A Bit of Nuance on the "Big Beautiful Bill"

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Hi all,

I have a couple of posts I’m chipping away at that will take more time to get to a place where they’re ready to share. In the meantime, I want to discuss something that’s been on my mind that’s more relevant to the health of all Americans right now.

While I hope the name of this newsletter already suggests that I discuss nutrition and health-related issues from a nuanced perspective, today’s post might be off-putting for some, simply because I use an example from the pandemic. I want to state, with intention, that even though it’s impossible to be completely unbiased, I try to keep an open mind on the issues I discuss here. The fallout from the pandemic, especially on social media, facilitated endless black-and-white thinking, which was the whole reason I started this newsletter in the first place. With that, I would love for you to share your perspective. I want this to be a platform for critical thinking and respectful discussion.

So, without further ado…

I’m sure I’m not the only one who’s been thinking a lot about the recent tax bill that narrowly passed the House of Representatives last Thursday morning and now heads to the Senate. I won’t go into all aspects of the thousand-page “Big ‘Beautiful’ Bill” (extra quotes around ‘beautiful’ because I would have used a different adjective to describe it), but I want to highlight some aspects of the bill that will make it harder for Americans to be healthy.

This bill gives me the opportunity to make an important distinction between A) public health guidelines: policies that help the largest number of people as efficiently and effectively as possible (i.e., the realm of policymakers and public health professionals), and B) personalized recommendations based on an individual’s specific needs (i.e., the realm of clinicians and healthcare providers, like me).

The COVID pandemic really clarified this for me. At the time, I’d been regularly posting on Instagram, and after the vaccine was released, I’d periodically receive questions about my thoughts on the vaccine. It may seem crazy that I (a dietitian) would be asked for my opinion on a vaccine, but I’m guessing it was because of my association with the “holistic” healthcare field. I suspect some people expected me to be “anti-vax.” My response to these inquiries wasn’t a well-studied opinion about vaccine research, based on years of training and expertise (I have none). Instead, I posted a photo of my vaccine card, showing followers what I chose to do. I didn’t tell them what I thought they should do.

Telling thousands of social media followers exactly what they should do is impossible for a clinician. Note that I didn’t say it’s impossible for a public health professional. We clinicians can’t know every single aspect of an individual’s life and health to know what’s best for them. When someone asks me whether they should cut back on sodium or go “plant based”, or to give them my thoughts on a low carb diet or intermittent fasting, or ask if they should take CoQ10, I can’t teleport through the screen to ask them about their medical diagnoses, their health goals, their current eating habits, their family history, their supplement and medication regimen, or about dozens of other factors that would influence my advice. These are things I would need to know when I’m considering the type of nutrition recommendations I might make.

Public health professionals simply can’t do that when speaking to the masses. This is why public health messaging is broad, generalizable, and considers the highest possible good for the largest number of people. Public health messaging can’t account for an individual’s egg allergies, gene variants, kidney disease, or any other unique aspects of an individual’s health. These are all essential considerations when personalizing care, but they aren’t possible in public health messaging.

Looking back on the questions I received about the vaccine, I regret that I hadn’t made it explicitly clear that my decision wasn’t solely based on what was best for me and my immediate family. I would have also added that I was taking into consideration my community, especially those most vulnerable to the risk of severe illness or death.

COVID showed me clearly how we can easily confuse personal autonomy and decision-making with the public good. While I believe it’s essential to prioritize what’s best for yourself and your family, it’s also possible to consider the impact your choices may have on your community. This leads me back to the “Big” bill that is now sitting in the laps of senators.

This bill proposes to do many things, but the two components most directly related to human health are the cuts to Medicaid and to the Supplemental Nutrition Assistance Program (SNAP).

The bill proposes cuts to Medicaid recipients, leaving millions without coverage by 2034. In terms of SNAP, it will cut $286 billion (with a B!) from the program over 10 years. This will leave many people who are already at higher risk for chronic diseases in an even more vulnerable healthcare position. It will leave children and families hungry. Passing this bill will not save us money. In fact, it will cost more money to care for these folks as they will use the emergency healthcare system instead of being covered for routine healthcare visits.

By no means am I trying to paint our governmental or general healthcare system as anywhere close to perfect. I could probably rattle off a hundred ways it needs to improve. However, asking our already-strained emergency medical system to take on even more also isn’t the answer to our systemic healthcare problems.

And when I hear anyone suggesting that people who use public assistance, like SNAP, need to eat healthier, I often imagine a mom and her two hungry kids walking through the grocery store. The mom has to decide between a $5 pizza that would fill their bellies for the night or a $5 bunch of broccoli. This helps me see that parents in positions like this are rarely choosing to eat “unhealthy”; they’re trying to make the best possible decision for their current situation when weighing the economic, personal, and practical needs of their families. To say that they should “just eat healthier” is an oversimplified and unrealistic solution to a complex problem.

If this budget bill passes, we will have individuals with even less access to healthy food, as food assistance will be cut. People will also have less access to healthcare due to significant cuts to Medicare and Medicaid.

I recognize that this may seem pretty rich coming from someone whose work involves providing in-depth, personalized nutrition care to individuals who can afford to pay out-of-pocket for their care. That type of care is essential. I believe we all deserve individualized care. I try to remind myself that we can care about and invest in our own health, and we can advocate for policies that help others receive the best possible care available to them. Remember, taxpayers pay for it either way. But, if we invest upfront in the programs that support prevention, we will save money and take good care of our neighbors.

With that, if you want to protect healthcare and food access for all Americans, please email, call, or fill out the contact form on your senators' websites. They need to hear from as many of us as possible that they shouldn’t pass this bill.