Gay

But do we really? The nutritional triad that we’ve been using is 50, minimum 50 years old. And what’s at the bottom of the fundamental triad that our kindergarteners are taught? At the bottom are carbohydrates and grains. I think we could all now agree that this is not exactly the healthiest foundation for our current diet and lifestyle.

Jack

I agree with you, Gay. There’s a lot to be done in terms of the nutrition program paying for food that is better than what is now being featured. There are multiple things within the Senate bill that do that. I’m just thinking about the American Academy of Family Physicians. I worked there for three years. Their advocacy all had to do with CMS, Medicare, and Medicaid reimbursement in the practice. The American Academy of Family Physicians has six or eight lobbyists and has 125,000 members as a healthcare organization. However, I don’t remember them once having any questions or curiosity about the farm bill.

Gay, they probably should have weighed in on the nutritional aspects of SNAP. However, they wouldn’t have done so, because they’re very risk-averse regarding that area of government policies and priorities. However, in a private conversation, they would have agreed with you that the nutritional standards of the SNAP are not adequate. I’m not sure how to infuse this perspective and these priorities into healthcare professionals, clinicians, and the healthcare industry. How do we jump into this to make some of those connections?

Bill B

Jack, I was thinking of a theme that has emerged forcibly in these forums. This theme concerns the perfect storm of big pharma, big agribusiness, and big medicine–and how the three all contribute to the other two. No problem if we’re messing up people’s bodies with bad food, big pharma can come in and try to save the day. We’ve devoted an entire session to this unhealthy alliance. Then big medicine enters the picture. Unfortunately, those of you in medicine who care most about this alliance and are working in primary care and family medicine are low status. As a result, you don’t have much to say at the table about these matters. And it’s back to an issue that we’ve talked about. What happens when you provide all the evidence? Jack, the articles you have been referring to provide all the evidence. But no one gives a damn.

Jack

There is an article that will be coming out that reports on results from a survey of primary care patients. They were asked what percentage of the healthcare expenditures in the United States do you think are devoted to primary care. The average estimate was 50%. Patients thought that half of the money in healthcare was spent on primary care. We know that it’s actually 5%. So they weren’t off by a little bit. They were off by a large percentage.