Sharon Astyk, author of Depletion and Abundance, co-author of A Nation of Farmers, subsistence farmer and mother of four looks at health care from the perspective of those growing our food:

Why National Health Care Is Necessary for a Viable Food System

Among younger small farmers getting started, I've watched many of them struggle with the insurance conundrum - they start out young and healthy, and often are willing to forgo health insurance because they truly and honestly want to do something good. But farming pays poorly, and the first serious injury can be a disaster - and working outside all day, you get hurt sometimes. Or perhaps they have a child - even those able to take on a homebirth find that the cost of having a child is a few thousand dollars or more - on a small household income. Those who must have a hospital birth or more interventions can find themselves rapidly indebted. Soon, finding a job with health care coverage starts to look awfully good - and there goes the farm, or it goes down to a part-time venture.

Farmers who experience a major injury or illness risk losing their land to bankruptcy - while losing your home is always traumatic, there's a big difference between losing the house you love but that mostly provides shelter and a good school district, and losing the land you use to make your living. Up to 10% of all agricultural bankruptcies are linked to illness and injuries - mostly among the uninsured. Once the land is lost, it is gone - most farmers once out of agriculture, are out for good.

Few of us think of the debate on health care in terms of food security and our agriculture - but we are on the cusp of a great shift in our food system, mostly driven by demographics. The average age of US farmers is approaching 60 years old, and there are not enough young farmers to follow them. If we do not make it possible to go into farming a profession - if we make it only the province of the young, the healthy, the childless, we risk facing a national food crisis far more acute that the one shadowing us due to other causes. The reality is that all of us have a real investment in our country's continuing to produce sufficient food, and the right kind of food - and that investment requires that it be possible to become a farmer without sacrificing your health.

That's all well and good, but what struck me from her article is something I've been mulling for quite a while.

Astyk, like most of us, wants to live a long life, but writes:

It is certain that there will be costs and losses in whatever system arises - in Depletion and Abundance I strive to acknowledge that we cannot do all the things we do at present, and that will hurt some people. That said, however, enormous cuts could be made in the costs we incur at critical times in our lives - for example, 1/3 of all medical interventions take place in the last 3 years of life. Some of that is inevitable - someone who gets cancer, has major interventions, but then dies two years later will fall in that category. But an enormous number of those interventions operate simply to draw out the process of death and add to suffering - my great-aunt, visibly dying, was pressured into having open heart surgery a few months before she died, simply because no one would say "you are dying, it is time to talk about relieving your pain." My husband's grandmother was pressured into giving her dying husband medications to prevent a heart attack that caused him great discomfort - at a point where a heart attack was the most benign and merciful sort of death possible.

I dimly recall some Greek myth in which a fellow asked his parents to take his place when Death came calling. They replied that life was still sweet to them, too, and I suspect that most people would agree unless they were in great pain. But long lives are part of the population problem. If one ninety year old man consumes as much during his life as two men that die in their mid-forties, I see a world of older people as essentially an increase in population.

We, especially the middle class, are hanging around longer - fewer of us die at birth or in infancy, and more of us survive the respiratory diseases that used to weed out the forty and fifty-year-olds. Chlorinated water and dental care helps us keep our teeth and eat meat longer. We live long enough to get cancers from all the carcinogens we create, then as Astyk notes, we spend gobs of resources trying to remove or remit them. And all the time we are alive, we consume resources.

I could see trading a long, miserable life for a shorter, happier one, but I suspect that the population problem, resource depletion, climate change, etc., will lead us to an age of very short, unhappy lifespans.