The Harvest

Nine of every ten dollars the United States spends on health care — out of a total approaching $4.9 trillion a year¹ — goes to people with chronic conditions. Diagnosed diabetes alone cost $412.9 billion in 2022²; heart disease and stroke run about $223 billion in direct care³; obesity, around $173 billion⁴. Much of that burden tracks what people eat.

The evidence has to be stated carefully. A 2024 review of forty-five analyses covering nearly ten million people⁵ found that greater consumption of ultra-processed food was convincingly linked to higher rates of type-2 diabetes and death from heart disease. Convincingly linked is not the same as proven to cause: most of the data is observational. The one controlled feeding trial that exists found people put on an ultra-processed diet ate about 500 calories a day more⁶ and gained weight — the clearest causal thread, and a narrow one.

Whatever its precise share, the cost lands unevenly. Americans hold at least $220 billion in medical debt⁷, and it concentrates among exactly the people least able to carry it — those in poor health, with disabilities, and low incomes⁸. To pay it, people skip food, drain savings, and borrow again. Risk flows downhill.

Profit flows the other way. The same sickness that bankrupts the patient is a market, and a fast-growing one.

The drugs that treat diet-related disease are now among the most valuable products on earth. Eli Lilly’s revenue rose 45 percent in 2025, to $65.2 billion⁹, more than half of it from a single molecule sold as a diabetes and weight-loss shot; Novo Nordisk’s obesity-care sales grew 26 percent¹⁰. Americans pay for the privilege: the same Wegovy that lists near $1,350 a month in the United States costs a few hundred in Europe¹¹.

Up the chain, the companies that make the pesticides hold the other half of the trade. Four firms — Bayer, Corteva, Syngenta and BASF — control roughly 60 percent of the world’s pesticide market¹². The maker of some of the most-used and most-litigated chemicals in American fields, Syngenta, is owned by the Chinese state¹³, through the conglomerate that bought it for $43 billion in 2017.

Follow the ownership and the pattern holds: the harm is local, the profit distant and shielded. Bayer, having paid out more than $10 billion in Roundup costs¹⁴, is now protected by the Supreme Court and a string of state laws. Syngenta’s chemicals are sprayed on American ground while its earnings run to a state enterprise in Beijing.

This is a choice, and other wealthy countries make it differently. The European Union works from a precautionary principle¹⁵ that puts the burden on the manufacturer to prove a substance safe; it banned the herbicide atrazine in 2004¹⁶, a chemical still spread by the tens of millions of pounds on American corn. Where its peers restrict the chemicals and negotiate the drug prices, the United States lets both run — which is why the same molecule is a public-health tool abroad and a profit engine at home.

Put the two ledgers side by side and the arithmetic of the series resolves. The protections around the food come off — the workers, the inspectors, the right to sue. The chemicals go in largely unexamined; the sickness comes out largely unanswerable. The patient pays, in money and in health. The interests that make the chemicals and treat the resulting illness are, increasingly, shielded and enriched.

It is worth naming the size of the enrichment, because it is the cleanest fact in the story. Diagnosed diabetes cost the country $413 billion in 2022¹⁷. The two companies that dominate the drugs to treat it took in more than $100 billion between them last year¹⁸, growing fast, at prices Americans pay several times over what the rest of the wealthy world does. The cheap meal was never cheap. Its price was only moved — downhill onto the people who eat and get sick and pay, and uphill to the industries that profit at both ends of the bargain.