Dear Mayor Bloomberg: One Does Not Live on Soda Ban Alone

In one of my writing classes at Fordham, we debated Mayor Bloomberg’s recent proposal to address the obesity epidemic by imposing a ban on 20 oz. soft drinks sold at New York City sports arenas, delis, and movie theaters. My students were convinced the ban would fail, not only because it challenged the self-determination of the individual (this comment came from an attorney, as you might guess), but because, quite logically, anyone who had a craving for a large soda would only have to go next door to the pharmacy or the local grocery store and help themselves. And if sugary drinks have a role to play in adding pounds to the bodies of the people who consume them, what about the tempting array of candy bars available at every convenience store, pharmacy, gas station and grocery store checkout line? Or the two-for-a-dollar bags of chips, loaded with artificial flavors, coloring, cholesterol and saturated fat? Banning sodas is little more than a symbolic gesture in light of all the other options available to the salt and sugar addict.

And yet symbolism is important. When I was a kid growing up in the seventies and eighties, smoking was still associated with glamor and sophistication. Now, at least in New York, smoking is synonymous with exile and social exclusion. The smoking ban surely has had a lot to do with that. So why shouldn’t a ban on soft drinks work the same magic? The obvious answer is that, unlike soft drinks, smoking stinks. The smell gets in your clothes, your hair, and your belongings, whether it’s you who’s smoking or the person next to you. If a person takes a drag and you happened to be in the wrong place at the wrong time, you could very well end up taking a drag too, whether you want to or not. In other words, smoking had an impact on the non-smoking public that was as apparent as it was bothersome. Thus turning smoking into a behavior with morally incorrect undertones was not such a long shot. Drinking soda is different. If the person sitting next to me slurps on a soft drink, it has little to no impact on my personal health. It won’t inadvertently end up going down my throat, giving me ulcers or rotting my teeth. Slapping a moral code on behavior that has no apparent impact on society as a whole – especially in a country where ill health is not only acceptable but clearly lucrative – will do nothing to curb trends in obesity.

So what will? The answer is simple. Ill health must become intolerable in the eyes of the general public. And the only way to make ill health intolerable is to make quality health care entirely accessible. Lack of funds or lack of transportation may no longer serve as explanations for why so many Americans go for years without medical check-ups or without treatment for illness and injury. If every resident in the New York metropolitan area had access to affordable health care, regardless of their income, then I would be less inclined to turn a blind eye to the health of the stranger nursing a soft drink next to me; both of us would have a stake in his effort to cut back on his consumption of sugar and salt.

This might sound far-fetched. After all not even the US federal government has been able to pass universal health care despite decades of attempts. Undoubtedly the elected official that presides over the institution of something so incontrovertibly beneficial to the American public would go down in history a hero, and that seems to be a status that no political party dares afford a member of the rival party – or a rival member of their own party for that matter. What I’m proposing, however, is not universal healthcare, but a scheme that would make sure every New Yorker, regardless of employment status, has consistent access to essential services. The plan would include emergency room visits, preventative and routine care, mental health care services, and prescription medicine. Premiums would be paid on a sliding scale according to one’s income and number of dependents. Rather than imposing a random and often conflicting web of in-network facilities for customers to sort through in the event of a health crisis, this plan would assign participants a local clinic: a place close to home where they could go and feel confident that they will receive the care they need or be referred to a specialist whose fees are covered by the scheme.

If any of this sounds familiar, it’s because it’s all based on San Francisco’s award-winning Health Access Program, which has been alive and kicking since 2007. If you are a resident of San Francisco earning up to 500% of the Federal Poverty Level  – that’s $54,000 or less for an individual and $111,000 or less for a family of four – then you are eligible for access to health care at a rate ranging from $0 to $450 per quarter. Program participants are assigned a ‘medical home’ where they receive regular care from personnel who are then able to keep consistent records of their patients’ medical history. The program is not meant to take the place of health insurance plans – it won’t cover your root canal or your new prescription glasses or any emergencies you might incur while outside San Francisco. But for those people stuck in the twilight zone between indemnity insurance and unaffordable health care packages, the Health Access Program has been a proven success: at the end of 2011, over 54,000 uninsured adults were enrolled in the program, accounting for 85% of the total 64,000 uninsured residents of San Francisco. That same year the program added two additional medical homes to its network of 36 total. All of this came at a cost of $177 .7 million in 2011, or approximately $272 monthly per each enrolled participant. Of this amount, 28% was covered by city revenue, 56% was covered by city and county subsidies, and 16% came from private community program providers.

I’m not a statistician, an economist or a psychologist. Yet I have a sneaking suspicion that implementing a comparable program in a big city like New York is not beyond the realm of possibility. At present the obesity epidemic costs the city of New York $4 billion and has put over 5,000 lives at risk. Instead of trying in vain to stop people from drinking so much soda, why not actively encourage people to take better care of themselves and give them the means to do it? It’s one thing when the mayor of New York – whom most of us have only seen on TV and in the newspaper – reaches down from on high and snatches away your 20 oz. soda cup; it’s another thing when a doctor sits across from you and calmly informs you that your diet is killing you and offers you the numbers to prove it. I personally would find the latter far more effective, and my guess is that most people would as well. What’s left is to afford all people – and not just those with far-reaching health insurance coverage – the chance to sit down with a doctor in the first place.

Mayor Bloomberg’s soda ban proposal has been called an attempt to create a ‘nanny state’ by some naysayers. Undoubtedly many would say the same about a city-wide program that promises access to health care for everyone, including the city’s poorest. But I claim that the exact opposite is true. Guaranteeing quality health care for everyone allows individuals to thrive. It means more people will go to the doctor when they’re sick and seek out treatment rather than ignoring their symptoms because they’re afraid that a diagnosis might lead to financial ruin. It means that more people will get treated for illnesses instead of ‘toughing it out’ because they can’t afford it and inevitably making themselves even sicker. And it means fewer people losing homes and going bankrupt because they are unable to keep up with medical bills.

As for critics who insist that affordable health care will result in a flood of attention-seekers with nothing better to do than take advantage of resources, I would counter that most people don’t actually enjoy being poked and prodded at the doctor’s office, and the numbers that do would be rendered insignificant compared to the numbers that only go when they need to. If San Francisco’s program is anything to go by, then I predict a healthier population, higher productivity, and an overall stronger sense of satisfaction with the city in which we all live. But more importantly, instituting such a scheme would make good health a moral imperative instead of a symbolic gesture. And instead of ignoring the guy beside me guzzling soda, I would be in a better position to bark at him in true New York style and tell him to move to New Jersey if he wants to trash his body.