By DAVID INTROCASO

This is Part 2 of David Introcaso’s review of the attempt by the Biden admin to do something about the massive carbon footprint of the US health care system. If you haven’t read part 1, start here.

Discussion

Under Secretary Becerra, HHS’s effort to decarbonize healthcare amounted to passive obstructionism or at best an exercise in performative guilt.

Inarguably, the climate crisis constitutes a permanent Public Health Emergency (PHE). Yet, Becerra refused to declare one. His Surgeon General, Dr. Vivek Murthy, whose job was to generate debate and build consensus concerning significant public health issues, failed to make climate breakdown or healthcare’s contribution to it a priority. HHS never signed an agreement with the EPA nor with the Department of Energy. It was striking Becerra failed to say anything about the Securities and Exchange Commissions’ 2022 proposed climate disclosure rule despite knowing the highly-leveraged healthcare industry faces significant climate-related financial risk exposure. 

Because Becerra also failed to obtain Congressional funding for OCCHE, until it was eliminated in 2025 OCCHE was largely relegated to producing monthly “Climate and Health Outlook” reports that attempted to identify where the next climate disaster would threaten the public’s health.

Per a White House call to action, in April 2022 Becerra announced a voluntary climate pledge program that constituted patented greenwashing. Pledgees would self-report, were not required to use Energy Star and the program lacked oversight and enforcement.   

A month later Becerra announced an Office of Environmental Justice. It too was never funded. The OEJ did produce an Environmental Justice Index that scored by census track environmental, health and social vulnerability. Possibly a good idea in theory but in reality, as a potential climate redlining tool it threatened to formally sanction climate apartheid. 

The 2021 White House EO also directed major agencies to develop climate resilience plans. Becerra would have been wise to ignore the directive.  Instead, HHS published a Climate Action Plan that pledged to make a “concerted effort to enhance resilience.” It’s worth noting building resilience is now widely promoted despite presenting insurmountable and distressing problems. Resilience requires ceaseless adaptation to and recovery from an endless cycle of climate-charged disasters. Because resilience assumes climate harms are endemic, they are made acceptable. People are forced to live in permanent danger because there is no alternative to ecocide capitalism. Resilience teaches apathy, hopelessness and fatalism. It is anti-human agency, a form of subjectification. As value free, it is an attractive political policy allowing for infinite deferral. Resilience allows institutions like HHS to abdicate responsibility, apologizes for exploitative resource use and licenses a disaster-ridden world. Refusing to envision any alternative future, resilience is nihilism. 

Becerra could have at minimum calculated healthcare’s annual carbon footprint. Either on its own or in cooperation with the EPA, HHS could have at least conducted source attribution, sentinel site or randomized stratified sampling studies, exploited proxy data, etc. 

More productively, Becerra could have exploited the 1946 Administrative Procedures Act’s “good cause” exemption.  This would have allowed Becerra to publish an interim final regulatory rule, that would take effect immediately, requiring hospitals under COP to at minimum publicly report Energy Star scores.

CMS’ effort was non-existent.