Tuesday, July 28, 2009
Medical school is long and hard, and doctors work hard to take care of people. It is difficult to be entering a profession that is being reviled and assaulted.
And, the Simpsons are on the stamp this month. I thought they would be more expensive - a fundraiser for kids with disease or something. I was prepared to pay more. Nope. Available for the egregious price of 44 centavos. each I recall 19 cents apiece. At least they are cool; no stagecoaches or crocheted hearts from a dying museum in Council Bluffs, Iowa. I am dangerously close to buying a stash and tucking them away somewhere. Dangerously close to starting a stamp collection.
Thursday, July 9, 2009
Re-branding Food Stamps: A Roadmap from High-Speed Agribusiness Toll Road to Targeted, Restricted, and Healthy Food Bridge
More Americans are utilizing federal funds to subsidize food purchasing than ever before. Over 30 million people use the food stamp program, recently re-named Supplemental Nutrition Assistance Program (SNAP). This program was established in the 1930s to be temporary, to address hunger, and to distribute excess food surplus. The program ended in 1943 and was permanently revived by Lyndon Johnson in the 1960s in an effort to eliminate poverty as part of the Great Society.
Fortunately, we no longer live in a world where hunger is the prevailing threat to human health, and the SNAP program as originally intended could be phased out. However, several entrenched interests ranging from non-profits to agribusiness have a strong interest in seeing the program continue, so abolishment is unlikely in the near future. SNAP and other food programs continue to operate with limited controls on the nature of purchases and the amount of time individuals may receive services. Unfortunately, SNAP as it exists expands the American waistline, permits permanent reliance on government aid, and feeds illness with unhealthy foods. Policy makers must take a realistic view of the program as it stands and adopt sharp modifications to contract its reach and mitigate the negative consequences of SNAP. Given the unlikelihood of abolishment, the program must be recast as a food program with a twin mission of calorie supplementation and provision of food to improve health.
In the modern era, obesity due to excess calories drives illness in poor communities, and the SNAP program has failed to adapt to modern food environments. The program operates with few restrictions on purchases, and high-calorie, low-nutrient foodstuffs can easily supersede the mission of putting nutritious, healthy food into American homes. Under current policy, food stamps can be used to buy anything that is considered ‘food’ excluding hot, prepared items. As a result, a person or family that relies on SNAP is free to buy chips, soda, cake, and bacon to feed their family. A cartful of Ramen noodles, Twizzlers, ice cream, and Pop-Tarts can freely be charged to the United States Department of Agriculture (USDA) under current SNAP guidelines. The consequence of unrestricted purchasing is the utilization of government resources to feed the obesity epidemic. The government often then purchases healthcare for the hypertension, diabetes, heart attacks, strokes, cancer, and myriad other health conditions that are the consequence of poor diet. Also, SNAP recipients often draw on several food assistance programs at once, resulting in over-apportioning of calories and resources. SNAP recipients can stay on the program forever; there is no time limit to dependence on SNAP.
While the stated mission of the SNAP program is to ‘help low-income people buy the food they need for good health’, a realistic assessment of the program will demonstrate that any food most often equals unhealthy food. The lack of food purchase restrictions may give comfort to policymakers loathe to pare the ‘rights’ of people on public assistance programs; I propose that people should not be guaranteed full access to the marketplace of options under government assistance terms. No child has ever starved due to a lack of cake or soda.
A proposal to restrict food stamp purchases will alarm food manufacturers that sell billions of dollars in cheap, unhealthy food to citizens on food assistance programs; I propose these manufacturers respond to the market demand and shift their product offerings towards healthier fare, develop their markets elsewhere, or seek to capture the unrestricted dollars that people spend on consumable goods. Others critics will fret that healthy food is too expensive, but, when held to closer scrutiny, this claim falls apart. SNAP allotments for families of 3 or more are higher than the average working family spends on food in the course of a month.
Of course, restriction of SNAP purchases is not a cure-all for the nutrition challenges facing poor communities, but will provide a strong signal from policy makers that the well-established links between unhealthy food choices and disease are being incorporated into food assistance programs to improve their outcomes. Also, education on healthy eating must be emphasized, and the lack of access to healthy food in poor communities must be addressed by the development of innovative business models to aggregate demand for high quality fare in poor communities.
Healthcare providers and policy makers are failing to make a dent in the obesity problem that threatens to, for the first time, cut short the lifespan of the next generation. There is an opportunity to start at the top – at the source of funding- to set a strong course for rational changes to SNAP policy that results in fewer costs, healthier purchasing, and improved health outcome for SNAP recipients. This policy change can serve as a specific, quantifiable touchstone in a matrix of food policy reforms in the next several years.
Introduction and History of the Food Stamp Program
The food stamp program was initially founded to address supply and demand problems during the Great Depression. City people could not afford food, and several farm products were in surplus. Subsidized vouchers could be redeemed for specific food items available via the federal Agriculture Department. The program ran from 1939-1943 and was stopped when the economy improved with the onset of World War II. The food stamp program was revived as a pilot project in 1961 by President Kennedy, but was made permanent by President Johnson as a component of the Great Society. Food stamp caseloads have contracted and expanded over several decades, with a notable decrease in caseloads in the 1990s due to welfare reform. The 2002 farm bill increased the cost of the program, re-established eligibility among non-citizens, and increased benefits for large families. SNAP serves over 31 million citizens at a cost of $30 billion dollars annually. People who live at 130% or greater than the poverty level automatically qualify for SNAP, and citizens with greater resources may qualify if they utilize a portion of their income to care for elderly and disabled persons at home. There is no time limit for food stamp access; recipients can stay on the program as long as they are able to demonstrate a lack of sufficient income. The work requirement to access SNAP is a formality at best; adult household members are required to be registered for, or looking for work, while on SNAP. This work requirement is being temporarily suspended while allotments are increased in the economic stimulus plan of 2009. The stimulus bill increases the food stamp allotment per eligible family by 13.6%. Food inflation in April 2009 was 3.3%.
Overall, food subsidy programs like SNAP cost taxpayers $55 billion in 2007. 61% of the USDA budget is dedicated to food assistance programs. The largest programs include SNAP, school breakfast and lunch programs, summer food service, after school snack and meals, child and adult care food programs, and Women Infants and Children (WIC), a program that provides a basket of specific food appropriate for improving the health of women and young children. In total, there are 26 food and nutrition programs operated by six different agencies. There is no cross talk between the programs to determine how many people receive overlapping benefits. As a result, social service agencies will enroll people in every program they are eligible, resulting in duplication of services.
Food stamps and increased obesity
Fortunately, a lack of food is no longer the central concern of health advocates. Instead, the problem of insufficient calories has been replaced by growing obesity problems. Nearly 70% of US adults and over 30% of child are overweight or obese, and the problem disproportionately affects low or no-income people. SNAP was established as a healthy food supplement for many of these families, but the program facilitates unrestricted access to calorically dense, nutritionally empty consumables that feed the obesity epidemic. Research has demonstrated that food stamps do not ensure consumption of nutritionally adequate diets. The inability of SNAP to perform its function may be due to several forces, including inefficient household budget management and inadequate nutrition education. It has been suggested that limited economic resources shift dietary choices towards an energy dense diet that provides maximum calories per the least volume and the least cost. Such a statement overlooks the role SNAP plays to bring low-income families to a purchasing power equal to or greater than similarly sized working families. In these cases, food choices are not about obtaining enough calories or staving off hunger. High calorie foods are generally not filling, because they are low in the fiber and water content. As a result, the food takes up little space in the stomach, and the stretch receptors in the stomach that signal fullness are not activated. As a result, more dense, high calorie food is needed to signal ‘full’ versus foods high in fiber and water content that expand to create a feeling of fullness. Rather, high calorie foods are chosen because they dominate the food environment and satiate a palate accustomed to high-fat, high-calories foods.
The link between food environments, food choices, and obesity is well established. The presence and intake of high fat, high-sugar food establishes a reward system in the brain that operates similarly to the addictive model of opiates. Naloxone, an opiate antagonist typically used to reverse overdoses of opiods like heroin or fentanyl, has also been demonstrated to reduce sucrose cravings in an animal model. Continued, unrestricted exposure to the offending substance needs to be addressed to break the cycle of unhealthy consumption in SNAP-sponsored food environments. The food stamp-obesity relationship has been studied and a model developed describing a three-week period of overeating when SNAP funds are available, followed by a one-week period of involuntary food restriction when resource have been depleted, followed by overeating when the allotment is restored. The twin insults of unhealthy food choices and uneven utilization drive the obesity epidemic in poor communities.
According to the USDA, most low-income people spent their limited SNAP funds on energy dense foods largely composed of added sugars and fat. Fruit and vegetable consumption did not increase in families on SNAP assistance. There are several examples of food stamp recipients who have successfully met the twin objective of spending within the food stamp limit and buying healthy foods. These successful cases did so by spending a larger share of the food dollar on grains, fruits, vegetables, and milk, and less on meat, soft drinks, sweets, and fats. Tight federal control over SNAP allotments presents an opportunity for the government to restrict the food choices of SNAP recipients to direct food purchasing towards healthier foods. When considering the benefits and burdens to the state, the merits of restricting food choices are plainly evident.
An argument for restricting the food choice of SNAP recipients
The primary reason to restrict food choices of SNAP recipients relates to health. SNAP can currently be used to purchase gum, candy, soda, chips, and every other junk food waiting in the aisles. Do these foods honestly serve the mission of SNAP to supplement homes with healthy food? The food stamp industry lauds the consumer choice in the SNAP program. Is consumer preference an appropriate consideration in a government sponsored ‘anti-hunger’ program? Are Cheetos and Coke required to stave off the hunger and poor nutrition SNAP portends to address? The USDA claims that SNAP benefits levels are set to allow households to purchase a set of low-cost foods that meet current Federal nutrition regulations. What regulations are they referring to? SNAP purchased food does not have to pass a nutrition regulation; this statement refers to the regulations that simply qualify something as a ‘food’. No serious policy contributor could suggest that allowing purchases of junk food with federal dollars serves the purpose of the SNAP program or the long-term health care goals of the country.
In an effort to influence choice, the USDA had expanded its investment in nutrition education. These programs are voluntary, and states must apply for additional funds to support these programs. $247 million was spent in 2006 on education programs that have not demonstrated an effect on purchasing patterns. Education programs are notoriously unsuccessful, especially in the realm of consumer behavior like food purchasing. The government is spending to subsidize purchase, and to influence purchase. Why not simply restrict purchases?
There are several options available to alter the purchase patterns of SNAP recipients. The first and most logical option is to create a purchase package for SNAP recipients similar to that developed for the WIC program. WIC is a preventive nutrition program that provides nutritious food, nutrition education, and access to healthcare for low-income pregnant women, new mothers, and infants and children at nutritional risk. WIC enhances the nutritional quality of the diet of participants through a prescription food package, a specified set of important foods that includes low-fat milk, cheese, juice, eggs, iron-fortified cereals, infant formulas, beans, and fruits and vegetables. WIC vouchers are used to pick up WIC packages at appointed stores. WIC studies on dietary intake in pregnant women demonstrate that the program increases intake of food energy and a number of nutrients, including protein, vitamin C, iron, and calcium.
Analogously, SNAP recipients could receive a specified set of foods that constitute a healthy diet. Such a process would ensure SNAP fulfills its mission. Will all the offerings be to consumer preference? Such a question distracts from the core function of SNAP: to provide families with healthy food. Consumer preference is secondary to balanced nutritional needs. There is no consumer preference when the costs are not born by the consumer.
A second, less restrictive model may allow people to pick from a set of foods available in store. Fresh, canned, or frozen fruits and vegetables would be permitted. Whole wheat bread, pasta, and specific breakfast cereals would be permitted. From dairy, low-fat/skim milk, yogurt, and cheese could be purchased. Olive oil and canola oil would be allowed for cooking. What else needs to be included if the goal is bellies full of healthy food? Explicit restrictions would be placed on soda, chips, juice, cake, cookies, and ice cream.
A central issue for poor people in urban and rural environments is the lack of access to large markets that offer high quality, healthy foods at reasonable cost. A key part of the policy recommendation on restricting food choices must recognize that the food access problem has to be dealt with through creative business models that can serve the low-income market. In the short-term, restriction on the purchasing options under SNAP will compel the small, expensive stores in poor communities to alter the fare they offer if that store relies on food stamp income.
A proposal to decrease food stamp allotments
A proposal to restrict choice compels an analysis of the amount of money apportioned to households on SNAP. According to the Food Marketing Institute, the weekly grocery bill for a household of one has been estimated at $61, two people at $91, 3-4 people $111, and 5+ people at $135 dollars. If these are industry averages, and the maximum monthly SNAP allotment for a family of 4 in 2009 is $668 dollars per month, why is the SNAP allotment $224 more per month than the average family of four would spend? For five people, the allotment is $252 more per month than the average family spends.
SNAP and junk food advocates will defend these allotments by suggesting that eating healthy food is expensive. This is a common retort of supporters who seek to expand food stamps or who suggest that restrictions will drive people into hunger. Studies on the costs of eating healthily vary widely. The argument that healthier eating is more expensive shrivels in light of the food stamp allotments. Subsidies are 33% higher than an average wage earning family that eats statistically healthier food would spend. This is in addition to the provisions offered by overlapping food programs that have dual eligibility.
Addressing Food Access Barriers
Proposed SNAP restrictions and decreased allotments shed light on the challenges of healthy food access in urban centers. In the modern American city, it is easier to find a BigMac and soda than to buy a banana and skim milk. These zones are food deserts, defined as regions in which people experience geographical or financial barriers to acquiring healthy food. The price of healthy staples, if available, is 20% higher in urban corner stores than a full-service supermarket, and healthy meals cost 30% more to make. Low-income urban residents pay this “poverty penalty” because market fundamentals do not bear on their economy; there is no competition to drive prices down, improve quality, convenience, and access to needed goods. Traditional approaches to food deserts involve enticing companies to build stores in urban neighborhoods. Companies resist because of revenue, safety, and purchasing power concerns. Negotiations are individual, complex, and costly to the city. Given the economic climate and the considerations, industry continues to resist exhortations to locate in urban zones. Other efforts attempt to place healthier foods in existing corner stores. These enjoy limited success, while requiring negotiations with individual stores to manage unfamiliar perishable inventory. Such efforts fail to create a market in which retailers compete on price, and in which consumers select from an array of quality products.
Several other innovations have sprung up to address this barrier. For example, farmer’s markets in cities nationwide have been wired to accept food stamps; users may receive a credit to their account when healthy foods are purchased. Sites from Kansas to Phoenix, to San Francisco and Cleveland are wired for these transactions. Unfortunately, farmers markets tend to be seasonal and inconsistently dispersed throughout urban centers.
Second, a virtual supermarket could be established to transform urban food deserts into neighborhoods that enjoy convenient, rapid access to affordable, healthy food. In this model, urban community groups enable pooled purchasing and same-day delivery to local neighborhood points via Internet ordering of healthy foods from large supermarkets. This option is unique because it solves the food desert problem through Internet-based food distribution channels. It marries the expertise of public health at targeting community needs to the expertise of supermarket retailers at distribution and managing inventory. This model can move quickly because it does not have to convince stakeholders to act in contrast to their missions. Neighborhoods and public health want healthier food; industry wants to sell it to them. Removal of the access barrier via the power of the global, online marketplace will be a transformative step towards ensuring that all consumers in the United States, regardless of location, race, or income levels, can access a range of healthy foods at fair prices. With access to such a model, SNAP recipients will enjoy more convenient access to healthy foods. This model is being piloted in Baltimore City.
A third option for cities to pursue is aggressive support of urban gardens. There is an increasing interest in transforming unused urban landscapes into productive farmland. The produce is subsequently harvested for personal consumption or for sale at markets. The development of these food sources within urban communities represents a win-win for several stakeholders: unused urban land is put to use, unemployed residents of the area are employed to grow food, and individuals become responsible for providing a portion of their family’s food needs and/or income. Most major cities has such ventures up and running; cities and business start-up groups should consider the development of urban gardens as a component of the solution to ensuring that inexpensive, healthy foods is available in urban neighborhoods. Philadelphia is one of the best examples of successful urban gardening efforts. 465 vegetable gardens are tended by 618 families, resulting in the production of $1.5 million worth of food.
Perhaps a portion of the billions spent on food subsidies could be converted to low-interest business loans designed to assist entrepreneurs in leasing vacant urban land for food production?
Who will resist changes to the SNAP program?
The central issue for policymakers to overcome is an unwillingness to restrict the choices and consumer preference of SNAP recipients. Philosophically, an individual’s ability to choose preferences from the market is restricted when someone else, in this case the taxpayers, is paying the bill. A similar approach is taken in health insurance; restrictions are placed on the utilization of services to encourage certain behaviors and to restrict program utilization. Gifts of goodwill from taxpayers to citizens in need can be restricted to serve many ends. Welfare, for example, was curtailed in the 1990s, and a time limit and work requirement were added to the program. Why, then, has the SNAP program been given a free pass – no time limits, no purchase restrictions, and benefits in some instances above the average costs shouldered by working, self-supporting families?
SNAP has continued unexamined because it is the chief subsidy program for agribusiness. 61% of the USDA budget is dedicated to the SNAP program and other food programs to serve the same constituency. Food manufacturers lobby vigorously against restrictions on specific foods, suggesting that any restrictions would be too cumbersome, require constant review, and would hinder the ability of food manufacturers to ‘innovate’. Any threat to the foodstuffs market is construed as a threat to choice, costs, and profitability.
To encourage alterations in policy, the most influential stakeholders- agribusiness, taxpayers, and policymakers - must be convinced that change is in their interests. Taxpayers ought to know that recipients can buy a cartful of Twinkies and Coke and the USDA is happy to pay since these meet the mission of providing ‘healthy food’ to the community. It must be made known that there are no time limits on food stamp assistance. How does this motivate movement away from dependence, towards independence? Taxpayers should know that politicians actively recruit people onto the food stamp program, because it brings federal dollars into the state. Politicians need to be convinced that the health benefit of restricting choice far outweigh the potential backlash from food stamp users and the food stamp industry that utilize and administer the program. Recipients of food stamps and their advocates will be at a loss to justify unrestricted purchase. Who can defend Twinkies and Pop Tarts in the public interest? Agribusiness will continue to fight for unrestricted access to its goods, but their rationale is ringing increasingly hollow in light of the obesity pandemic.
The most hysterical advocate from the food program industry will fret that restrictions to food choices or allotments will cause people to drop out of the program. I am tempted to ask the obvious question: so what and to what? Dropouts will seek food elsewhere and be able to meet needs outside government assistance; this is exactly what food assistance programs should promote. SNAP should be a last stop solution for achieving food security; a drop-out on account of purchases restrictions is likely not in a food security crisis.
In an ideal circumstance, SNAP would cease to exist and food security would be achieved through a combination of work, urban farming, private charity, business innovation and community support for its poor. In the short-term, while working towards a gradual dissolution of SNAP, there are several policy changes that can return food assistance to its core function: to be targeted, temporary, and driven by nutritional needs.
The restriction on purchases and purchase points sends a strong signal from the Obama administration that it understands the relationship between food environments, obesity, and disease, and that the federal government will not stand to see its resources spent on unhealthy foods that drive disease. Restriction on allotments would further emphasize that SNAP is meant to be temporary, and that options among those receiving public assistance to guard against hunger need not include unhealthy goods. Transparency in purchasing will reveal to stakeholders how restrictions alter food choices. These gestures can begin to transform SNAP from a saturated agribusiness highway to a small temporary program that offers survival sustenance to households transitioning to independence.
Monday, September 15, 2008
* If you grow up in Hawaii, raised by a single Mom and your grandparents, you're "exotic, different " and not a real American.
* Grow up in Alaska eating mooseburgers , a quintessential American story.
* If your name is Barack you're a radical, unpatriotic Muslim.
* Name your kids Willow, Trig and Track, you're a maverick.
* Graduate near the top of you class from Harvard Law School and you are an elitist who's not a real American and certainly not qualified to be President of the U.S.
* Attend 5 different small colleges before graduating or finish close to last in your class at the Naval Academy , you're well grounded and the most qualified to hold the two highest offices in the U.S.
* If you spend 3 years as a community organizer, become the first black President of the Harvard Law Review, create a voter registration drive that registers 150,000 new voters, spend 12 years as a Constitutional Law professor, spend 8 years as a State Senator representing a district with over 750,000 people, become chairman of the state Senate's Health and Human Services committee, spend 4 years in the United States Senate representing a state of 13 million people while sponsoring 131 bills and serving on the Foreign Affairs, Environment and Public Works and Veteran's Affairs committees, you don't have any real leadership experience.
* If your total resume is: local weather girl, 4 years on the city council and 6 years as the mayor of a town with less than 7,000 people, 20 months as the governor of a state with only 650,000 people, then you're qualified to become the country's second highest ranking executive.
* If you have been married to the same woman for 19 years while raising 2 beautiful daughters, all within Protestant churches, you're not a real Christian.
* If you cheated on your first wife with a rich heiress, and left your disfigured wife and married the heiress the next month, you're a maverick and a someone to be looked up to as promoting Christian values.
* If you teach teach children about sexual predators, you are irresponsible and eroding the fiber of society but if while Mayor of your small town, you charge rape victims for rape kits you are to be applauded for your leadership.
* If, while governor, you staunchly advocate abstinence only, with no other option in sex education in your state's school system while your unwed teen daughter ends up pregnant, you're very responsible.
* If your wife is a Harvard graduate lawyer who gave up a position in a prestigious law firm to work for the betterment of her inner city community, then gave that up to raise a family, your family's values don't represent America's ; however if you can't remember how many houses you own, your wife is one of the richest people in America who inherited her money and wears dresses every day that cost several hundred thousand dollars, the two of you have more in common with and can relate better to "real" Americans than the snooty Harvard Law graduates who paid their own way through college and law school. *
If you're husband is nicknamed "First Dude", with at least one DWI conviction and no college education, who didn't register to vote until age 25 and once was a member of a group that hates America and advocated the secession of Alaska from the USA, your family is extremely admirable.
* If you repeatedly lie about your own record and that of your opponent while your opponent refuses to make up lies about you, you're a maverick who is to be admired while your opponent is weird, out of touch elitist.
Saturday, September 6, 2008
Wednesday, September 3, 2008
You will not hear any of these in a replay of her adolescent acceptance speech, which basically talked about energy for 2 minutes and spent the other 30 minutes making fun of Obama and Biden. She apparently never got out of high school. She is still running for beauty queen of Wasalia by making fun of the competition’s hair, or job, or wife. The Republicans have no issues to stand on, so they are going for character assassination and gossipy one liners. Do not be fooled again. This is culture war 101. Women know better than this. Seriously. Stop dividing people based on culture choices. It is not less obvious because you are using a high heel instead of a wedge.
Furthermore, I am disappointed by her reliance on mockery. This is the sign of a weak person with no real ideas to offer. My mama, Audrey Hope Monti, also has 5 children, and gave me one of the wisest pieces of advice I have ever heard. We were driving along in the back seat of our little Subaru, coming home from KinderCare day care center, after my mom had been at work all day as a high school teacher. We were bickering at each other. She pulled the car over, stopped dead on the side of the road and said, ‘There are enough people in the world to make fun of you. I do not know why you have to make fun of each other.” That is a working woman’s wisdom. Not to insult people and then do high fives over the margarita blender in the kitchen. This country needs more grace than that, more recognition that we are in this together. She is a blatant dive back to Bush politics.
In the meantime, here are five questions to ask Palin, if she is ever allowed off the leash:
1) Do you believe in equal pay for equal work for women?
2) Do you believe God has ordained the Iraq war?
3) Do you believe in evolution?
4) What do you think causes poverty?
5) Who do you think are America’s top allies, and why?