Why strawberries and healthcare are much better in Europe than in the US

Why strawberries and healthcare are much better in Europe than in the US

When’s the last time you ate a really good strawberry? I don’t mean one of the tasteless monstrosities on display at a typical American grocery store (or worse, Costco). I mean one that’s absolutely packed with flavor and sweetness. (Hopefully it hasn’t been so long that you can’t recall the experience.) Did you grow it yourself, perhaps? Buy it at a farm stand?

For me, it was just a couple weeks ago while we were still in London. My wife had purchased a pack of strawberries from a nearby Marks & Spencer grocery, and I enjoyed a few as an after-lunch desert. Speaking of which, when was the last time you ate a really good tomato? We had just come back from Lina Stores, an Italian restaurant in Marylebone, London. I’m not sure where they source their produce, but the result was impressive. Which brings me back to the tomato question. Why on earth can’t you buy a fresh tomato in a US grocery store that tastes anywhere close to one in Italy? Imported, canned tomatoes, sure, like these from Bianco DiNapoli. But a fresh tomato? Utterly flavorless!

An expat friend of ours, who’s lived in cities around the world, is convinced that there’s something distinctive about the soil in Europe (call this the terroir theory). I’m not convinced, though. Does Europe have better agricultural technology than the US? That’s laughable. The US agriculture industry is the most technology-intensive in the world. Is it the fault of non-organic or genetically-modified foods? No. Organic farming has important benefits, but despite popular belief, taste isn’t one of them. And most American produce that you find in grocery stores, including strawberries and tomatoes, aren’t GMOs. (They’ve been engineered the old-fashioned way, through selective breeding.)

The real answer is mis-optimisation in the agriculture industry. 

American farmers optimise for yield, durability during transport, and appearance, not for flavor. Because that’s what they get paid for. Produce distributors judge strawberries and tomatoes based on weight and appearance (color, uniformity), rather than flavor, which is invisible and is harder to test. And sadly, because these factors are baked into agriculture business models, it’s an incredibly hard system for any one player to disrupt. This LA Times story from 5 years ago, for example, expressed optimism that genetic research into tomato flavor might lead to better breeding of commercial tomatoes. Yet the on-the-vine tomatoes I purchased last week from a Utah supermarket, despite being perfectly round and deep red in colour, had almost no discernible tomato flavor at all (resulting in a deeply disappointing salsa). Why do customers (including me) keep buying these awful products? It’s probably a form of learned helplessness.

The American healthcare industry works much the same way. Commoditization and financialization of healthcare services require use of simplistic, scalable metrics, which is why insurance pays for volume and surrogate measures of quality, rather than actual quality. But, you say, what about all those quality measure programs, like the CMS Star ratings,  or Leapfrog? Or the worst of all, US News and World Report? All of these programs measure things that are visible and easy to measure, such as the rate of mammography, rather than what’s invisible yet important, such as the ability to effectively manage a patient’s disease, or effective communication between doctor and patient. Big health systems, for their part have figured out how to game the system for maximum profit, which is perhaps analogous to breeding color and roundness into tomatoes while breeding the flavor out.

And just like agribusiness’s appearance standards for produce, flawed surrogate measures for healthcare quality are so baked into massively scaled payment and distribution systems that they’re almost impossible to root out.

In the mean time, I recommend you grow your own strawberries and tomatoes.  

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Jamie Larson