you should eat the fats of the land daily in the form of beef, with all other meats in moderation, I have come full cycle back to the ancient, 'Eat mainly of animals with cloven hooves, that chew their cud'. These of course are mainly represented by domesticated cattle and sheep, grass fattened as in history.
      Further in 1996, looking for evidence, with my veterinary daughter, through the good offices of our local Department of Fisheries, and the late, Dr Robert Ackman, who became known as Dr Omega 3 locally, we discovered that beef feed to our protocol, predominately grass fattened, was higher in Essential fatty acid Omega3 in 6:3 balance than ground codfish. This was on Analysis of Ground beef Trim.
      Since then I have been researching continually and constantly reviewing emerging on line scientific evidence around the world. Natural or Naturalized grass fattening pastures, apart from grass/clovers also contain medicinal plants, synergistic to the health of cattle and subsequently human health, throughout our evolution. These facts of history cannot be denied and these greens of fattening pastures contain carotenoids and antioxidants at ten times the levels found in healthy green domesticated vegetables. It necessarily follows, that these human inedible greens. ruminated through cudding and gut fermentation, are further concentrated, in the muscle proteins and unique fat profile of ruminants. Apart from believed anti cancer, anti inflammatory Omega 3 and CLA, Vitamin A,D,E and K2 are fats soluble. Taken as a whole such food is a form of stored sun energy allowing our lives to sustain throughout the seasons.
      It will eventually be re discovered that such 'fats of the land' are not only the foods of our evolution and brain development, but also our sustainable future and the natural fertility of our beautiful planet, not the arable, soil destroying grains mainly for chicken feed and grain fed meats.

  2. As Usual Great Post Amy!!! no need to keep them short for me!!

  3. To continue with the car analogy, if you do not keep up with your maintenance, the performance drops and the repairs become more costly. For health insurance in Canada with medicare, additional personal coverage is necessary and for some provinces obligatory to have.


  4. Very good. I agree. If you could only walk through my clinic and see the suffering brought on to people by Flour and Sugar, you would likely run screaming out the door! ;) Just kidding you develop a tolerance for the nasty wounds and for the indifference that comes with chronic disease. DM2, kidney failure (hemodialysis will drain us dry), congestive heart failure, morbid obesity and degenerative joint disease name a few. Oh there's much more but, again I agree if we put time and money into body maintenance we would have fewer roadside breakdowns.

  5. Absolutely agree with everything in this post, Amy. It irritates me to no end when I hear people say, "Oh, but my insurance covers the IVF treatment, so it's only xx dollars!" And, there's no concept AT ALL of the true cost that is actually being paid! This is just one example that I heard recently from someone, but you can substitute almost any medical procedure...

    So frustrating...