BY DAVID INTROCASO
In May, the Centers for Medicare and Medicaid Services (CMS) simultaneously released two proposed Medicaid rules (here And here) intended to further improve access and quality. The two discussed at length the agency’s commitment to “addressing health equity.” The first sentence of the two identified health equity as a priority for the Medicaid program. The proposed “ensure access” rule stated that CMS “take a comprehensive approach to . . . better address issues of health equity in the Medicaid program. CMS went on to state that “we are working to advance the health equity by designing, implementing and operationalizing policies and programs” by “eliminating avoidable differences in health and quality of life outcomes for disadvantaged or underserved people”.
Nonetheless, CMS’s focus on health equity is entirely performative. It is impossible to believe that the agency is legitimately interested in “eliminating avoidable differences” because management is well aware THE The biggest threat to health equity for Medicaid – and Medicare – recipients is the climate crisis. This is due to the fact THE most vulnerable to the climate Americans are Medicaid and Medicare populations. Yet the climate crisis is never addressed let alone mentioned in any of the proposed Medicaid rules. The word “climate” never appears in the 291 pages of the Federal Register.
This is explained by the fact that despite the “whole-of-government approachto “address” the climate crisis, HHS has refused to address the threat posed by the climate crisis by regulating the massive carbon footprint of the healthcare industry.
Children, 36% of whom are Medicaid recipients, are particularly vulnerable. Fine respirable particles resulting from the burning of fossil fuels are particularly harmful because children breathe more air than adults relative to their body weight. Research published last year concluded that the health effects of the fetus, infant and child include premature and low birth weight, infant mortality, hypertension, kidney and lung disease, dysregulation of the system immune, structural and functional changes of the brain and a constellation of behavioral health diagnoses.
Medicare beneficiaries, already compromised due to higher incidence rates of comorbidities, are even at greatest risk linked to arthropod-, food- and water-borne diseases, as the climate crisis may increase the severity of more than half of known human pathogenic diseases. Episodes of extreme heat are particularly deadly. Over the past 20 years, heat-related mortality among the elderly has increased 54%.
Healthcare in the United States, the largest industry in the world’s largest economy, emits approximately 500 million tons greenhouse gas (GHG) emissions, the equivalent to burn 553 billion pounds of coal per year. GHG pollution from health care is equivalent to approximately 9% of total annual GHG emissions in the United States and 25% of total global GHG emissions from health care. If health care in the United States was its own country, it would rank 11e or 12e worldwide in terms of GHG pollution. To truly appreciate just how massive healthcare industry emissions are, if each nation emitted the per capita rate of greenhouse gases from healthcare in the United States, the total would be approximate the ththe entire global carbon budget to limit warming to 1.5⁰C by 2030. Emissions from health care alone have been estimated at more than 98,000 Deaths in the United States and about three times that number worldwide. This helps explain why the use of fossil fuels is the leading environmental cause of human mortality. Fossil fuel-related air pollution is 58% annual excess deaths in the United States and approximately ten millions globally. Associated health care costs in the United States are estimated to exceed $820 billion annually. Despite all of this, the healthcare sector remains firmly committed to decarbonization. For example, less than 4% of US hospitals are EPA Energy Star certified.
CMS’s failure here is consistent with broader agency policy. The agency “Health Equity Framework, 2022-2032fails to acknowledge the fact that health care’s own GHG emissions disproportionately inflict countless and unrelenting harms on the health of HHS recipients. CMS'”Strategic plan“ignore the problem, especially the plan”2023 Strategic Framework.” The same goes for CMS in 2022″Diversity, Equity and Inclusion Strategic Plan.” Medicaid”strategic visionsketched in 2021 also makes no mention of the climate crisis.
CMS’s Centers for Medicare and Medicaid Innovation (CMMI) has also done nothing to mitigate industry emissions or improve the delivery of climate-related health care. At a recent National Academy of Medicine virtual meeting all CMMI Director Liz Fowler could offer was to note that the Center for Innovation’s recent Medicare Advantage demonstration offers participating plans the ability to offer undefined “climate change supports in the future.” It’s also worthless, neither the climate crisis nor health equity is an office of the Surgeon General priority.
There are a lot of things wrong with CMS’s continued recklessness.
Among other things, what makes the climate crisis a unique threat to health is that it is not just one problem among many. As a meta-problem, it exacerbates all other health conditions. Research published in 2019 concluded that fine particles resulting from burning fossil fuels can damage every cell in the human body. Efforts to improve health equity as well as quality of care and patient safety in the absence of GHG emissions mitigation is therefore compromised. Might be futile when you realize HHS dedicated to “sound and sustained advances in the sciences underlying medicine, public health and social services,” contribute substantially to biological annihilation as the climate crisis increasingly contributes to the continued evolution and human-made acceleration of the planet. sixth mass extinction.
Health professionals take a moral oath to do no harm. However, instead of fostering a business model rooted in beneficence, HHS instead offers one that works like a mischief-maker. harm-treat-harm catastrophic loop where health damage is dealt with in a way that further aggravates health damage. Since the damage to health resulting from healthcare GHG emissions is largely predictable, CMS’s regulatory malfeasance can be described as reckless, negligent, the worst kind of moral hazard and moral betrayal. The Hippocratic oath has become nonsense.
You would think that the most powerful health care regulator in the world would be particularly concerned about the rapid destabilization of the biosphere. Among many other realities, the heat content of the oceans is at alarming recording levelsthe northern hemisphere’s summer disaster season started early, as evidenced by heat waves around the worldthis explains for first time last month, surface air temperatures around the world exceeded 1.5°C, and a wildfire season in Canada that is already the the worst ever recorded. Three recent publications in Nature draw three startling conclusions: 9% of the world’s population already lives outside the “human climatic niche; » climatic tipping points are triggered significantly faster than previously thought; and, seven of the eight life support systems earth system boundaries have already been crossed. In June, UN Secretary General Antonio Gutters was again forced to sound the alarm. Speaking at a press conference in New York, he said: “The collective response remains pitiful. We rush towards disaster, eyes wide open. “There are too many risks for us to stay away. Now is the time for ambition and action.
CMS refuses to address the fact that healthcare is a climate-destroying industry that makes HHS guilty of fossil fuel racism. All of this is essentially Orwellian. Orwell’s characterization of Party members in “1984” aptly applies to the leadership of the HHS. They “could be done accepting the most flagrant violations of reality, for they never fully grasped the enormity of what was being asked of them, and were not sufficiently interested in public events to notice what was happening.
Devoted THCB readers may recall that of the 25 articles I wrote between 2016 and 2018, three were about the climate crisis.
David Introcaso is a health care research and policy consultant based in Washington, D.C.