In Remaking Society, Murray Bookchin writes, “All ecological problems have their roots in social problems.” If we apply his theory of social ecology to our modern world, we can appreciate that the ongoing climate crisis is a function of the concentration of capital among a small minority of individuals who plunder natural resources and exploit the working class to accumulate wealth and power. Conversely, it follows that reducing this exploitation would fundamentally decelerate climate change. Bookchin believed that doing so would require a reimagining of nearly every institution within our society. As a doctor who was trained in the midst of the COVID pandemic, I’ve seen, first-hand, the deep waste and inequality of the American healthcare system as it dealt with a virus that was itself molded by the exploitation of nature by an unregulated market economy. In turn, as we reform our social institutions to combat climate change, we must see that the U.S. medical-industrial complex is not left immune to this process.
The U.S. healthcare industry is responsible for 8.5% of national greenhouse gas emissions. Comparatively, the emission rate of the U.S. healthcare industry far exceeds that of other developed countries, such as Germany (5%) and England (4%). Why is the carbon footprint of the U.S. healthcare industry so much higher than those of nearly every other developed country? Simply put, they have single-payer healthcare systems while the U.S does not. The U.S. consumes an incredible amount of healthcare resources, spending more on healthcare than any other high-income country. And yet, it performs much worse with regards to health outcomes. This inefficient consumption combined with the lack of coordinated federal oversight directly leads to higher per-capita emissions. In turn, if we’re serious about decarbonizing the U.S. health sector, then we must promote fundamental healthcare reform as a means of getting there.
To understand why the healthcare industry produces a large amount of emissions, it’s essential to recognize that healthcare is a commodity. A commodity is created by converting raw material into items can be bought, sold, or traded. Over the past half-century, our economy has transformed healthcare into a commodity. Doing so has allowed us to accelerate the creation of new medical technologies. However, we have become unprepared for the downstream consequences of this rapid scientific progress. The production, delivery, and use of these medical technologies requires a tremendous consumption of raw materials. Think of the thousands of cell cultures that go into producing one vial of a therapeutic monoclonal antibody. Think of the millions of viral vectors that go into producing a gene therapy. These advances have led to some modest improvements in mortality rates over the last few decades, but at what cost? The environmental consequences, in addition to the well-documented financial toxicities, are substantial. The unregulated consumption of this expensive and low-value medical technology unduly increases our carbon footprint without providing a significant social benefit. While some healthcare organizations have taken steps to “go green” by choosing suppliers based on emissions criteria or by adopting telehealth models, these efforts fail to cut at the core of the problem. To truly decarbonize our healthcare system, we need to move towards single-payer healthcare.
A single-payer healthcare system can regulate the use of these advanced medical technologies in a way that delivers high-value care while promoting environmental justice. Providing high-value care inherently involves the sustainable consumption of healthcare resources, naturally reducing the industry’s carbon footprint. The solution is simple; what’s needed is the cultural and political praxis to translate it into the real world.
Bookchin once said, “The assumption that what currently exists must necessarily exist is the acid that corrodes all visionary thinking.” Reading this recently, I thought of our healthcare system as it relates to climate change— simply because it exists in its current form doesn’t mean it should continue to exist in that way. Accordingly, transitioning to a single-payer healthcare system and in turn, restructuring the U.S. medical-industrial complex will have a subtle but impactful role in averting climate collapse.