This past Friday, August 21, The Health Care Blog, posted this writing.

At: https://thehealthcareblog.com/.

As I note, though unsurprising, it is nevertheless remarkable that both recent House and Senate price transparency hearings inviting at least 11 expert witnesses to testify and none of them either had expertise in health equity/disparities or thought it sufficiently important or necessary to discuss or at least mention the inevitable or predictable consequences price T will have on the disenfranchised.

Needless to say this writing is related to the July 28 THCB essay regarding external reference pricing I cowrote with Dr. Adam Cunningham.

As always, comments and questions are welcomed.

Thank you.

It’s at: https://thehealthcareblog.com/blog/2026/07/28/the-limits-of-disclosure-and-the-power-of-the-outside-option-a-case-for-external-reference-pricing-in-healthcare/.

As healthcare policy students are well aware the Congress has been debating for several months whether to weigh in regarding HHS’s 2021 price transparency rule because it has been woefully ineffective. E.g., see this past June 10th Energy and Commerce Health Subcommittee hearing. More recently, both the House Energy and Commerce and the Senate HELP committees have voted price transparency bills out of committee.

Transparency or disclosure may be a precondition for price discipline, but it’s not discipline itself.

Leaving aside the inconvenient fact healthcare is not a shoppable market commodity (think: Ken Arrow, 1963), the legitimate premium price/cost shift answer is of course introducing competitive market forces – that Hopkins’ Gerald Anderson explained during a 2006 Energy and Commerce C hearing. As Anderson noted, “The amount charged is determined solely by one party in the transaction – the hospital. It is not a market.” Due to consolidation and concentration, the hospital industry is a textbook definition is a “missing market.”

As this essay argues or outlines, what’s needed are external reference prices (ERPs) to discipline the hospital market and hospital prices. Absent such hospitals will continue to be price setters and commercial insurance plans price takers.

At: https://www.nature.com/articles/s41558-025-02525-5. Sadly, a subscription is required.

If, like I do, you think it’s beyond comprehension that it takes a year or longer to publish a brief “climate change” (someday, like the rest of the world, we’ll drop this phrase) essay, you might appreciate an understanding of how and why this happened. If so, I recommend reading Mark Neff’s lengthy 2020 essay in “Issues In Science and Technology,” titled, “How Academic Science Gave It’s Soul to the Publishing Industry.” At: https://issues.org/how-academic-science-gave-its-soul-to-the-publishing-industry/. You’ll not be disappointed if for no other reason than Robert Maxwell (yes, Ghislaine Maxwell’s father) plays a prominent role.

The work is at: https://thehealthcareblog.com/blog/2017/01/23/aca-repeal-and-the-ethics-of-belief/.

I concluded by writing:

Despite being unable to propose a comparable ACA alternative over the past seven years, Republicans appear fixed in their belief they’ve evidence to justify repealing a law that, beyond insuring more than 20 million more Americans, has slowed both health care price growth and spending growth, in part by reducing out of pocket Medicare Part D spending by $5 billion annually, and lowered premiums. National health expenditures for the first decade of the ACA have been projected to be $2.6 trillion lower than pre-ACA projections. That’s to say gains achieved under the ACA have been free. 13 Beyond improved individual and family financial security, the law has also reduced income inequality and health care disparities and has improved health care quality by, among other things, lowering hospital-acquired conditions and hospital readmissions.

The evidence for ACA’s repeal amounts to dissembling. It begs belief. What do we make of politicians seeking to overturn the ACA? “The existence of a belief not founded on fair inquiry, William Clifford argued, “unfits a man for the performance of . . . [his] duty.” “Every time we let ourselves believe for unworthy reasons” or “believe anything on insufficient evidence,” one is left, Clifford wrote, unable to avoid doing “great wrong towards Man.” “The danger to society is not merely that it should believe wrong things, . . . but that it should become credulous, and lose the habit of testing things and inquiring into them; for then it must sink back into savagery.”

Oh yes, if you’ve never heard of William Clifford, a 19th British mathematician, I also wrote, “Clifford’s essay became a seminal work in the field of ethics because he posed a central question in life. Is it ethically wrong to believe something based on insufficient evidence?”

“Now after OBBBA cuts to the Medicaid and Medicare programs, 500 rounds fired into six CDC buildings, one killing a police officer, and seven months of HHS moral obliquity we are confronted with the reality that healthcare policymaking is now unambiguously on the road to nowhere. This may be because, having failed to appreciate Richard Hofstadter, Humphrey Building leadership is busy fomenting a new chapter in anti-intellectualism. We’re left to ask if healthcare enshittification has now been achieved possibly because healthcare policymakers have adopted Mark Manson’s “The Subtle Art of Not Giving a F*ck.”

The good news is the storm and stress about HHS no longer being fit for purpose could be effectively cured if the Congress, along with support from MedPAC, MACPAC and others, would work to free the department from politicization or partisan influence by redefining it as an independent agency. If policymakers exercised more imagination such a simple and obvious reform would have already received serious attention.”

Considering US healthcare’s climate nihilism, it was rejected by Health Affairs, JAMA, STAT News, and at least eight other journals and media outlets.

I wrote:

“In late July the UN International Court of Justice (ICJ) announced its long-awaited and highly-anticipated climate advisory opinion. The ICJ ruling represents an historic moment in climate accountability.”

“Because the International Court of Justice recognizes an inherent link between anthropogenic warming and human rights, the opinion implies the right to health cannot be secured without addressing US healthcare’s own climate obligations. Meeting these pose a substantial challenge for the industry for several reasons.

“US healthcare trade and professional associations including those dedicated to hospital care, infectious diseases, pediatrics and public health have to date neither discussed nor recognized the 2023 ICJ resolution and now the ICJ opinion despite knowing, for example, well over half of known human pathogens can be aggravated by climate hazards or pathways.”

You’ll quickly conclude I largely trolled HHS because the public was told by President Biden via a January 2021 Executive Order that his administration would, as I noted ad nauseum, take a “whole of government” approach to “fighting the climate crisis.” Clearly that did not happen. If there was one writing that may have had an effect it was #19 since HHS created an Office of Health Equity a few months after it was published.

As for state of play, if you’ve not been keeping up, HHS’s Office of Climate Change and Health Equity no longer exists (not that it ever legitimately did having never been funded) and Secretary Becerra’s climate pledge (patented greenwashing) is defunct. HHS’s co-sponsorship of the National Academy’s Action Collaborative to Decarbonize the Health Care Sector has ended but the Collaborative, privately funded, will, now in its fifth year, continue it appears through 2026. Its new co-chair former Sen. Bill Frist, in introducing himself at a Collaborative virtual public meeting last October 8th, immediately dropped the classic manufacturing doubt line, “there’s still not a clear understanding of what can be done.” (It’s worth noting none of his family’s 185 hospitals, under the name HCA Healthcare, are EPA Energy Star certified for energy efficiency.) Sen. Frist more recently argued the industry has “been slow to seek” IRA subsidies because “much of the industry operates with negative margins,” a comment or belief seldom if ever questioned despite the fact that Americans pay the healthcare industry nearly $5 trillion annually for grossly overpriced mediocre care for just 4% of the world’s population despite not being comparatively or exceptionally disease burdened. As for financial distress, for example, Sen Frist’s older brother is worth an estimated $20 billion.

Yesterday, EPA Administrator Lee Zeldin announced he will consider scrapping the 2009 “endangerment” finding that the EPA could/would regulate GHG emissions under the Clean Air Act. Think: he’ll rescind.

To use a phrase that has recently been beaten to death: this is where we are. As for the other oft repeated line, “we’re in this together,” the Ds certainly fooled me.

It may be time to pack up the moon and dismantle the sun.

1. “HHS Says It Is Working to Stop the Climate Crisis. But It’s Really Just Climate Washing,” STAT (8/15/24). At: https://www.statnews.com/2024/08/15/hhs-climate-change-climate-washing-health-care-greenhouse-gasses/

2. “The US Department of Health and Human Services’ Ongoing Failure to Address the Greatest Threat to Human Health,” 3 Quarks Daily (8/1/24). At: https://3quarksdaily.com/3quarksdaily/2024/08/the-us-department-of-health-and-human-services-ongoing-failure-to-address-the-greatest-threat-to-human-health.html

3. “The SEC’s Climate Disclosure Rule Will Reveal Healthcare’s Significant Climate Risk Exposure,” Columbia’s Sabin Center for Climate Change Law Blog (7/23/24). At: https://blogs.law.columbia.edu/climatechange/2024/07/23/the-secs-climate-disclosure-rule-will-reveal-healthcares-significant-climate-risk-exposure/

4. “Efforts to Build Climate Resilience Do Not Protect Human Health,” Undark Magazine (7/11/24). At: https://undark.org/2024/07/11/opinion-climate-resilience-human-health/

5. “HHS’s Proposed Rule Pays Lip Service to Addressing the Climate Crisis, the Greatest Threat to Human Health,” STAT (May 20,2024). At: https://www.statnews.com/2024/05/20/hhs-proposed-rule-lip-service-addressing-climate-crisis/

6. “With Solar, We Can Solve Non-Profit Hospitals’ Carbon and Community Benefit Problem Simultaneously,” The Hill (3/2/24). At: https://thehill.com/opinion/healthcare/4500802-with-solar-we-can-solve-non-profit-hospitals-carbon-and-community-benefit-problem-simultaneously/

7. “The Social Costs of Greenhouse Gas Emissions in Healthcare Are Astonishing – And We’ve Been Ignoring Them Completely,” The Hill (1/12/24). At: https://thehill.com/opinion/energy-environment/4405074-the-social-costs-of-greenhouse-gas-emissions-in-healthcare-are-astounding-and-weve-been-ignoring-them-completely/

8. “How US Hospitals Undercut Public Health,” Undark Magazine (10/5/23). At: https://undark.org/2023/10/05/hospital-emissions-deaths/

9. “Why Are Congress’s Budget Experts Failing to Address the Rise of Climate-Related Health Care Spending,” The Hill (8/21/23). At: https://thehill.com/opinion/finance/4162309-why-are-congresss-budget-experts-ignoring-the-rise-of-climate-related-health-care-spending/

10. “As the Climate Crisis Intensifies, HHS Refuses To Do Its Part,” The Hill (7/9/23). At: https://thehill.com/opinion/energy-environment/4085604-as-the-climate-crisis-intensifies-hhs-refuses-to-do-its-part/

11. “HHS’s proposed Rule Pays Lip Service to Addressing the Climate Crisis, the Greatest Threat to Human Health,” (5/20/24). At: https://www.statnews.com/2024/05/20/hhs-proposed-rule-lip-service-addressing-climate-crisis/

12. “When Will the US Government’ Failure to Decarbonize the Healthcare Industry Compel Litigation,” 3 Quarks Daily (5/15/23). At: https://3quarksdaily.com/3quarksdaily/2023/05/when-will-the-us-governments-failure-to-decarbonize-the-healthcare-industry-compel-litigation.html

13. “HHS’s Environmental Justice Index Institutionalized Climate Apartheid,” STAT (3/1/23). At: https://www.statnews.com/2023/03/01/hhs-environmental-justice-index-institutionalizes-climate-apartheid/

14. “FYI: The Healthcare Industry Is Not Decarbonizing,” The Hill (1/5/23). At: https://thehill.com/opinion/healthcare/3801506-fyi-the-health-care-industry-is-not-decarbonizing/

15. One Small Regulatory Update Can Lay Out the Path Toward Decarbonization,” Health Facilities Management (11/18/22). At: https://www.hfmmagazine.com/articles/4609-one-small-regulatory-update-can-put-the-health-care-sector-on-the-path-towards-decarbonization

16. “How the Inflation Reduction Act Can Help Decarbonize the Health Care Sector,” STAT (9/30/22). At: https://www.statnews.com/2022/09/30/inflation-reduction-act-reduce-health-care-industry-greenhouse-gas-emissions/

17. “How To Solve HHS’s Failure to Address the Climate Crisis,” Health Affairs (9/9/22). At: https://www.healthaffairs.org/content/forefront/solve-hhs-s-failure-address-climate-crisis

18. “FDA User Fee Legislation Needs to Mitigate the Pharmaceutical Industry’s Carbon Pollution,” STAT (6/8/22). At: https://www.statnews.com/2022/06/08/fda-user-fee-legislation-address-pharmaceutical-industry-role-climate-crisis/

19. “HHS’s Failure to Address the Health Harms of the Climate Crisis Constitutes Environmental and Institutional Racism,” STAT (3/28/22). At: https://www.statnews.com/2022/03/28/hhss-failure-to-address-the-health-harms-of-climate-crisis-constitutes-environmental-and-institutional-racism/

20. “The National Academy of Medicine’s Climate Crisis Effort Must Turn Words Into Action,” STAT (October 15, 2021). At: https://www.statnews.com/2021/10/15/climate-crisis-effort-national-academy-medicine-words-to-action-2/

21. “Public Reporting: The First Step in Addressing the HealthCare Industry’s Bloated Carbon Footprint,” STAT (6/29/21). At: https://www.statnews.com/2021/06/29/public-reporting-health-care-greenhouse-gas-emissions/

22. “We Must Connect the Climate Crisis With Human Health,” 3 Quarks Daily (2/5/21). At: https://3quarksdaily.com/3quarksdaily/2021/02/we-must-connect-the-climate-crisis-with-human-health.html

With little notice and even less attention the US Department of Health and Human Services (HHS) published in late August the federal government’s first ever regulatory rule intended to reduce the US healthcare industry’s massive carbon footprint.   

Federal regulation of healthcare’s greenhouse gases (GHG) has untold significance for several reasons.  HHS is in effect the world’s most powerful healthcare policy-making entity responsible for regulating nearly a $5 trillion market that accounts for approximately half of annual global healthcare spending.  US healthcare, the largest industry in the world’s largest economy, remains on balance uncommitted to decarbonizing.  Significantly due to infamous inefficiency and waste, in 2018 healthcare was accountable for an estimated 554 million metric tons of annual GHG emissions, or roughly 9% of total US emissions, that is accompanied by a social cost of upwards of $3 trillion.  If it was its own nation, US healthcare would easily rank within the top 10% of carbon polluting countries.  HHS’s Medicare seniors and Medicaid children are forced to pay the greatest climate penalty, ironically those whose health and wellbeing the department is budgeted nearly $2 trillion annually to protect.

Promulgated by HHS’s Centers for Medicare and Medicaid Services (CMS) and termed the “Decarbonization and Resilience Initiative,” the rule will allow roughly 700 hospitals selected to participate in a five-year Medicare payment demonstration beginning in 2026 to voluntarily report hospital building and purchased electricity GHG emissions along with anesthetic gas and transportation emissions largely via the EPA’s Energy Star program.  Volunteering hospitals will also answer eight sustainability planning questions. 

CMS will in turn provide hospitals with yet-to-be-specified technical assistance concerning GHG emissions measurement and approaches to deliver less carbon-intensive care.  For those participating CMS will post a “hospital recognition badge” on the agency’s website.  In sum, CMS justifies the rule by simply stating, “establishing a baseline understanding of GHG emissions . . .  is a necessary first step to lowering emissions.”

Immediately upon taking office the Biden administration published an executive order pledging to take a “government-wide approach” to “tackling the climate crisis.”  Eight months later HHS Secretary Xavier Becerra promised to use “every tool in the toolbox at our disposal to address the climate crisis.” 

The immediate question begged therefore is why did HHS wait four years to finalize a voluntary rule that both requires and promises nothing.  “The proposed decarbonization initiative,” CMS states, “could [emphasis added] directly lead to lower emissions.” 

In unpacking the rule, GHGs identified constitute just 20% of total hospital emissions.  HHS excludes supply chain emissions that account for over 80%.  There already exists a “baseline understanding.”  Energy Star currently calculates energy use intensity for over 3,000 hospitals by Core Based Statistical Areas (CBSAs) – the same metric CMS is using to select demonstration hospitals.  All one likely needs to know however is that over the past ten years just 37 hospitals on average, or approximately 0.5% of all US hospitals, were Energy Star certified for energy efficiency.  This number is made more trivial by the fact Energy Star currently excludes supply chain emissions.  Though hospitals will be participating in a Medicare demonstration that financially incents performance improvement, CMS will not consider emission reductions in calculating financial rewards - despite the fact Medicare has for years programmatically incented hospitals for improving care quality and patient experience.

That the rule is again voluntary may cause one to question HHS’s motives.  First, it’s oxymoronic.  Here, CMS reinvents the definition of a regulatory rule defined by the 1946 Administrative Procedures Act as a “requirement.”  In practice, voluntary reporting by a small number of hospitals creates selection bias making it unlikely HHS can legitimately draw generalizable conclusions.  Moreover, to expect hospitals to voluntarily report is disingenuous since the healthcare industry has long resisted doing so.  The reporting incentives CMS offers are largely meaningless because the EPA along with the Department of Energy are expert in identifying emission-reducing technology and solutions and partnering with industries to implement.

What renders the rule ultimately futile is CMS’ decision not to audit or verify reported emissions data.  Like HHS’s 2022 climate pledge program, the rule amounts to green washing or virtue signaling.  It also directly conflicts with the US Security and Exchange Commission’s climate disclosure rule finalized this past spring that does require publicly-traded hospitals to attest GHG emissions are verified.

This year will likely surpass 2023 as the warmest on record.  Limiting global warming to 1.5°C is now thought impossible.  The growth in natural gas and coal-fired electricity generation still exceeds solar and wind.  The climate provisions in the 2022 Inflation Reduction Act will have no effect on decreasing petroleum demand and despite President Biden’s 2021 pledge and his recent comments at the United Nations, the US is not on course to reduce GHG emissions by 50% below 2005 levels.  Nevertheless, the federal government’s choice to mitigate the healthcare industry’s massive carbon footprint by conducting a voluntary study will only demonstrate HHS’s disregard for planetary health.

Just to re-post:

On August 1^st, 3 Quarks Daily posted, “The US Dept. of Health and Human Services Ongoing Failure to Address the Greatest Threat to Human Health,” at: https://3quarksdaily.com/3quarksdaily/2024/08/the-us-department-of-health-and-human-services-ongoing-failure-to-address-the-greatest-threat-to-human-health.html.   It opens with, “Arguably the greatest global health policy failure has been HHS’s refusal to promulgate any regulations to first mitigate and then eliminate the healthcare industry’s significant carbon footprint.”  

On July 23, Columbia University’s Sabin Center for Climate Change Law published via its “Climate Law” blog, “The SEC’s Climate Disclosure Rule Will Reveal Healthcare’s Significant Climate Risk Exposure,” at: https://blogs.law.columbia.edu/climatechange/2024/07/23/the-secs-climate-disclosure-rule-will-reveal-healthcares-significant-climate-risk-exposure/.  I drafted with the Sabin Center’s Ms. Cynthia Hanawalt.

On July 11, Undark Magazine published, “Efforts to Build Climate Resilience Do Not Protect Human Health,” at: https://undark.org/2024/07/11/opinion-climate-resilience-human-health/.  Though I do not cite, I’d recommend Wainwright and Mann’s 2018, Climate Leviathan, especially chapter 3, “The Politics of Adaptation.”

On May 20^th STAT published, “HHS’s Proposed Rule Pays Lip Service to Addressing the Climate Crisis,” at: https://www.statnews.com/2024/05/20/hhs-proposed-rule-lip-service-addressing-climate-crisis/.  This past week CMS finalized its 2025 inpatient hospital rule that will allow a small number of selected Medicare demonstration hospitals to voluntarily report their GHG emissions – that I argue constitutes a regulatory illusion intended to accomplish nothing.  For a related discussion, see Tad Daley’s just published, “Future of Denial, the Ideologies of Climate Change.”  

Thank you.

At: https://3quarksdaily.com/3quarksdaily/2024/08/the-us-department-of-health-and-human-services-ongoing-failure-to-address-the-greatest-threat-to-human-health.html#more-260074.

US healthcare is particularly exposed to climate-related financial risk because the industry is heavily dependent on debt financing, accounts for a massive amount of greenhouse gases (GHG) emissions and remains uncommitted to mitigating its emissions.

At: https://blogs.law.columbia.edu/climatechange/2024/07/23/the-secs-climate-disclosure-rule-will-reveal-healthcares-significant-climate-risk-exposure/.

The essay is my 17th climate-related healthcare policy publication over the past two years.

I conclude, “For HHS, climate resilience leaves the department the author of its own endangerment. For Americans, we’re left hopeless. “

At: https://undark.org/2024/07/11/opinion-climate-resilience-human-health/.

I conclude by writing:

In Judge Josephine Staton’s 2020 dissent in Juliana v. United States, a case in which 21 children alleged the government “willfully ignored” the dangers of burning of fossil fuels, she concluded that “never before has the U.S. confronted an existential threat that has not only gone unremedied but is actively backed by the government.” Though “the government accepts as fact that the U.S. has reached a [climate] tipping point crying out for a concerted response,” she wrote, the government “insists it has the absolute and unreviewable power to destroy the nation.”

Should HHS affirm Judge Staton’s opinion and finalize the proposed inpatient hospital rule’s decarbonization initiative, its only legitimate purpose will be to serve as an example of what historian and philosopher Hannah Arendt defined as the “banality of evil.” CMS will have propagated a business-as-usual regulatory rule so thoughtless, divorced from reality, and depraved it cannot be, as Arendt phrased, “an expression of anyone’s conscience.” Such a policy could only be crafted by a bureaucracy whose functionaries have mastered the art of not looking.

If HHS chooses to address the incalculable misery and suffering resulting from health care’s massive carbon footprint by allowing a small fraction of hospitals to voluntarily report their emissions for a few years, the country will have assuredly reached an Illichian tipping point where health care constitutes what theologian and social critic Ivan Illich defined as “a sick making enterprise” and a “major threat to health.

The writing begins in part with, “It is remarkable, however, that the CBO has yet to publish a single report on the effects that the climate crisis has on federal health care spending, for at least two obvious reasons.”

It is at: https://thehill.com/opinion/finance/4162309-why-are-congresss-budget-experts-ignoring-the-rise-of-climate-related-health-care-spending/.

The first two paragraphs read:

“In January I argued the Department of Health and Human Services (HHS) appeared uninterested in mitigating the healthcare industry’s massive carbon footprint. To appreciate how massive, if every nation emitted our healthcare system’s per capita rate of greenhouse gases (GHGs), the total would approximate the entire global carbon budget to limit warming to 1.5 degrees Celsius by 2030.

U.S. healthcare is the largest industry in the largest economy in the world; HHS should not be a cause of the climate-related health harms it reimburses the healthcare industry to alleviate. Having again failed to promulgate any regulations to mitigate industry hydrocarbons this year, and it being inconceivable to do so during the upcoming election year, HHS has in effect declared defeat.”

It opens with:

"The climate crisis — the greatest threat to human health in history — is often framed “in ways that pay little attention to its health dimensions,” as the authors of The Lancet’s annual “Countdown: Tracking Progress on Health and Climate Change” report were forced to remind us.

This tragic reality was on display in Health Affairs, JAMA, Kaiser Health News, and The Lancet itself, among others, when they limited their reporting on the recently passed Inflation Reduction Act to its enhanced Affordable Care Act subsidies and drug cost reforms. They failed to highlight for the health care industry that the IRA’s tax credit provisions for renewable energy, formally called energy security, are for the first time refundable for tax-exempt entities. This means that the largest greenhouse gas polluters in the health care industry — the vast majority of hospitals that are nonprofit or tax exempt — can take advantage of these economic subsidies to reduce greenhouse gas emissions." 

At: https://www.statnews.com/2022/09/30/inflation-reduction-act-reduce-health-care-industry-greenhouse-gas-emissions/. 

“Keeping up the masquerade of equality” accurately defines CMS’s continuing pretense to value or prioritize health equity.  Earlier this month, CMS published a request for information (RFI), titled, “Make Your Voice Heard, Promoting Efficiency and Equity Within CMS Programs,” soliciting providers, communities and individuals to, in part, comment on how the agency can “further advance health equity” by identifying “policies, programs and practices” “that may help eliminate health disparities.”   Comments are due by November 4th.  In the accompanying press release, CMS stated, “advancing health equity is core work for CMS,” and that “health equity is embedded within our DNA at CMS and serves as the lens through which we view all our work.” 

More of this “CMS-is-committed-to-placing-health-equity-at-the-center-of-our-work” rhetoric can be found in CMS’ 40-page, April “CMS Framework for Health Equity 2022-2032” report. For example, “CMS Framework . . . supports CMS’s ability to assess whether, and to what extent, its programs and policies perpetuate or exacerbate systemic barriers to opportunities and benefits.”  The reports five priorities include assessing the causes of disparities and moving to address them.  “CMS is committed to,” the report notes, moving “beyond observation and into action, assessing our programs and policies for unintended consequences and making concrete, actionable decisions about our policies, investments, and resource allocations.”

CMS is committed, really?

First, at this point, if for no other reason than we are nearly three years into the COVID pandemic, is anyone really lost on at least the major causes of health and healthcare disparities? 

Second, anyone who has done policy worked in DC for more than a week knows that when federal policymakers do not want to do anything, they put out an RFI, tell someone to do a study or hold a meeting.   I’ll add, the magic of an agency RFI is that unlike formal regulatory rule making, the agency, here CMS, does not have to make public RFI responses.  HHS did the same thing this past spring when the Office of the Assistant Secretary of Health (OASH) released the RFI, “2022 HHS Environmental Justice Strategy and Implementation Plan Draft Outline.”      

Moreover - and you’ve heard this from me before - this exercise lends even more evidence to the fact CMS refuses to address, much less recognize, the greatest threat to human health in human history - the climate crisis, that is made substantially worse by the largest industry – healthcare and its largest funder – CMS, in the world’s largest economy – the US.     

The RFI makes no mention anywhere of the problem, here moreover the disproportionate health harms inflicted on minority populations and the frail elderly, including in the “advancing health equity” discussion.  In CMS’ “Framework,” the climate catastrophe is literally an afterthought.   Framework authors wrote, “this [framework] plan also considers the impacts natural disasters (e.g., earthquakes, fires, viral outbreaks) and manmade disasters (e.g., oil spills, lead poisoning, climate change).”  That’s it, one mention, no discussion. 

To compare, last week the EPA announced it was establishing an office of environmental justice, or more accurately consolidating three smaller related offices, led by a Senate-confirmed administrator reporting directly to the EPA Administer.   The redefined office will enjoy a $100 million budget, be staffed by 200 and be merged with the EPA’s Office of Civil Rights.  This past May HHS announced it was establishing an Office of Environmental Justice.  It will exist within the unfunded Office of Climate Change and Health Equity (OCCHE), meaning it will have a skeletal staff, and its relationship to HHS’s Office of Civil Rights is at least unclear.

Also, late this past week, the World Health Organization along with 65 international cities and governments, 200 global health associations and 100 Nobel Laureates, signed onto a call to action urging governments to agree to a legally binding, i.e., enforceable by the international criminal court, non-proliferation treaty on fossil fuels.  The analogy is the 2003 WHO Framework Convention on Tobacco Control.  At the United Nations this past Saturday, the President of the Pacific Island nation of Vanuatu, Nikenike Vurobaravu, called for the same.   

The legally binding aspect is not farfetched.  Coincidentally, in his recent review of three climate-related books, under the titled “Where Will We Live,” in The NY Review of Books, Bill McKibben, cited data showing that today there are approximately 24 million climate-related refugees and by 2050 there could be as many as 1.5 billion.  This led McKibben to argue that since the vast majority of these individuals have had or will have had little or nothing to do in causing an increasingly destabilized climate, “you could fairly say the climate crisis is a kind of crime.”  This crime, in which the health care industry’s intransigence looks increasingly like that of the oil, gas and electricity industries, disproportionately falls on the US.  No country will ever come close to matching upwards of this country’s 40% of total historical worldwide greenhouse gas emissions.