A new study of mortality in 16 countries offers reasons why Americans are less healthy and die younger than people in other wealthy countries: We eat more poorly, get fatter and have less access to health care.
The 404-page report, done by the Institute of Medicine and the National Research Council also found that even though we are a so-called wealthy country, we have more people living in poverty.
In too many cases, out health care system contributes to that poverty.
We tallied up lower scores than these other nations on infant mortality, injury and homicide rates, teen pregnancy and sexually transmitted illnesses, HIV/AIDS, drug addiction, obesity and diabetes, heart disease, lung disease and disabilities.
So, what's the problem here?
Well, for one thing, out food supply is contaminated by chemicals and it's less nutritious than it could be because of our industrialized agriculture.
Why is it that many glucose-intolerant people can eat wheat in Europe but not here? It's because they're not reacting to the glucose but to something else -- likely some chemical we're adding that Europeans are not.
We add high fructose corn syrup to everything because it's cheaper than sugar, and our bodies do know the difference, despite what the corn industry's ads say. High fructose corn syrup is metabolized differently, leaving our bodies unable to use insulin the way they should, leading to a higher likelihood of type 2 diabetes. Corn sugar also makes our bodies feel hungrier, leading to overeating and obesity. The "epidemic" of obesity and diabetes began in the 1970s, which is exactly when we started using so much high fructose corn syrup in our food.
Americans spend less on food as a portion of our income than any other wealthy nation, but we get what we pay for -- lousy nutrition. These contaminated, compromised foods are what's making us sick, but we continue to belly up to fast food counters and wolf down the crap they dish out. We continue to eat processed food because it's more "convenient."
The food industry is as powerful as Wall Street when it comes to fending off regulation, so we have to be smarter consumers. We have to buy locally from small farms whenever we can, organic, when we can't get local. Know our farmers. Most places have tailgate markets and farmer's markets now. There's really no reason to eat antibiotic- and hormone-laden meats. Yes, local, humanely raised meat is more expensive, but what is your health worth? Eat less meat.
Our food system is leaving us open to so many illnesses and millions of us are lacking full access to health care. We get sick and fat and we either don't have insurance or our deductibles and co-pays are so high we can't get the care we need for our high blood pressure, high cholesterol and diabetes, so our condition gets worse until we have a heart attack or stroke, go into renal failure or lose a limb. Then we go deep into debt from the cost of crisis care. In right-to-work states, people lose their jobs because of illness, leaving them sick, in debt and uninsured.
Our poverty levels are only partly caused by health care costs, although that is a contributing factor. The real problem is that we are paid less than we were a generation or two ago. There has been a steady erosion of workers' wages and rights since 1980 as the power of unions has eroded. We work harder, make less and are less secure in our jobs than any time since the 1930s. As poorer people, we are less able to afford decent nutrition and we have less access to quality health care. We live in less safe neighborhoods and we are exposed to more dangerous pathogens because of the lack of food regulation.
Our children are at higher risk of STDs and teen pregnancy because rather than teach them about safe sex, we pretend they won't become sexually active until their wedding nights and they wind up pregnant or worse. We pretend that talking to them will make them want to experiment so they begin to experiment anyway with little or no education.
Overall, we're a mess and the causes are easy to identify but difficult to fix with our current political polarization and the control huge corporations have over our government.
We have to make the changes we can and lobby for changes at a higher level. We need real regulation of our food supply and real access to health care.
In 2009, the National Alliance on Mental Illness gave the United States a D in its overall efforts to provide care to people with mental illnesses. Things haven't improved much since then.
Suicide deaths in the military exceed combat deaths, but states continue to cut mental health services. More than half of the people in our jails have mental health issues. And although people with mental illnesses are not likely to harm others, if you give someone who can't reason ready access to guns, he or she is more likely to commit mayhem.
Still, "reform" efforts across the nation have eliminated hospital beds for people in crisis, Medicaid reimbursement rates are so low that most service providers can't afford to take on too many patients.
Starting in 2001, North Carolina began to "reform" its system "to offer consumers more choice." I cringe whenever I hear that phrase because it means privatization, and mental health care should never be left solely to the private sector.
People with severe and persistent mental illnesses need a lot of care, and they're not easy patients. If their illness is not well controlled, they might not even show up for appointments; they might stop taking their medications, in which case the illness will get worse.
Our system in North Carolina imploded. People were dying on the streets -- literally. And the state General Assembly is still looking to make more cuts.
The system is changing from a fee-for-service to block grants, which will total less than what was being spent. The money just isn't adequate, as our local management agency here in Asheville learned from experience.
So now, instead of reviewing cases every year, it is done every three months, which means four times the paperwork and four times the likelihood that a person's care will be reduced or terminated. Fewer care providers are willing to do this increased and unpaid work.
Instead of being an hour, sessions are now 45 minutes. You can still bill for an hour, but you will be reimbursed for only 45 minutes of your time.
More people are falling through the cracks and then turning up in jail or dead.
When NAMI revisited its national report card in 2011, the advocacy nonprofit found more cutbacks in states' systems.
The Affordable Care Act contains some strong advocacy for people with mental illnesses, including a mandate that insurance companies cover psychiatric care at the same level they do every other specialty. You can't charge a $50 copay for an endocrinologist and $75 for a psychiatrist. You can't allow 52 visits to a gastroenterologist but only 12 to a psychiatrist.
That's great for people who have insurance, but people with severe and persistent mental illness aren't likely to be able to hold down a job, and our health insurance in this country is tied to employment. Even after the Affordable Care Act takes full effect in 2014, most of us still will get our health insurance through our employers.
So, people with mental illnesses are left to fend for themselves. Some will have access to disability, but if they have been able to work for any length of time, they will only be eligible for SSD, which means they might lose Medicaid and not have access to Medicare for two years.
Some have sporadic employment and so will not be eligible for Medicaid, especially in states that refuse to expand Medicaid.
None of this makes any sense to me. It's so much more cost effective -- not to mention humane -- to treat this chronic illness properly.
But there still are people who believe we can all control our own brain chemistry and that someone with a mental illness is somehow morally deficient.
Many evangelical Christians believe people can and should pray the illness away, even though they would never say the same thing about asthma.
We as a society are punishing people for an illness over which they have no control, and it's costing us billions in lost productivity, in criminal justice dollars and
According to an article in Sunday's New York Times, health insurance companies are raising their rates by double digits again, despite the promise of some 30 million new customers in the coming year.
It's not big businesses that are getting hit with these 20-percent increases, but individual customers and small businesses; big companies are seeing rate increases of about 4 or 5 percent.
In California, where the request by Anthem Blue Cross Blue Shield to raise rates by 39 percent in 2010 helped put the Affordable Care Act over the top, companies once again are seeking rate increases of up to 26 percent.
Not all states are subject to the whims of Big Insurance, though. New York, for example, has a commission that must approve rate hikes, and insurance companies must prove they need the revenue to get the raise. So far, 37 states allow regulators to reject or reduce increases of 10 percent or more.
Under the Affordable Care Act, regulators are required to review any request for a rate increase of 10 percent or more; the requests are posted on the federal Web site,healthcare.gov, along with regulators’ evaluations.
Historically, Big Insurance has gotten its way almost every time it has wanted something. Its lobbyists were able to gut the plan for a public option in the Affordable Care Act, which would have made the industry face some competition.
Now, the industry has a monopoly with nowhere near enough regulation, and we the consumers have nowhere to turn if we're treated unfairly, overcharged, denied coverage.
Yes, the Affordable Care Act provides for appeals, but the states will set the specific rules for those appeals. In the law passed by the NC House in 2011, the consumer protections were minimal at best and the insurance company protections were strong as steel. Fortunately, that law never made it through the state Senate and North Carolina will partner with the federal government in its insurance marketplace.
The proposed NC law for its marketplace also allowed oversight of the Benefits Exchange by insurance companies and health care business associations, making the chances for successful challenges even tougher. It seems no one understands the meaning -- or the danger -- of conflict of interest anymore.
So, perhaps it's time to change tactics -- maybe we should start making a lot of noise about getting a public option added to the Affordable Care Act so we can have a real choice.
Let me buy into Medicare.
Let me escape the greedy grasp of the insurance companies.
Dear Gov. McCrory,
I didn't vote for you, partly because I didn't believe you were a moderate Republican. You can prove me wrong.
Soon now, you will announce whether North Carolina will expand Medicaid to about a half-million people in the state. The action won't cost the state a dime in the first three years, and then we'll pay just 10 percent of the cost each year after that.
I urge you to stand up to people who for ideological reasons alone would allow 500,000 people to be denied basic health care.
People who make less than 133 percent of the federal poverty level can't afford even the most basic care, so they don't get checkups and they can't manage chronic illnesses.
So, let's look at the logic here. If we deny them care, we will pay a whole lot more down the road as people show up in the emergency room in renal failure or with a massive stroke or heart attack, or with cancer that has progressed beyond the point of any hope for a cure.
People who don't have access to care are much sicker by the time anything is done for them, and by then it may be too late to save their lives.
That's what happened to my son, Governor. He couldn't get insurance because a birth defect was a pre-existing condition, and without it, he couldn't get the screening tests he needed. He got sick and he got sicker and was finally admitted to the hospital weighing just 110 pounds (he was 6 feet tall). He was so sick it took them five days to stabilize him, and his cancer was stage 3. He had to leave his wife to get Medicaid, and his chemo cost about $600,000. That's just the chemo, not the two surgeries, the radiation, the other medications and the loss of his tax revenues. So, by cheaping out on his care, we probably spent more than $1 million.
My son would be an attorney now, making decent money and paying his fair share in taxes.
Multiply that by 500,000 people, and I'm just talking about the financial cost.
How about the emotional cost? How about the cost to our souls as human beings?
Have you ever lost a child, especially one who shouldn't have died? I wished my own heart would stop when his did, and many days I still do.
You have the chance to save thousands of lives of people in this state. I know your buddy, Art Pope, is advising you to let those poor people fend for themselves, but I hold out hope that you have more character and compassion than that.
Make no mistake about it, Governor, we are talking about letting people die just to make a political point.
If that isn't evil, what is?
The years seem to go by faster and faster. How can it be 2013 already when I just got used to writing 2012 on my checks?
I think I have passed the age when I make resolutions based on a calendar date, but I can't help but reflect on the year just ended and wonder how I can make the coming year better.
I have spent a lot of time answering questions about the new health care law, dispelling myths and helping people understand what new rights they have already. I was more involved in political campaigns that ever before because of the importance of health care policy. I found myself educating candidates about the potential of the Affordable Care Act.
I spent the first half of the year with fingers crossed about how the Supreme Court would handle the case and was pleasantly surprised with the result, and most of the second half worrying about whether the Affordable Care Act would be repealed.
Still, the states are left to decide whether they will expand Medicaid and offer access to care for everyone whose income is less than 133 percent of the federal poverty level. Even though it won't cost states a dime for the first three years, and then just 10 percent of the total cost , several states have said already they won't expand Medicaid. The hopeful thing for me is that only six states opted into Medicaid when it became law in 1865.
It seems wherever I go, the talk turns to health care, as it has since Mike died. It will be five years April 1 and some family members and friends are still waiting for me to get back to "normal."
But losing a child changes you. The old normal is gone and it doesn't matter how many years pass, it isn't coming back.
So, this new year brings some changes -- the health benefits exchanges have to be ready for people to enroll beginning in October. Before then, "navigators" who will help people choose the right plan for them, will have to be trained and certified.
I will stay committed to working toward access to health care for every American.
I might lose a few pounds, keep the house tidier, ride my bike more ... but the most important thing in my mind is social justice for people in need -- a living wage for people who work full-time, safe and affordable housing, safe and nutritious food, and of course, access to quality health care for everyone. I don't think any number of years passing will change that.
And of course, here's wishing a happy and healthy New Year to
These aren't the names of children; they are the names of people our society didn't care enough about to save.
Some struggled with mental health issues or addiction, others lost jobs or became ill and then lost their homes.
These 20 names don't mean much to most people. Only about 100 people attended a memorial service for them this morning.
Whatever you might think, these lives were as precious as yours or mine in the eyes of God, and except for better luck than they had, you or I might have been in their shoes. This year there were 20 names of people who were homeless who died; there were more who were not named.
On this, the shortest day of the year, people gathered in the chapel of First Baptist Church here in Asheville, as we do every year, to honor the lives lost from among our homeless.
I used to cover this service when I was a reporter and I continue to attend each year as a health care advocate and as a person who believes everyone deserves a safe place to sleep at night.
I go because four years ago, when we learned Mike was dying and raced to be with him in Raleigh, another man I never met was dying.
Tommy McMahon had gone to the emergency room the night before with a respiratory infection. He had been there before; the staff knew him. The doctors there gave him antibiotics and an inhaler and discharged him.
But Tommy knew he was too sick to go back out into the cold and wind and he refused to leave. Someone called the police and Tommy was offered the chance to go to jail for the night. He was arrested.
Sometime during the night, Tommy died, and an editor called me in Raleigh to ask who a reporter might interview for a story. As I gave the names and telephone numbers of a few people, I knew my precious son would die surrounded by love, and he did just six weeks later.
Tommy, on the other hand, died alone in a jail cell.
This season always brings Tommy to mind as much as it does a baby born in a stable and placed in a manger. I wonder if anyone loved Tommy, whether he had family and if they had given up on him. That happens a lot with homeless people -- they burn through all their family members before they're turned out onto the street. Did he have a mental illness that should have been treated? Was he addicted to drugs or alcohol and not able to get the help he needed to sober up? Did he become homeless because of an illness or a lost job?
I wonder whether anyone grieved him as I do my son and I grieve for him just in case. I pray for his soul to be at peace. I do that for each of the homeless people who die every year, but especially for Tommy McMahan because he is forever connected to my son in my heart.
Tommy's death made me understand that we are all connected, that we are responsible for each other. I got to say goodbye to my son; Tommy's mother didn't. Both men died because of injustice. They died because no one who could save them cared enough to do so.
This year, as the names of the dead were read, a little about each one of them was shared -- at least something about the people that someone knew and could speak about.
- Fred Blevins, who perfected the sport-coat-over-a-bare-chest look.
- Paula Jean Gump Chrishawn, a mother of five whose battles with mental illness and addiction caused her to lose all of them because she couldn't care for them. She loved the color purple, and she finally won her battles. She was one week away from moving into her own apartment when she died in September.
- Douglas Dillingham
- Dennis Gillette, an outgoing "gentle giant."
- Floyd Hill, an accomplished storyteller with a deep mountain drawl and a veteran.
- David Isles, a veteran who smiled often.
- Herman Lee, a veteran known as "Buffalo."
- Andrew Marsh, called Sammy, was known for his generosity.
- Dan Mason, who fancied himself a bodybuilder, even as he became increasingly weakened by illness.
- Joseph Metcalf, a soft-spoken native of West Asheville.
- Kenneth Myrick
- Rebecca Plemmons, a mother who was just rekindling her relationship with her daughter.
- David Pounders, a kind man who divided his time between his beloved mountains and the coast of Florida.
- Donna Ray, a woman of kind and gentle spirit.
- Jeff Reynolds, a young man still struggling to navigate the world.
- Delois K. Smith, a kind and gentle soul with a great sense of humor.
- Jackie Todd Stipes, a former carnival worker who bragged that he often let the rides go longer than they were supposed to because he enjoyed the looks on the children's faces.
- Grace Teague, who adored cats.
- Luzella Whittemore, who was firercely independent.
- Ivie Ward Yearns, called by his middle name, was a large man and quiet.
If you have time for a prayer today, please include these 20 souls and the people who loved them.
Several states have chosen to opt out of the expansion of Medicaid, and it is not in the best interests of their people or their health care businesses, especially hospitals.
The Affordable Care Act cuts the amount of money hospitals receive to compensate them for the care they provide to people who can't pay. The logic was that the expansion of insurance coverage, especially the expansion of Medicaid, would cut down on the amount of uncompensated care hospitals need to give.
But the Supreme Court threw a wrench into that plan when it decided that states don't have to expand Medicaid. Several states have said they won't expand Medicaid, but the law still provides for cuts to the money the federal government pays to hospitals for uncompensated care.
Although some are calling for an increase in federal money for hospitals in those states that refuse to expand Medicare, others are saying the states that refuse to cover more people under Medicaid shouldn't be rewarded -- especially because the expansion costs states nothing for the first three years and then the costs to the state rise to 10 percent of the total cost of the expansion. In other words, federal money is already available to these states and if they choose not to take it, that's their problem; the government shouldn't reward them with money from somewhere else. Here is the solution. Get on board or not, but those are your only choices.
When Medicaid was enacted in 1965, few states wanted anything to do with it. But eventually, all 50 states saw the advantages of a centralized system to care for people in need.
Those states that refuse to get on board will face a lot of pressure from hospitals, which will be less able to care for the poor, and probably from voters who don't understand why people in their state can't get care when it doesn't cost the
Let me start by saying I'm tired of the politicization of life-and-death issues in this country. Twenty children and seven adults are dead in Newtown, Conn., and people are screaming about politics.
It's political because lobbyists pay billions to make it so.
We can't talk about gun safety without being political. I noticed the same thing during the health reform debate.
I know what it is to lose a child who shouldn't have died and I'm trying to wrap my heart around all of those families in Connecticut. I at least got to say goodbye to my child.
This is a tragedy beyond my ability to even comprehend. I have spent much of the time since hearing the news praying for healing that I know will never really come completely. Losing a child is not something you ever get over.
This is about people's lives, and gun manufacturers have made it Republican vs. Democrat. They have many of us believing that guns are perfectly safe; it's people who are dangerous.
Well, it's people with guns who are dangerous. Not all of them, mind you, but enough of them to cause havoc every few weeks.
This is not a simple problem with a simple solution. This is not just about guns, although guns certainly play a huge part.
I see this as a three-pronged problem:
- The ease with which people can get guns and ammunition;
- The lack of diagnosis and treatment for mental illnesses;
- Our country's love affair with violence.
This is a public health issue and an education issue. The gun lobby has too much power and it has billions of dollars driving that power. A lot of the talking points I'm hearing come from those dollars.
- We shouldn't regulate guns because then only criminals will have them.
- We should put guns in the hands of more people so they can shoot back.
- We should honor the victims by not discussing gun laws.
- Guns don't kill; people do.
- Only crazy people go on rampages so we all need guns to protect ourselves from them.
- People will find other ways to kill if we take away their guns.
And on and on ...
Without going into all the anti-gun rhetoric, let me just say 20 children and seven adults were killed yesterday. Three people died in a mall in Oregon less than a week ago. The bodies are piling up and we're still arguing instead of talking.
We as a nation regulate cars more than we do guns -- we require a licence that has to be renewed periodically. We have more laws regulating the manufacture of teddy bears than we do guns.
It's well past time to have some sensible regulation of guns, including banning of assault weapons and background checks of everyone who wants to buy a gun -- even at a gun show.
The reason so many "nut cases" go on killing sprees is because they have a chronic illness that gets worse when it isn't treated, and we keep cutting funds for mental health. People with serious mental illnesses don't often have insurance because they can't hold a job and our access to care is tied to employment. In addition, most insurance policies don't cover much mental health care, although that will change in 2014, thanks to the Affordable Care Act.
I have watched as our mental health system in North Carolina has imploded because of state "reform," which privatized much of the system. Add to that the defunding of the system in recent years and you have a disaster.
So, people with severe and persistent mental illnesses don't get the treatment they need, and their illnesses get worse, just like any untreated chronic illness.
Until we address this problem, we will continue to see "nut cases" with guns going on shooting rampages -- unless, of course, we make it more difficult for them to get guns.
We can demand improvement in our mental health system, and we will see it if enough of us demand it. Call your legislators and let them know you won't back down.
Finally, we have a love affair with violence in this country. We adore it. It's in our movies, on TV and in the games we play. The military uses violent video games as a recruiting tool -- go to the Army's web site and play for free.
Every year, the special effects in our entertainment get more grisly and realistic and the violence more graphic because it takes more to shock us. We've become desensitized to it, and there's some good scientific research to back that up.
I do not advocate censorship, but I do think parents should try to protect their children from it. If we don't buy the violent video games or go to the grisly movies, they won't be profitable so they won't be made.
We are the ones who drive the market.
We are the ones who can make change.
Now is the time -- before the pain of this loss of innocent life diminishes.
While our hearts are still broken, let's honor the victims by being the force of change needed to prevent another massacre.
As happens most days, I got a call this morning from someone who needs health care information. She recently lost one son to cancer and another son is ill, was recently injured and now needs rehabilitation services.
Because this son only recently got SSI disability, he has to wait two years for Medicare to kick in. Because he has a 401K savings plan from when he was able to work, he isn't eligible for Medicaid. He was planning to buy a small mobile home with that money, but now he has to spend it down -- even though he can't withdraw it without paying a penalty because he isn't of age yet.
There is no reason to make people who get disability wait two years for health coverage; the reason they get disability is because they can't work, and in this country, health coverage is tied to work.
This is not an unusual situation; thousands of people are caught up in this gap every year. Many lose their savings and their homes and some die. Four years ago I interviewed a family caught in this gap and they received four calls from the bank during the two hours I was there. The woman told me they were getting eight to ten calls every day. Their power had been turned off once and the woman couldn't find a dentist who would take care of her infected teeth, which were damaged by the drugs she was taking for another condition and causing her a great deal of pain.
She had nowhere to turn.
The same is true of this family I spoke with this morning. If they can't pay for the bed in rehab, the man will be sent home, where there is no one to care for him properly.
If someone has Medicaid before getting disability, they often lose eligibility for Medicaid when they begin receiving disability checks because the $400 or $600 a month they get puts them over the income threshold in their state. In Texas, someone making just 12 percent of the poverty level can be kicked off Medicaid. And a single male adult isn't eligible, no matter what.
Congress could fix this easily by making anyone on disability eligible for Medicare immediately instead of making them wait two years.
If states expand Medicaid to over anyone with an income less than 133 percent of the federal poverty level, people won't lose eligibility for Medicaid so easily. But a number of states have said they won't expand Medicaid even though they won't have to pay a cent for it for three years and in the long run will only pay 10 percent of the cost.
Only Congress can change this, but they haven't been inclined to do so. It seems they haven't been inclined to do much to help people in need in recent years.
It seems to me this family has been through enough, but there are those who would call them moochers because they need help because of circumstances beyond their control
The Kansas City Star just completed a yearlong investigation of the beef industry, and it's worth reading if you care about what you and your family are eating.
The industry was reformed somewhat a century ago after Upton Sinclair's book, "The Jungle" was published in 1906. Although the writing style is dated, the book is worth reading because government regulation seem to have regressed back to that time.
The problems are different today, though, and it makes the meat much more dangerous.
Beef cattle are pumped full of antibiotics, which make the bacteria that survive extremely virulent. Plus, the antibiotic we ingest with our burgers makes those very drugs less effective when we really need them, increasing the number of antibiotic-resistant infections. When these cows' manure is used to fertilize crops, bacteria in the soil can strengthen and become resistant to antibiotics. The Star details the story of children in Joplin, Mo., getting antibiotic-resistant infections following the tornado there because dirt with resistant bacteria got into their wounds.
But animals that have no infections are still being pumped full of antibiotics and there aren't likely to be laws against it any time soon, thanks to the lobbying power of the beef and pharmaceutical industries.
Cattle also are given beta blockers to make them grow faster and fatter, and the residual amounts of the drugs we get with our meat can cause cardiovascular problems. They're also given growth hormones, which cause them to grow faster, but also are found in the meat we eat.
The way cattle are kept before being slaughtered is nothing short of revolting. They stand in feedlots, shoulder-to-shoulder, sometimes knee-deep in their own feces, eating things cows were never meant to eat, including corn and ground up bone meal from other cows.
The new machines used to tenderize the meat push dangerous pathogens (including e. Coli
) into the middle of the meat, which is less likely to be cooked to a high enough temperature to kill the bacteria. The same is true of ground beef.
To combat this, some of the meat -- the stuff once deemed unusable -- is processed with ammonia. The resulting mush, called pink slime, is added to ground beef. Almost every frozen ground beef patty in America contains some of this slop.
Regulations in this country are so lax that if federal inspectors find bacteria in meat, they can't even force a recall -- recalls are voluntary. Fortunately, meat processors still have to worry about adverse publicity, so they do recall bad meat.
The retailer Costco has more rigorous inspection criteria than the US government, although even its inspections don't find every bad batch of meat. According the the Star, Costco officials boast that, until recently, they did more E. coli testing in the company’s lab than the US Department of Agriculture does nationwide at all other beef plants combined.
In fact, Costco officials boast that, until recently, they did more E. coli testing in the company’s lab than the USDA does nationwide at all other beef plants combined.
And it's not just the beef industry that's troubling; pork and chicken share many of the same problems.
The solution is to buy pasture-fed beef, pork and chicken, and buy it from local producers. Meat that's pasture-fed is lower in saturated fat and cholesterol, so it's healthier, and it's tastier. It's more expensive, but you get what you pay for. It probably won't hurt you to eat less meat.