(Sept. 17, COLUMN)

Whoever gets elected president will have health care reform high on his agenda.

The subject is on the public’s mind more than ever. That’s a far cry from the days of the Clinton administration when Bill and Hillary tried — and failed — to get reform.

The situation is far different now. Such diverse groups as the National Federation of Independent Business and the American Hospital Association are calling for change. The NFIB polled 3,500 members, the vast majority of which have between 3 and 200 employees.

Todd Stottlemyer, president of NFIB, reports the survey shows that “health care is the No.1business problem.”

The reason: cost. The costs have risen 129% since 2000. A lot fewer companies can afford to offer health care now — it’s down to 59% from a high of 68%.

Here’s a shocker: According to Stottlemyer, fully 27 million of the 46 million people uninsured are small business owners, their employees or family members.

A lot of big companies face the same problem. Health costs nearly sank General Motors, once the largest industrial company in the world.

A lot of supermarket chains have seen their competiveness rocked by health care costs driven by union-mandated coverage. Nonunion and part-timers often have no health care coverage.

Both candidates, Democrat Barack Obama and Republican John McCain, have detailed health care reform plans. If someone could combine the best of both plans then a highly workable program could be put in place.

The Obama people are hoping for a big win, with foolproof majorities in the House and Senate, and control of the White House. Even if McCain wins there seems little likelihood the Republicans will control Congress, so compromise will be required.

Obama wants to give coverage to everyone through a plan “equal to that enjoyed by members of Congress.”

The program would be open and guaranteed to all, subsidized, portable, with tax credits for small business for up to 50% of premium payment. Safety net programs, such as Medicaid and children’s coverage, would be expanded.

There would be more money spent on food safety, on better nutrition in schools and in feeding programs, and an effort to make sure communities have access “to grocery stores with fruits and vegetables.”

McCain would offer affordable coverage to all through a $5,000 tax credit for families, supplemented with health savings accounts. Families would shop for coverage. The insurance would be portable, and for those who cannot get coverage because of illness or prior condition, McCain would work with states to create insurance pools call Guaranteed Access Programs.

Both plans seek other reforms, such as cheaper drugs, more electronic record-keeping.

While not a part of the health program, McCain does call for a temporary worker program that would allow workers into the U.S. to work in agriculture, including the fresh fruit and vegetable industry.

That would assist with produce availability and help keep costs reasonable. McCain has also called for marketing programs to promote fruits and vegetables.

Obama has more to say about prevention, including better school nutrition.

The truth is, any successful health care program needs to have a strong nutrition component, including better diets, which calls for plenty of access to fruits and vegetables. Fresh produce has a role to play in fighting disease, childhood obesity, cancer, and a host of other problems.

It’s the antioxidants, potassium, lycopene, carotene, fiber, vitamins and other nutrients that can actually cut costs by either delaying or stopping the onset of disease. No, they won’t allow you to live forever, but longer and better.

Spending billions of dollars to promote produce use, to educate, enhance diets, provide benefits through food stamps and other programs would save tens of billions later on.

But prevention has always been the stepchild of medicine. It doesn’t pay the rent.

My brother, a medical doctor in practice for decades, doesn’t get paid much for preventive medicine, although he practices it all the time by advising and educating patients. Some of his colleagues, who do the complex procedures and surgeries, make the big bucks.

A gastroenterologist can make thousands of dollars a day doing colonoscopy exams searching for colon cancer. A doctor might get $50 counseling a patient to eat a better diet to prevent colon cancer.

There is no doubt prevention works and can cut costs. Diet and nutrition are crucial to prevention.

Any health reform that doesn’t take this into account or that doesn’t develops programs for better diet and nutrition ought to be viewed with great skepticism.

Produce has place in candidates’ health care plans
Larry Waterfield