In 2007, the line ran down the street, as people queued to get in on the action. Some apparently waited for days hoping to purchase a condo in a building to be built. With such demand, the developers kept upping the unit prices – literally posting the ever-rising prices on a billboard. The penthouse, for the record, was sold to a Hong Kong man who had agreed to drop $25 million.

One Bloor condo building was a project that died with Lehman Brothers. It has not stayed dead for long.

Originally meant to stretch 80 stories over Toronto’s luxury shops of the Yonge and Bloor area, the condo building that would host a hotel and swath of stores (supported by the American financial powerhouse that had survived the Depression but not subprime mortgages) was not built in 2008. The next year, the developers mulled a scaled-back version. And then, nothing. For months, the lot stood empty, symbolic of a world that collapsed into recession.

And in 2011? The building is going up and the condos are being sold. Welcome to Canada.

It’s no longer 2008 and while the rest of the world stews in malaise and economic crisis, Canada is doing just fine. One Bloor has new owners and the plans are ambitious. Rumors circulate that Apple is eyeing some retail space. (For the record, Toronto now rivals New York City in the number of Apple stores.) The building will soon stretch tall over a prosperous Toronto, in a prosperous Canada.

The world may be in recession, but Canada isn’t. The economy expands, posting a robust 3.1% last year.

Are Greek banks safe? What’s going on in Spain? Is Italy next? Canadians worry only about the impact of other countries on a prosperous land.

Others have noticed. When the G20 gathered in Toronto, the Washington Post ran a fawning article on the stability of our housing market and the Huffington Post provided America’s jobless with clever if unusual advise: move to Canada.

Forbes joins a growing list of fans, putting Canada at the top of its list of places to do business. The ranking considered 11 factors for 134 countries, including property rights, red tape, corruption, freedom, and stock market performance.

Writes Forbes’ Kurt Badenhausen:

During the run-up to every U.S. presidential election, countless Americans threaten to move to Canada if their preferred candidate does not emerge victorious. Of course, few follow through with a move north. Maybe it is time to reconsider.

Canada gets special mention for avoiding the banking meltdown and good economic performance.

Such rankings are easy to criticize. For instance, Canada gets top marks for freedom – odd in a country where you can easily get a marijuana joint in most big cities, but not a private MRI scan; the health care sector remains hopelessly overregulated.

Still Canada does well. It’s a marked contrast from just a few years ago, when the country seemed on the cusp of falling apart, literally in the wake of Quebec’s separatist ambitions (falling just 10,000 votes shy of secession in a 1995 referendum).

Some of Canada’s success can be tied to good fortune. Commodities are booming, and Canada is rich in many natural resources (within ten years, it could be the second largest oil producing nation in the world). And in this recession, as in the early 1980s, and unlike the 1930s, a barrel of oil continues to fetch a good price.

But not all of this is luck. At a time of bad public policy, Canadians remain calm and reasonable. Taxes are coming down and public spending has been relatively restrained. After all, Canada isn’t the United States.

Will it continue? Canada’s manufacturing is hot because of exports to the United States — how long will Americans buy Canadian made cars if their economic woes continue? Commodities trade high — how much longer before Asia catches the American flu? On the day that Forbes chose to highlight Canada, its dollar fell to the lowest level in a year, rocked by international economic instability. But compared to many other countries, these are (relatively) good worries to have.

After all, it’s Canada’s One Bloor moment – a time of wealth and exuberance.

September is National Childhood Obesity Month, and the President marked the occasion with a proclamation calling on all Americans to “take action by learning about and engaging in activities that promote healthy eating and greater physical activity by all our Nation’s children.”

Obesity is a major issue; a third of American children and two thirds of adults are obese or overweight. So we must ask: how to fight it? For many policy-makers, the answer is better labeling. But is that enough?

Calorie labeling, whereby restaurants post the calorie contents of their menu items, has become a cause de jour in the public health community. Bloomberg’s New York City was an early experimenter. As is so often the case with the war on obesity, so goes the Big Apple, so goes America. The idea is contained in the sweeping health reform bill passed last year, with full implementation pending. (Britain is also experimenting with a voluntary version of the policy.)

For the public health community, calorie labeling fits with a larger view of obesity. Call it the McVictim Syndrome – that greedy corporations are taking advantage of Americans, conning them into buying unhealthy foods. Inform the masses, and they will slim down, or at least cut down on the junk food.

There’s only one problem:  according to a slew of studies, calorie labeling seems to be a public-policy dud.

Consider a quick review of the literature.

October 2009. Researchers from Yale and the NYU School of Medicine publish a study in Health Affairs they tout as a “first look” at the impact of calorie counts in New York City. Result: “we did not detect a change in calories purchased after the introduction of calorie labeling.”

August 2010. Researchers from Stanford University and the National Bureau of Economic Research review sales data for New York City Starbucks. They conclude: “food calories per transaction fell by 14% (equal to 14 calories per transaction on average)” and beverage calories “did not substantially change” for a net calorie drop of just 6 percent per transaction.

January 2011. In the American Journal of Preventative Medicine, researchers from Duke – NUS Medical School tracked buying decisions in Taco Time franchises after a Washington State county passed a mandatory calorie posting law. They find: “No impact of the regulation on purchasing behavior was found. Trends in transactions and calories per transaction did not vary between control and intervention locations after the law was enacted.”

February 2011. The lead author of the first NYU study expanded on those results for the International Journal of Obesity, focusing on key groups: teens, parents and children in low-income neighborhoods. “We found no statistically significant differences in calories purchased before and after labeling.”

Four studies. Three failing grades and one marginal pass.

There has been just one hold out so far: New York City.

In a 2009 conference presentation, the Department of Health and Mental Hygiene reported that the law helped customers cut their consumption by an average 12.3% in lunches purchased at New York fast food restaurants.

But, with better collection of data and comparison, it seems that even New York data doesn’t support the New York initiative.

This summer, a paper published in the British Medical Journal suggests that calorie labeling doesn’t do much of anything.

Surveys were conducted by the New York for the months before and after the labeling took effect. The study’s novelty was its scope: researchers looked at a cross-section of all fast-food chains in New York City, and collected receipts from around 15,000 people.

And the results? Average calories bought showed no change. In fact, only about one in seven people claimed to even use the calorie information. Armed with information, people’s decisions were mixed: at McDonald’s they seemed to pick a bit better, but actually increased consumption of higher-cal foods at Subway.

Calorie labeling is popular among policy makers but it just doesn’t seem to work out. Frankly, that’s not exactly surprising – does anyone really order, say, a Big Mac with an extra large fries and assume it to be a healthful meal?

The President’s biggest anti-obesity initiative, in other words, will not work and issuing proclamations will not help. The President should send his advisors back to the drawing board.

My friend and colleague Paul Howard is hardly a fan of the President’s efforts, and has been sharply critical of the final legislation. Paul, though, has done us a favor in his ongoing analysis of American health care: he’s looked at the post-passage landscape while acknowledging that there are deep and significant problems with health care in the United States to begin with.

Those deep and significant problems include the individual insurance market in many states. New York, where Paul lives and writes, is a case in point. If you are not covered by your employer, the options for health insurance are few and far between – and feverishly expensive. Part of the problem, obviously, is the way in which health insurance is organized; part of the problem is the clunky reforms New York State has experimented with over the past decade and a half.

So dire is the situation that, in New York City, tens of thousands have joined the Freelancers Union, which allows the self-employed to essentially opt out of the individual market, giving them more choices.

For the record, New York small businesses may be spared some of the worst regulations those in the individual market face, but nonetheless are subjected to incredible administrative costs (some estimates suggest as much as 20 cents on the health insurance dollar goes to administration).

Obamacare calls for health-insurance exchanges to be established in 50 states by 2014, allowing individuals and small businesses to choose from competing plans in one state-wide “marketplace” of insurance. The idea itself is clunky – a last minute compromise that saw the original idea (a national exchange fashioned after the insurance that federal employees have) replaced with state-based exchanges.

Opponents of Obamacare have been fiercely critical of these exchanges, suggesting that they will lead to more bureaucracy, more regulations, and more subsidies, without fundamentally increasing options. States like Florida have decided not to establish the exchanges (and thus forgoing the federal dollars that come with participation).

Paul takes a more measured approach. In an excellent new paper, “Building a Market-Based Health-Insurance Exchange in New York,” he weighs the opportunities and pitfalls of such exchanges.

He considers the state-based health insurance exchanges already in existence. Yes, of course, that includes the Massachusetts Connector – the widely-known centerpiece of the 2006 health-reform legislation forged by Massachusetts’s then-governor Mitt Romney, a Republican, and the Democrat-controlled state legislature. It also includes, though, the exchange established in Utah.

The two experiments could hardly be more different. Massachusetts is rich in regulations and cost; the entire Utah exchange is overseen by just two state employees and functions something like a Hotels.com for insurance options.

The Affordable Care Act gives states some flexibility and much in the way of subsidies. Paul closes with some recommendations for New York as it pulls together its exchange.

A summary:

Open Competition among All Qualifying Health Plans. The exchange should primarily be a clearinghouse for insurance competition… As in the case of Medicare Part D and the FEHBP, flexibility in insurance design is critical to reducing health-insurance costs to taxpayers and consumers. The state should also resist mandating additional essential benefits for exchange plans.

Flexibility in Insurance Design. Policymakers should reform regulations… as needed to allow greater variation in co-pays and deductibles—including allowing HSAs and other high-deductible plans to be sold outside the exchange. They should also allow more limited benefit plans to be sold, allowing consumers to find more affordable coverage options.

Affordable Insurance Options for Younger and Healthier Enrollees. Although the ACA allows New York to maintain its current pure community-rating standards, this regulation is one reason that the state’s individual insurance market has become unaffordable for many uninsured individuals and small businesses. By expanding the state’s age-banding rules to the ACA allowed 3-1 premium ratio (a reform that would require legislative action), many more affordable policies would become available inside and outside of the state’s insurance exchange.

Freedom from Political Influence. The exchange should not have responsibility for reviewing the reasonableness of plan rates or for blocking exchange entry to otherwise qualified health plans.

Defined Contribution Plans for Small Businesses. A defined contribution option (as in the Utah and HealthPass exchanges) for small businesses, combined with a premium aggregator function, should help many more small businesses and their employees find affordable health-insurance options. To save on exchange implementation and operation costs, the state should consider designating one or more private regional exchanges (such as HealthPass) as the state’s small-group health-exchange option.

Paul’s paper is focused on New York, but his ideas would be sound in other states, whether or not Obamacare is implemented or repealed in the coming years.

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On a cool November morning, shortly after President Bush won reelection, I spoke to him about his efforts to tame his company’s health expenses. Dr. Mahoney, then the Pitney Bowes’ corporate medical director, oversaw a small army of employees tasked with pouring over the data generated by the 46,000 American employees and their families.

Dr. Mahoney had a frustrating job. In the mid-2000s, health costs rose at double or even triple general inflation.

The soft-spoken physician explained that his team had found several reasons for the rise. He had a long list, with many things that were unsurprising: Americans and their doctors like diagnostic tests; an aging population requires more care; Americans smoke too much, eat too much, and drink too much.

What made the conversation intriguing, though, was that he was dealing with real-life problems. This wasn’t a discussion confined to the think tank conference world, filled with opinion and ideology. Rather, Dr. Mahoney was looking at real data. And, in doing so, he and his team found some curiosities. Hospital costs would soar in a state like California year to year, not because employees ended up at, say, the LA County Hospital with more frequency than in the past, but as the result of aggressive hospital mergers, which gave hospitals greater negotiating power.

While Pitney Bowes’ employees were all across America, many were in large centers. And in cities like Los Angeles and New York, ER visits were frequent and expensive.

From a distance, this may suggest a raft of accidents. The problem, though, wasn’t mail room mishaps or the like, but rather the challenges of accessing primary care in those big urban centers.

In New York, he noted, family doctors offices often close at 5 P.M. Families find themselves in other settings for their primary care – like ERs.

“It’s one-stop shopping,” he told me. His argument was obvious: families can get all the tests and consultations needed in one visit when they go to an ER – and not take time off work. Sure they may pay more of a co-pay, but they save in wages and convenience.

Of course, not everyone saw it that way. For Dr. Mahoney, the ER was the expensive choice: costing the company roughly $700 for the ER, as opposed to a more modest $75 for the GP.

So goes Pitney Bowes, so goes New York. In a 2006 study of New York ER visits, researchers found 40% of visits could have been dealt with in a primary care setting.

Pitney Bowes has attempted to address the issue by offering their own primary care, through a network of office-based health clinics. But company employees are stretched across the country, often working in the offices of other companies. In other words, Dr. Mahoney could identify the problem but couldn’t really offer up a solution.

* * *

American health care is wonderfully large and complicated – indeed, the health economy of the United States is larger than China’s entire economy. And as we look to solutions for one set of problems, it’s easy to neglect another area.

Last week, I was reminded of Dr. Mahoney’s comments. My friend and colleague Paul Howard of the Manhattan Institute wrote a report considering primary care in New York City, in the light of health-care reform efforts.

Howard considers a delicate question: what to do about primary care?

For the right – eager to see a market-alternative to Obamacare – more primary care options could mark the beginnings of a more functional market for health services. For the left – hopeful that last March’s East Room signing ceremony will result in full implementation of Obamacare – expanding primary care is key to providing care to millions of newly insured Americans.

Yet, despite the common interest in primary care reform, little work has been generated from think tanks or academics in the last couple of years, as experts have turned their attention to the increasingly bitter debate over Obamacare.

Howard isn’t exactly a fan of the President’s efforts, but recognizes that the number of insured Americans is likely to rise in the coming years. He also sees a potential Massachusetts’ problem, where a big health-care reform effort resulted in a big glut of insured people unable to find primary care.

As Howard notes:

In July 2010, Massachusetts released data showing that use of emergency rooms in the state increased by nearly 10 percent from 2004 to 2008, disappointing hopes that broader insurance coverage would reduce it. The same report noted that “expanded coverage may have contributed to the rise in emergency-room visits, as newly insured residents entered the health-care system and could not find a primary-care doctor or get a last-minute appointment with their physician.”

What then is to be done with the potential of 32 million Americans joining the ranks of the insured?

Howard sees part of the solution to be found in Wal-Mart – or rather, the retail clinics that are often found in Wal-Mart, Walgreens, and other stores across the country. Retail clinics, typically staffed by nurse practitioners, offer a variety of services at low costs.

Need a flu shot? The solution can be found off aisle 12.

Retail clinics aren’t the solution to all of our primary care needs, but they could be part of the solution. Howard notes study after study suggesting high satisfaction rates from patients, good adherence to clinical guidelines (frankly besting family docs in the treatment of sore throats), and overall cost effectiveness.

So, a quick review: a win-win for consumers and the system. But retail clinics aren’t much found in big cities like New York, and Howard tries to explain why.

The problem? Howard finds a raft of regulations stand in the way of these clinics. He focuses on New York City, of course, but the problem is all too familiar to people in other large cities.

Take Certification of Need (CON). In order to offer the good people of Soho, a low-cost option for, say, their flu shot needs, clinic owners need to get city approval, showing that the clinic is “needed.” (Imagine if we held Chinese restaurants or convenience stores to that standard.)

CON regulations date back to the 1970s, when health planners worried about a medical arms race and hoped to temper health inflation. Today, these rules still exist often championed by vested interests. (A few years ago, I was nominally involved in the Crist administration’s attempts to overhaul Florida’s CON law. The administration’s chief opponent? The hospital lobby.)

Howard concludes his insightful study by offering some practical suggestions for increasing the number of New York retail clinics – good advice for policy-makers that will benefit New Yorkers and today’s Dr. Mahoneys.

But Howard’s work also speaks to the incredible challenges that reform efforts will face in the coming years. Republicans and Democrats need to take note. Yes, there are problems with access, cost, and uneven quality. But American health care also suffers from decades of hyper-regulation, making even modest changes difficult. And while it’s wonderful that the left champions Obamacare and the right favors empowered health savings accounts, the example of retail clinics in New York City speaks to limitations of both approaches until this hyper-regulatory environment is addressed.

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As America comes to grips with the disastrous effects of a national obesity epidemic, there’s a new feeling in the air: defeatism. Former Carter Administration advisor Amitai Etzioni seemed to succumb to it when he wrote an article entitled “dieting gets you nowhere” for CNN late last year. In it, the liberal sociologist cited a recent nutritional study that found 8 out of 10 Americans who try to lose weight fail. So in Etzioni’s mind, “all the hoopla about dieting” only diverts resources “from the one group in which healthy eating, especially if combined with exercise, can make a significant difference – children, the younger the better.” His message: adults should simply give in on obesity and move on to the next generation.

How individuals – and policymakers – react to claims like this is important to the future of the United States.

Obesity is a financial epidemic, since the collateral damage from obesity is driving health care costs out of control. Obesity is an economic epidemic, since a heavier workforce is a less competitive, less productive workforce. Obesity is a national security epidemic, since it cuts down America’s potential pool of military recruits before America’s future enemies have even fired a shot. Obesity is a tragic epidemic, since it shortens lives and crushes the self-esteem of millions of decent people.

But most of all, obesity is a voluntary epidemic. Most overweight people choose to eat poorly, and they make premature death more likely when they do. On the other hand, people who choose unhealthy diets today are equally free to choose a healthier diet tomorrow. Even a modest change can be important.

There’s no need for defeatism, for two reasons. First, preventing every new pound of excess, unhealthy weight is a victory, even though almost three quarters of Americans are already technically overweight. That’s as certain a fact as gravity.

In fact, it has a great deal to do with gravity. Bearing more weight than the human body was designed to carry puts premature wear on the joints, fueling America’s rising quota of costly knee and ankle replacement surgeries. Being overweight makes muscles relatively weaker, and breathing relatively harder, restricting a person’s ability to stay fit. Obesity increases pressure on blood vessels, with consequent risks for potentially lethal cardiovascular diseases. The greater your weight, the greater the risk of diabetes. And so on.

Those factors were at play in a study released last month in the New England Journal of Medicine. Researchers pooled data from 19 studies to consider the effects of excess weight on health. Merely being mildly overweight increased the risk of premature death for women by 13% over the study period (an average of ten years). Add more pounds, and the risk grows rapidly – to as high as 88% greater risk of premature death for obese women, and almost 250% increased risk for the morbidly obese.

These numbers give new meaning to the phrase ‘an ounce of prevention.’ The level of one’s excess weight is important, too. So obesity isn’t an either-or problem; keeping extra weight off even if you’re already overweight can make a real difference to your health.

But the flip side is also true. While crash diets, fad diets, and diet pills are sure to fail in the long run, medically overweight or obese patients should know that reducing weight – gradually – is the surest way to bring immediate health benefits, too. Among the obese, even mild weight loss can dramatically reduce long-term diabetes risks. Mild reductions in weight can also have an immediate and positive impact on blood pressure and hypertension risk.

In short, even if just eight in ten Americans lose a little weight and keep it off, it’s more than worth the trouble – for their sakes, and for everyone’s sake.

“I am a student of public policy, not medicine,” Etzioni wrote. And it shows in his analysis, since he makes it seem as though it’s impossible for most adult Americans to gain anything from keeping their weight down. Indeed, Etzioni’s position seems to flirt with fat acceptance – call it fat defeatism.

Sure, it’s true that eating well and walking a block a day might not do much for a crash dieter who wants to fit into a new pair of jeans by next Tuesday. However, if we measure the fight against obesity the way it should be measured – by medical standards – then even a little progress can be a lot of progress.

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Answer: not much.

In my other life, I’m a physician, and one who often deals with chronic mental illness. Obviously, I’ve never interviewed Jared Loughner, nor have I had the opportunity to speak to his friends and family. But given his age, his paranoid views, and his behavior, the suspect seems to be very mentally ill.

Media reports are a dime a dozen and, with such a hot topic, quality isn’t necessarily guaranteed. Still, consider this description of Loughner from the front page of the New York Times.

In a community college classroom here last June, on the first day of the term, the instructor in Jared L. Loughner’s basic algebra class, Ben McGahee, posed what he thought was a simple arithmetic question to his students. He was not prepared for the explosive response.

“How can you deny math instead of accepting it?” Mr. Loughner asked, after blurting out a random number, according to Mr. McGahee.

His writings and Internet rants have mentioned mind control, world currency, and his anger at the U.S. government because of control of “grammar.”

Some have speculated that he may have Schizophrenia. That seems reasonable speculation, though – again – all this is at a distance.

In the days since this tragic event, some emphasized the need to move past politics and blame. As hot as American political rhetoric has grown in the past years, Loughner seems driven by a chemical imbalance, and not some bad reaction to a radio show.

But let’s not quite excuse politics for the moment. Politics influences policy. And in this tragedy, we can take a moment to consider how we address chronic mental illness.

Consider that a decade ago, California college student Laura Wilcox was shot dead by a paranoid man who had refused treatment for his mental illness. The public outcry helped lead to the passage of Laura’s Law, which authorizes court-ordered treatment for individuals with severe mental illness who meet specific criteria.

As noted by the Treatment Advocacy Center, ten years after Laura’s death, the law she inspired has been implemented in only 2 of California’s 58 counties. And how does Arizona fare? “In the years leading up to the deaths in Tucson, Arizona distinguished itself as the second-worst state in the US for criminalizing mental illness and providing needed hospital beds,” according to this Center that was founded by the eminent psychiatrist E. Fuller Torrey. Arizona, for the record, has just 5.9 psychiatric beds per 100,000, versus the recommended level of 50.

The Treatment Advocacy Center, for the record, emphasizes the need for all states to have laws that enable court-ordered treatment for certain mentally ill. A handful of states still don’t even have that. And, after decades of lobbying by patients and civil libertarians, many of the laws on the books are weak or not enforced. Incredibly, some of this lobbying – allowing mentally ill patients to go untreated – has been funded by taxpayers. My friend and colleague Sally Satel writes well on this point, see here.

Would any of this have made a difference in Arizona? At this point, we simply don’t know.

But if there is any good to come out of this nightmare, perhaps it will spark a local and national examination of the way we as a society handle serious mental illness.

Obesity is a major problem in the United States, with 3 in 10 Americans being obese, and nearly two thirds of us qualifying as overweight. Our increasing girth is – literally – reshaping our society. (See, for example, this story on the funeral business in Iowa.)

But the obese man in the story isn’t an American. He’s British.

As a percentage of the total population, the United States leads the world with obesity. But other countries are, unfortunately, catching up.

Indeed, just late last year, the OECD released a report on the challenges of obesity across the Western world, with an eye on prevention.

The full report is, obviously, rich in data. But take a look at the graph below (from the report) that details the trends across different nations. The United States is an outlier, but countries like Canada, Australia, and England have their own steep curves, reflecting sharply rising rates of obesity.

The OECD report largely focuses on member nations, but across the world we see the same phenomenon. In China, for example, the overweight (including obese) have doubled as a percentage of the population in a fifteen-year period, from 1991 to 2006, from 13.5% to 26.7%. Obese individuals are a small proportion of that heavy subpopulation, but there is no good news here – the percentage of obese people tripled over the same period of time. Diabetes is now as prevalent in China as it is in the United States, with some 92 million cases.

Look from the world’s largest nation to one of its smallest, but you will see a similar pattern. For an usual take on obesity, consider this Nightline story, cleverly titled The Fattest Place on Earth, on a South Pacific paradise with a big problem.

In a Washington Times article, I consider the globalization of obesity, and its policy implications.

Name a liberal policy cause, and chances are someone has found a way to sell it based on America’s rising obesity rate. Liberal pundits and public-health experts serve up a rich buffet of scapegoats for obesity. Our foods are chemically addictive, they claim, so governments must step in to regulate them. Suburban Americans tend to be more obese, so we need fewer cars and more costly transit options, urbanists insist. Corporate ads, cheap fast food, the lack of Canadian-style health insurance – the list stretches on. Here, though, is the reality. Yes, Americans are getting fatter, but so is everyone else in the industrialized world, and that understanding challenges current wisdom on obesity, suggesting the issue may be more cut and dry than liberals make it out to be.

The full essay can be found here.

Such criticism seems downright tame compared to the objections raised by some on the right. Passage of the child nutrition bill has evoked a conservative firestorm. A FoxNews segment, as an example, was titled: “Don’t touch my muffins!” There’s a grassroots movement – cleverly titled “My Food. My Choice!” – that’s declared December to be National Bake Sale Month.

And, on the larger issue of obesity, conservative heavyweights Sarah Palin and Rush Limbaugh have scoffed at White House ideas.

Are conservatives beginning to sound on this issue like… liberals?

RealClearPolitics columnist Cathy Young notes the parallels between the left and the right on the obesity issue.

The irony, too, is that right-wing griping about the food police can converge uncannily with the left-wing “fat acceptance” movement. This movement champions the idea that fat people are an oppressed group and that disapproval of obesity is bigotry…

Strange bedfellows. Some conservatives grouse about the rising influence of the state – but end up dismissing any policy initiative that would address the obesity epidemic. Liberals, unable to criticize people no matter how pathological their behavior, fall into a similar policy inertia.

That’s not quite to suggest that all conservatives are in the nanny-state-dismissal group; nor are all liberals in the fat-acceptance crowd. Still there are strong voices on both sides of the spectrum with – ironically enough – a similar policy prescription, or lack thereof.

But neither position is particularly thoughtful. There is a role for public policy here – both in what government should be doing (more physical education in our schools, for example) and what it shouldn’t be doing (some agribusiness subsidies). Likewise, while important to remember that life events can lead us to bad life choices, a permissive approach to obesity is as absurd as excusing the smoker for his habit because dad didn’t like to play baseball with him.

For the record, Ms. Young’s column closes with a nice observation:

Conservatives have often argued that, in order for a free society to flourish, individual freedom must be coupled with self-restraint. Perhaps some appreciation of this old-fashioned virtue is just what’s needed in the debate over food and fat.

In

Barbecued chicken patty

Whole grain roll

Locally grown carrots

1 percent milk

Sliced apples

Out

Fried chicken patty

White roll

Canned green beans

Whole milk

Package of snack cakes (from vending machine)

So reports the New York Times, with information from the Center for Science in the Public Interest, a good news story given the passage of the child nutrition bill in the House of Representatives last week.

And who wouldn’t agree that school lunches today are something of an embarrassment and in need of an update? (For an unusual take on the problem, one Chicago teacher is eating school lunches for a year and blogging anonymously on her meals, complete with pictures.)

Add in the fact that millions of kids’ meals are federally sponsored with the school lunch program – meaning that the unhealthy food served often receives a double subsidy (to agribusiness and then to schools). In other words, taxpayers are paying and paying again to bring up a new generation of diabetics.

And so, with the passage of the bill authorizing the school lunch program last week through the House (and passage before it in the Senate back in August), many are breathing a collective, nonpartisan sigh of relief. Better food is on the way.

It’s an important cause. But is the new legislation a meaningful and lasting step in that direction?

Start with the fact that there were nutritional standards in the first place. Set 30 years ago, today’s schools are actually governed by strict regulations.

Yes, that’s right – there really are strict regulations in place. And, from a distance, they seem reasonable enough, banning the sale of “foods of minimal nutritional value.”

Notice that sodas, candy bars, salty snacks, pizza and French fries are all meeting that minimal-nutrition standard.

The Carter Administration set the standards to ensure that foods sold in schools had at least 5% of an essential nutrient, like protein or calcium. What about fat or sodium or high calories? Current standards do nothing to limit them. And, of course, there are loopholes. The end result? A donut can be sold in your daughter’s high school cafeteria, but not a lollipop. Breath-mint? No. But cookies are okay.

In fact, the legislation enabling the school lunch program is renewed by Congress every five years, meaning that there is ongoing Congressional oversight.

Liberal groups emphasize that this process has been heavily influenced by lobbyists fighting for the billions of dollars at stake in the setting of nutritional standards. (Check out this clever video). But then, ironically, they collectively champion a dubious idea: heavier regulations from Washington.

And the child nutrition bill is a heavy hand if there ever was one.

Not only will the Agriculture Department be empowered to strengthen and update regulations around school lunches, it will have oversight over much of everything food related in schools. Even bake sales.

“Don’t touch my brownies!” begins an AP story on the subject.  The article is unbiased and, despite the fun opening, it does note that bake sales are only subject to regulations if they are frequent.

Still, there is something absurd about the Agriculture Department weighing in on fundraising and brownies. Or school lunch programs, for that matter. This is a case of the fox watching the hen house – the people busy subsidizing corn production and talking up the consumption of cheese, will now be charged with better regulating the school lunch programs they’ve been negligently regulating for 3 decades.

What’s a better approach? Several states have released voluntary, common-sense guidelines for school lunches, and then published the names of schools that have signed on and not signed on. That approach empowers parents – and that makes more long-term sense than the Washington-empowerment seen in the child nutrition bill.

Washington regulations and oversight, after all, seem to offer much in way of lobbying, rules, and red tape, and little in way of true accountability. The better approach is – to steal a line from the organic crowd – to go local.

First the bad news: a large portion of our population either has the disease or is pre-diabetic.

Now, the really bad news: diabetes and pre-diabetes rates are going to soar in the coming decade, according to the analysis, in part driven by the obesity crisis.

I’ll return back to the study in a moment, but it underscores a paradox: medicine has never been better; our overall health, however, is worsening.

Indeed, after seventy years of staggering medical progress – whereby medicine has evolved from passive care to miraculous cure – we seem to have entered into a new age, one in which personal decision will increasingly influence our health and the cost of our health care.

The problem is that almost no one in Washington seems to have noticed.

*  *  *

On this, we can all agree. Medicine has been transformed in the past decades.

Pre-1941: Prior to 1941, the state of medicine is well represented by Luke Fildes’ famous etching.

The doctor looks august, thoughtful and pensive. But notice what he isn’t doing – much of anything. Frankly, there isn’t much difference between the passive approach of physician here and the distraught mother in the background. Outside of thyroid supplement and insulin, medicine offered little but empathy to its patients.

The Modern Era: On February 12, 1941, the era of modern medicine was ushered in when the first clinical use of penicillin. Medicine went from passive care to miraculous cure. The doctor in that famous etching got off his chair and started to do things.

The latter part of the twentieth century saw one discover after another. Steroids, antipsychotics, open heart surgery, kidney transplants – all within a dozen years of penicillin’s first clinical use. The pace of change has been extraordinary.

Today, medicine has never been so advanced. Surgeries are done on fetuses months before birth; death by cardiovascular disease has fallen by two thirds in fifty years; diseases that were once death sentences, like childhood leukemia, are curable.

The Age of Preventable Illness: But if medicine has never been so advanced, the actual health of Americans is far less robust. The Era of Modern Medicine has given way to the Age of Preventable Illness. Americans have embraced a culture of extremes: too much alcohol, tobacco, drugs, and food, and not enough exercise and restraint. American leads the way in medical innovation, winning more Nobel Prizes in Medicine than all other countries combined. We also lead the world in obesity, and have the poor life expectancy statistics to show for it.

The consequences of the culture of extremes are unfortunate.

Indeed, as others have argued, including Dr. Steven Schroeder in the New England Journal of Medicine, we have reached a point where traditional causes of premature death – environmental exposure or lack of access to health care – are modest. What isn’t modest? Dr. Schroeder argues “behavioral patterns.”

The statistics are discouraging: 1 in 5 smoke; 3 in 10 are obese; 1 in 3 don’t even take their prescribed medications for illnesses like hypertension.

Which brings us to that study on diabetes.

In “The United States of Diabetes,” researchers at UnitedHealth estimate the rising cost of diabetic care in America. Diabetes has no single cause but, with profound weight gain, it’s clear that our obesity problems are causing diabetes to become ever more common.

This new study estimates that health spending associated with diabetes and pre-diabetes is currently $194 billion a year (7% of total U.S. health spending). That cost is projected to rise to $500 billion by 2020, as the percentage of people with diabetes and pre-diabetes rises to 52% of the population.

Interestingly, taxpayers are the ones who would be most on the hook for diabetic care and the treatment of diabetic complications, since the majority of diabetics will be on Medicare and Medicaid.

A few thoughts on the UnitedHealth study:

1) Washington Doesn’t Get It

For much of the last two years, Washington politicians of both parties have debated how to reign in healthcare costs. But as obesity rates rise and the resulting illnesses like diabetes become ever more common, we stand little chance no matter what happens to ObamaCare.

The larger debate is not about the IPAB or health-insurance exchanges or Medicaid expansion, it’s about health.

2) The ObamaCare Model is Dated

For Democrats, the view of healthcare is dated – they see illness as an act of God, leaving patients stricken with disease that could not have been avoided. Not surprisingly, then, ObamaCare seeks to divorce people from the financial consequences of their health decisions – regulating insurance to treat people equally regardless of age or illness (community rating), offering many no-deductible services, mandating the coverage of other services, and sweetening the deal with heavy subsidies.

Let’s be clear: a patient with Schizophrenia shouldn’t be punished because his father and grandfather had the disease. But many illnesses are preventable. Rather than encourage health, ObamaCare seeks to socialize the costs of bad health.

3) Public Health Efforts Have Been Weak

In the past, governments looked to “knee-jerk regulation.” Anti-obesity efforts – well meaning as they are – represent “feel-good regulation.”

Calorie listings, salt reductions, trans-fat bans. These efforts offer little potential of success.

Consider a NYU-Yale study that surveyed 1,100 fast food customers in poor New York neighborhoods. While people claimed making healthier choices when given the calorie-count information, researchers found that customers actually ordered more calories, not less.

The issue isn’t ignorance (does anyone really order a Big Mac and assume it to be a healthful meal?) or the plague of one bad ingredient (like salt), it’s a culture of excess. Policy prescriptions need to address the larger problem.

4) Conservatives Need More to Say

The conservative response to date has been anemic. With rising rates of obesity and diabetes, many have been happy to attack meddlesome liberal efforts, without offering anything in its place.

Take as an example Sarah Palin. Speaking in Plumsteadville, PA, the former VP candidate criticized the Pennsylvania’s State Board of Education’s plan to limit sweets in classroom parties. Earlier in the day, she had brought cookies to a classroom. She explained:

I heard there’s a debate going on in Pennsylvania over whether public schools were going to ban sweets. I wanted these kids to bring home the idea to their parents for discussion: Who should be deciding what I eat? Should it be government or should it be parents? It should be the parents.

The issue is more complicated than portrayed by the media, and Ms. Palin isn’t entirely wrong. The State Board of Education is considering pushing all children’s celebrations to one month and requiring that there be non-sugary food options at classroom parties.

It’s difficult to find this compelling (January kids would then celebrate their birthdays in, say, June?) or particularly practical (will children in large numbers opt for a medley of vegetables over the birthday cake?). And involving parents is reasonable enough.

But Ms. Palin’s attack is also paper-thin. Yes, the Board of Education seems to have identified a real issue and matched it with a bureaucratic answer, but what to do about the larger issue? Conservatives seem happy to attack the “nanny state” (to quote Palin’s Tweet) but offer little in its place.

And there is a conservative response on this issue. At a time of rising rates of obesity, we should emphasize physical education in our schools and better food in their cafeterias. Washington spends billions subsidizing big business and bad health choices through agricultural subsidies – it’s difficult to ever see the justification for this, but, at a time of record deficits, there is none. Health insurance needs to move from a model of sick care to one that promotes wellness. And, finally, we need to practice more restraint in our eating habits.

Conservatives have long argued for the need for personal responsibility, bemoaning fatherlessness and divorce. It would be a pity, then, to see the movement fall into obesity nihilism.