Climate Change Denial Will Leave Us Thirsty

Today, we got some bad news from the International Energy Agency. The IEA reported that energy related CO2 emissions in 2010 were the highest in history.

After a dip in 2009 caused by the global financial crisis, emissions are estimated to have climbed to a record 30.6 Gigatonnes (Gt), a 5% jump from the previous record year in 2008, when levels reached 29.3 Gt.

This, of course, at a moment when leaders of the Republican party are in full climate-change denial mode (at the behest of their enlightened base.)

I’ll say it. I’m tired of climate change being denied and climate policy being ignored.

Look, I understand that environmental problems are hard to address politically for myriad reasons, not the least of which is that consequences will be felt far in the future and are thus easily ignored. I get that politicians want to deal with the short term (what will get them re-elected) rather than the long term (what will save their children’s children).

But guess what? Climate change isn’t all flooded coastal towns circa 2100. Climate change has near term consequences, too. To see climate change’s consequences unfold in real time, just look beyond our borders to Australia.

In Australia there is little doubt that climate change is real. For more than the past decade, Australia has experienced what locals call The Big Dry – rainfall well below the historical average, and well below what Australians require to survive. Over the next week, I’ll recount a few stories from Charles Fishman’s The Big Thirst about how a few Australian cities are dealing with their dwindling water levels. The stories are nothing short of fascinating. They show how water is a strikingly personal resource, how that makes the politics of water fierce and challenging and how we are, as a people, shockingly unprepared.

As you might imagine, after living in a world with access to a seemingly unlimited supply of water, water scarcity is not an easy problem to solve. Addressing it not only requires expensive desalination plants and water recycling systems. It requires fundamentally changing the way we think about water.

Let me be clear, the point here is not that the we should all be water scarcity alarmists now. We don’t need to be, yet. The point is that we should see Australia’s example as a cue to start the conversation. We can disagree about how to solve tough climate-related problems like water scarcity. That is a reasonable debate to have. But to deny climate change’s existence so as to preempt the possibility of such a debate? That is just irresponsible.

Doctors Can’t Be Cowboys Anymore

Worried about health care reform? Need a dose of inspiration? Do yourself a favor and read Atul Gawande’s Harvard Medial School commencement speech.

In comparison to all the politically charged rhetoric around “rationing” and health care reform, Gawande is refreshingly honest, in both his description of the problem and prescription. Here’s Gawande, laying the smack down:

Two million patients pick up infections in American hospitals, most because someone didn’t follow basic antiseptic precautions. Forty per cent of coronary-disease patients and sixty per cent of asthma patients receive incomplete or inappropriate care. And half of major surgical complications are avoidable with existing knowledge.

In other words, the medical profession is too complex for doctors to go it alone any longer. There is no room for cowboys. Doctors need to act in tandem with large teams – pit crews – to provide quality care.

Still, at the risk of being a bit obvious, this is an important but small part of the solution. When will the science of health care delivery catch up? When will we be able to capture the huge amount of patient data and analyze it to provide better care? Yes, doctors need to change the way they approach their profession. But this seems simple (or at least manageable) when compared to the administrative and political challenges involved in fundamentally changing the science of health care delivery itself.

Why Health Care Rationing Still Makes Me Uncomfortable

I have always had an aversion to health care rationing. Why? Because shouldn’t I be able to get all the health care that I want, if I can pay for it?

I know this is wrong. Enough people who know much more about health care reform than I have told me that I am wrong. But I was never convinced, until I read through Ezra Klein’s pass at a definition of “rationing”:

My hunch, however, is that the only thing that’s really rationing is the thing your doctor tells you is rationing. If he can’t start you on a fourth drug regimen because the insurance won’t pay for it or the government says no, that’s rationing. If he doesn’t start you on a fourth drug regimen because he doesn’t think it’ll help and the focus now has to be on making you comfortable and trying to get you into a clinical trial, well, that’s just good care.

This is a very helpful distinction for me and, indeed, the way we should be talking about rationing. Rationing will always exist. But, ideally, the doctor has my best interest at heart. He or she will make the decision that is best for me. I can buy that.

Also, I should mention that from a rhetorical perspective this is powerful because the onus is put on the insurance companies and the government, rather than the doctor.

But as a recent convert, I still think there is an issue here. How good are doctors at making that decision? Is the decision to forego the fourth drug regimen as clear cut as Klein makes it out to be?

Perhaps not. As Aaron Caroll, over at The Incidental Economist, argued recently, there are two issues here. One is that often “doctors just don’t have the evidence to make good decisions.” But even when they do…

It’s a lot more complicated than that. Physicians are human beings, and just as susceptible to biases as you are. It’s no easier to change their minds, or their behavior, than anyone else’s.

Aaron Carroll is a physician by the way.

So, it’s not that our doctors are not smart enough. It’s just that they are human. And while our understanding of medicine gets better every year, it is still (understandably so) not perfect. So, when confronted with a scared and sick patient, I imagine deciding between different types of care is often very difficult. And if the doctor has trouble making this decision, how can the insurance company or the government ration care responsibly?

At the end of the day, the point of rationing is to reduce health care costs while maintaining an equitable level of care. I like Klein’s distinction. But, unfortunately, I’m not convinced that the world he describes could ever exist. At least not until we have a much better understanding of the comparative effectiveness of different procedures.

What Makes Good Policy?

Hello world!

I started this blog to sate a not-so-hidden hunger of mine – public policy. If you know me, you know that I spend an inordinate amount of time reading political and economic blogs. If you don’t know me, I’m 6’5 with striking blue eyes, a winning smile and biceps the size of…

No, but all kidding aside, I do love reading and thinking about public policy. But I realized that I do not have a systematic way of thinking about what actually makes public policy good. Or successful. Or useful at all, for that matter.

The goal of this blog is to figure that out.

Come back for more soon! First up, in honor of the Mrs. Wood’s second graders at Glenmont Elementary: “Water, Water Everywhere!” and the fascinating (you heard me right) world of water policy. I’ll be taking a look at Las Vegas’ water policy and a few businesses that get it right without government intervention.