Earlier today we looked at the penny-wise, pound-foolish impact the economic recession was having on our health—skipping a test now that could have prevented a much more costly (and dangerous) disease in the future. To understand why our society fails to invest in wellness and prevention, we need to understand the incentives for health and health care that exist in our current system.

An apple a day keeps the doctor away, but, unless you're counting farm subsidies, all the incentives in health care point the other way. Our fragmented system is filled with cross subsidies and opaque prices that obscure the true value and costs of care. It rewards volume not value, focusing on output, not outcomes. Changing the status quo is not easy. As Dr. Gary Kaplan, Chairman and CEO of the Virginia Mason Medical Center and founding member of Health CEOs for Health Reform wrote on this blog:

When doctors substitute low-margin, high-value care for high-margin, low-value care, they incur an immediate financial penalty. Ironically, doctors often receive much less reimbursement or no payment at all when they provide simple, value-added care.

Fortunately it doesn't have to be this way. Virginia Mason has worked collaboratively with regional employers and insurers to share in savings of high-value care for such expensive and difficult to treat conditions like back pain.

Kaiser Permanente provides another example of what's possible. As a more integrated system of health care, the incentives for patients, providers, and payers are better aligned to deliver high value care. Kaiser has been one of leading innovators from health IT to better chronic disease management—and now farmers markets.

Wednesday's LA Times profiles the initiative, which brings fresh produce to patients, staff, and members of the surrounding community at 30 Kaiser medical facilities in four states. The brainchild of Dr. Preston Maring, the markets seemed a logical complement to Kaiser's emphasis on preventive medicine.

"It's a big, huge challenge to get people to live a healthy life. Patients have to walk through here to get to the doctor. It puts in their mind that we take healthy eating seriously," Dr. Robert Riewerts, chief of pediatrics as Kaiser Permanente in Baldwin Park, told the newspaper.

The Robert Wood Johnson's Commission to Build a Healthier America has gone to great lengths to document the factors beyond medical care that affect a person's health—from your level of education to the neighborhood you live in. Clearly there is more to health than health care.

Farmers markets in the parking lots and lobbies of hospitals won't solve our problems over night, but the sooner we recognize the shared responsibility of our society, at all levels, to promote a healthier America, the better.