The social costs of greenhouse gas emissions in health care are astounding — and we’ve been ignoring them completely 

The social cost of greenhouse gas (GHG) emissions is considered to be the single most important measure in addressing the climate crisis, and generally includes the health harms resulting from unpaid or externalized GHG emissions. Defined as an estimate of social damage.Researchers are calculating this cost decades.Federal agency launched incorporate regularly The social costs of these emissions in 2008 now exceed that 80 federal regulations Reflects its usage.

Although GHG emissions are defined as: The biggest threat to human health For the better part of this century, the social costs of health care industry emissions have somehow escaped the attention of the Department of Health and Human Services (HHS).

This is difficult to understand because the medical industry emits enormous amounts of greenhouse gas pollution.

A 2020 calculation by academic researchers estimates that GHG emissions for healthcare organizations are: 553 million tons of CO2e (CO2e, or carbon dioxide equivalent, is a term used to describe how much a particular GHG contributes to global warming if it is carbon.) According to the Environmental Protection Agency (EPA), this amount is equal to: 12% of total US emissions 2018.As an outlook, U.S. medical emissions almost 5 times That is that of the US military, the world's largest organized consumer of fossil fuels.

If US healthcare were its own state, it would easily fall into the following ranges: top 10 percent Among the countries with the highest emissions.

of biggest industry In the world largest economic zoneAbout half of U.S. healthcare — or $4.7 trillion — of total global annual health spending.known since ancient times wasteful expense, U.S. healthcare is extremely energy inefficient. for example, Of 6,129 hospitalsthe industry's largest greenhouse gas emitter; Only 37, or 0.6 percent; EPA Energy Star certified for energy efficiency in 2023. This number becomes even more trivial when you realize that Energy Star only measures Scope 1 and 2 energy use intensity. only 25 percent Percentage of total hospital greenhouse gas emissions.

Despite the fact that GHG emissions from healthcare are increasing; cause undue harm Dear Medicare and Medicaid beneficiaries, HHS does not regulate medical GHG emissions. HHS has never discussed the social costs of his GHGs. A recently released report by HHS and the National Academy of Medicine doesn't even mention Energy Star. sustainability journey map, The aim is to support the decarbonization of healthcare.

President Biden in January 2021 issued a presidential order That led to E.P.A. Publish report in November It updates the annual social cost or monetary value of the net social harm of a tonne of carbon dioxide, methane or nitrous oxide emissions, or the net social benefit of a reduction. Each of these gases is 79.4%, 11.5%, 6.2% of all greenhouse gas emissions in the United States.

Briefly, a federal interagency working group, including the Secretary of HHS, generated three conservative estimates for each greenhouse gas using three discount rates and three damage models from 2020 to 2080. I calculated it. Specifically, the three discount rates are 2.5%, 2.0%, and 1.5%. Percent – EPA calculated the social cost of carbon dioxide to be between $120 and $340 per ton in 2020. For methane, the societal costs were estimated to be $1,300 to $2,300 per tonne, and for nitrous oxide, $35,000 to $87,000.

For those who don't know, discounting is based on the premise that a dollar is worth more today than it will be in the future. Therefore, the discount rate determines the present value of a cost or benefit that will occur in the future by discounting it by a constant amount each year. Using three damage models, EPA calculated the social cost of carbon dioxide in 2020 to be $110 to $120 per ton, methane $190 to $200, and nitrous oxide $330 to $370.

The difference in social costs between these gases is that they trap heat or absorb solar radiation at different rates, resulting in different global warming potential (GWP) scores.For example, methane has been GWP 30, In other words, one ton of methane absorbs more than 30 times more energy than one ton of carbon dioxide. Annual social costs increase significantly as environmental and economic systems become more stressed. For example, the EPA puts his 2080 price for nitrous oxide at more than $200,000 per ton. It is also important to note that EPA assumes that social costs reflect the global value of climate impacts, primarily for two reasons. That is, the United States' GHG emissions have a global impact, and the United States is closely connected to the global economy.

Calculating the total societal cost of GHG emissions from healthcare is difficult primarily for the following reasons: EPA's Commercial Sector GHG Inventory It does not disaggregate GHG emissions from medical care. On the other hand, the EPA does not clarify the large amounts of carbon dioxide, methane, and nitrous oxide emissions in the medical sector. This also means that EPA does not calculate the societal costs of anesthetic gases beyond nitrous oxide. This is especially problematic because his GWP scores for the commonly used desflurane, isoflurane, and sevoflurane are much higher. For example, desflurane has GWP 2,540 compared to 289 for nitrous oxide. Worldwide, emissions of these gases are estimated to be: 3 million tons of CO2eapproximately 80% of which is derived from desflurane.

According to the above percentage distribution, it is assumed that 553 million tons of CO2e in healthcare facilities equals 439 tons of carbon dioxide. 64 tons of methane and 34 tons of nitrous oxide (and if we ignore the remaining 2.9 percent of his GHG emissions, or 16 million tons), in 2020 dollars we can conclude:

• Using EPA discount rates, the social cost of U.S. healthcare GHG emissions in 2020 ranged from $255 billion to $3.3 trillion.
• Using EPA's damage model, social costs in 2020 ranged from $1 trillion to $3.6 trillion.
• In 2030 terms, the social costs of all six of EPA's models range from $1.5 trillion to $4.2 trillion.

For comparison, $3.6 trillion is more than double Medicare and Medicaid spending in 2022. equivalent to $1.75 trillion.

EPA's November report could have at least two short-term effects.

1. At the White House this September Fact sheet published The government has announced that it will take additional measures to reduce GHG emissions. These include directing the Office of Management and Budget (OMB) to work with federal agencies to use the social costs of greenhouse gas emissions to calculate the impacts of federal programs and justify budget proposals; . Presumably, this will mean OMB working with HHS to begin calculating GHG social costs for Medicare and Medicaid programs. The fact sheet also encouraged federal agencies to consider incorporating the social costs of greenhouse gases into regulatory penalties, for example through Medicare. Values-based programming.

2. The Securities and Exchange Commission's highly anticipated final rule requiring commercial organizations to publicly disclose climate-related financial risks will cause major disruption to the health care industry. (Health care nonprofits cannot reasonably be expected to avoid similar scrutiny and pressure.) This is largely because health care has always done it. significantly delayed All other major industries publicly report environmental impact data. As a capital-intensive industry, healthcare is highly dependent on financial investment. This means that access to and cost of capital for industries that rely heavily on fossil fuels, such as healthcare, will become increasingly limited and expensive.it is proposed rule There is no specific mention of the social costs of greenhouse gases. The SEC promulgated this proposed rule primarily in response to years of efforts by institutional investors and insurance companies seeking better information to assess climate change, susceptibility, and adaptive capacity.

There has been a virtual arms race in capital markets to identify comparable, consistent, and reliable numbers that represent acceptable greenhouse gas emissions. EPA's GHG social cost calculation is this number.

Dr. David Introcaso is an independent health policy consultant specializing in health policy reform related to the climate crisis. He has conducted environmental and health policy research for the U.S. Congress and the Department of Health and Human Services. He is also the creator and host of “The Healthcare Policy Podcast.”