Health care for people and the planet

The current kerfuffle over the Affordable Care Act is generating all kinds of froth and misinformation in today's over-caffeinated, over-polarized political and media spaces. But at a deeper level, the principles at stake in health care and in planetary sustainability are connected.

The deeper issue in the ACA debate is this: do we see ourselves and behave as one people, or as a loose affiliation of individuals, in which most of us can pretend not to need or care about the others? The ACA seeks to get care to everyone and to ask everyone to pay in. There are too many Americans who need care and can't get it. My daughters are among them: both over 26 next year, both low-income, both with pre-existing conditions. Under the current system, they would get either no coverage or unaffordable coverage. Under the ACA, and in the Maryland health exchange, they will get fair coverage with subsidies to offset their low income status.

Most Americans have health insurance through their employers, and while they may complain about this and that, they are complacently content with the system. So naturally they don't like change, especially when the Fox News crowd keeps feeding misinformation about what the law really does. They are not inclined to entertain the idea that rates might go up, that their plans may change, and so on. But the deeper reality is that for Americans to act as one people, we need to stay with the ACA, fix the website, make adjustments here and there, but stay committed to providing health care to everyone.

There are, to be sure, deeper issues with health that the ACA doesn't and can't address. It can't address our addicted culture, where we run to the doctor for another pill every time we get anxious, can't sleep, have pain, etc. We need to refocus our health culture on self-responsibility, prevention, promoting wellness. We each need to look for ways to be healthy through our decisions about eating, exercise, and awareness.

Interesting, the ACA is already encouraging this. My employer is introducing Consumer-Directed Health Plans (CDHPs) next year; these have lower premiums, higher deductibles, and are connected to Health Savings Accounts (HSAs). I have selected a CDHP with a $2000 deductible, and my employer is contributing $2000 to my HSA. What that means is that the first $2000 of care next year is covered by my HSA--I give providers the HSA debit card, and don't have to play the claim-game with the insurance company. And I can add to the HSA with pre-tax savings to the level I can afford. I like this--less paperwork, more choice, and more awareness of what things cost and how I use my health dollars. And by the way, preventive care like checkups and cancer screenings are fully covered, no deductible. This is where we need to go to keep health care affordable and to make us responsible health care consumers.

So how does this connect to the more global sustainability issues? The nub of it is connectedness--do we see ourselves and behave as connected to the rest of the world, or not? When a storm like Haiyan, whose record intensity is likely due in part to climate change forcing, brings forth a global wave of compassion and action to bring aid, we see the best of human nature. But when the catastrophe is less dramatic, and takes a slower path, we don't act so connected. We don't see that record wildfires in Austrialia, chronic drought in the American Southwest, and creeping desertification in sub-Saharan Africa, are all symptoms of the same global challenge. We are less willing to take the policy and personal actions needed to get GHG emissions under control.

This century will test us, more and more. When increased storm severity, increased drought, increased flooding, begin to disrupt our economic and political systems, as they have already done in places like Darfur, we will be increasingly confronted by situations that we can't address by writing a check to the Red Cross. Refugee migrations, such as millions of Bangladeshis crossing into India or Burma, will create new, larger, and messier conflicts.

But we can choose now to keep such future calamities to a minimum. We can reform health care now to extend coverage to all Americans, as most of our industrialized partner nations do. We can enact climate and clean energy policies now, that put a price on dirty energy, moderate energy demand, and increase clean energy supplies. If we do this, and act as a connected, responsible people, we can manage the challenges this century is presenting. If not, we are in for a hard ride.

Clues to the Climate Puzzle

Climate deniers are fond of pointing to the climate "pause" or "plateau"--a recent 10-year pause in the long-term trend of rising global air temperatures--as evidence that global warming is not happening and that the climate change issue is a hoax created by environmental extremists to halt the march of progress. A review of the climate field, however, explains most of this effect.

First, terminology. Global warming is the simplistic term used by many to refer to climate change. It is true that average global air temps are rising and will continue to rise--on average and over the long term. But climate change effects are not equally distributed in time and space. Climate science actually says that despite overall average increases in air temps, local weather will become more variable and more extreme. So we will see hotter--and colder--weather in various places at various times.

This is already happening in the northern temperate latitudes, including most of the USA. As arctic sea ice melts, its coverage of the polar regions varies more from summer to winter and from one side of the region to another. This contributes to a breakdown in the formerly-solid high pressure area that used to sit over the north pole, and that used to regulate the flow of circumpolar winds and weather systems, otherwise known as the jet stream. The jet stream used to have a nice, even sine-wave shape, and produced alternating hot and cold, wet and dry weather patterns with some predictability. With the breakdown of the polar ice cap, however, the jet stream has become more irregular, loopier, slower, with the effect of making temperate-zone weather less predictable. So lately we get extended heat, or extended cold, or extended wet or dry periods, with less predictablity. That's the core paradox about climate change--it's not uniform hotter temperatures, it's increased unpredictability. And it's that unpredictability that is stressing agricultural, forests, species adaptation, etc.

Now back to the "pause." The recent plateau in air temps is explained by a few factors: one is the role of the oceans in regulating heat flow in the climate system. Oceans take up huge amounts of heat from the atmosphere, and recent analysis indicates that's been happening recently. However, that heat will find its way back into the atmosphere over time, so the plateau is only temporary. Second, for the last 25 years nations have been reducing emissions of chlorofluorcarbons (CFCs, mostly found in refrigeration systems as coolants) under the Montreal Protocol, which was signed in 1987 to address the stratospheric ozone problem (remember the "ozone hole?"). But CFCs are also very potent greenhouse gases, much more potent than CO2, and so reductions in CFC emissions have contributed to reductions in their associate greenhouse effect. Finally, changes in Asian rice cultivation methods have cut emissions of methane, which is 20+ times more potent than CO2.

So the temporary "pause" tells us several things: (1) it's NOT proof that climate change is a hoax, (2) changes in human activity such as CFC phaseout and agricultural methods can help solve the problem, and (3) deniers can't use spot data like cold snaps or freak snowstorms to deny climate change, because such events are in fact entirely consistent with climate science. Let's keep our eyes on the prize, and keep working on the solutions that we know are effective--cutting emissions of CFCs and then their successors HFCs, reducing methane emissions via agricultural and forestry practices, reducing black carbon (soot) pollution using proven methods, using energy efficiency as the economically-sound "first fuel" to limit growth in CO2 emissions, and then driving clean energy on the supply side to drive down emissions. We can do this!

Water is the canary

As climate change continues to dry out continental interiors in places like the American Southwest, sub-Saharan Africa, and Australia, the mix of denial and predatory behavior becomes more disturbing.

In Texas, we see climate denier Governor Perry seeking a constitutional amendment to raid the state's "rainy day fund" (letting the irony pass) for emergency water supply projects. Meanwhile, the state Attorney General keeps pumping water on his lawn by drilling his own well, further depleting the acquifer on which his neighbors also depend.

It is disturbing indeed to see the privileged and the powerful react this way--by denying the root of the problem on the one hand, and using their money and their privilege to "get theirs," leaving the rest of us to fend for ourselves. Water is just the leading example, the "canary in the coal mine," and will be followed by other crises as people compete for liveable lands, stressed food supplies, etc.

There are other ways to respond, if the human race is to survive this century without brutal new manifestations of Social Darwinism. First, the denial has got to stop. There is too much history, from the Vatican's silencing of Galileo to the chemical industry's attacks on Rachel Carson to the tobacco industry's generations of denial, to allow the fossil-industry-funded denialist fringe continue to block serious action on this central issue of our time. The media needs to stop giving equal time to these people: they represent a tiny minority with no institutional scientific backing. No scientific organization has supported the denialist views. Yet journalists, under pressure to provide "balance", are too often lazy enough to get one quote pro/one quote anti and call it a story. Activists also need to up the ante on outing these people, on showing their willful ignorance for what it is.

Once we get the denialist smoke cleared, there are plenty of economically sound policies that can bend the GHG emissions curve down. First and foremost--energy efficiency. Standards for appliance efficiency and vehicle fuel economy, tax incentives, utility efficiency programs, and the like are already flattening US energy demand, and letting cleaner fuels and power sources de-carbonize the energy system. We need to double down on this front, as the President's climate action plan is doing.

Developing countries are more challenging, but energy efficiency is still the "first fuel," and is also key to economic development. I've been in Tanzania and Bangladesh this year, and getting energy demand under control is key to their economic growth, because as things now stand, they can't expand their grids to take on new industry. The Chinese have thought this way for years---energy efficiency is a linchpin of their economic development strategy. This strategy works everywhere there is an industrial base, a building stock, or a vehicle fleet--in other words, everywhere. Then, developing clean fuels presents other challenges, but as they enter the market, their costs decline, and as fossil fuel depletion drives prices up, renewables will be better able to compete.

Corruption and bad policy must be avoided in developing and well as industrialized countries. Energy development gets away will corner-cutting, polluting practices in too many places, and uses its clout to stifle the kinds of environmental policies that would properly price fossil energy. Republicans in the U.S. complain that EPA policies are killing jobs, but employment in the energy industry has never been stronger. What's happening, and has been happening for over 40 years, is that environmental policies are properly pricing dirty energy and dirty industrial processes. The same parties argue that this can offshore jobs--point taken. But the correct path is for other countries to improve their policies, not for the U.S. to roll ours back. That would be a race to the bottom with disastrous consequences for us all. One reason so many people want to live in the USA is because it is clean--has mostly clean air, most rivers are cleaner than a generation ago, lots of wetlands and forests and wilderness areas have been protected.

We must build on this record, not destroy it. Teddy Roosevelt was the first President to take on conservation in a big way--and he was a Republican. The greatest leaders EPA ever had, Russell Train and Bill Reilly, were Republicans. The present GOP has abandoned one of its strongest legacies and further narrowed its base. If the party wants to become a ruling national party again, it must reach back to its roots and become the party of environmental conservation again.
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