interviews
Managing The Unavoidable
by Michael Brumage
April 1, 2020
This interview with Michael Brumage, the Medical Director of Cabin Creek Health System and Program Director of Public Health/General Preventive Medicine Residency at WVU School of Public Health, was conducted and condensed by frank news.
frank: Thank you for speaking with us Michael. Will you tell us about your background?
Michael Brumage: My name is Michael Brumage, I'm an MD and I have a master's in public health. Currently I'm the medical director for Cabin Creek Health Systems. I'm also the program director for the general preventive medicine residency at West Virginia University in the school of public health.
I am a native West Virginian. I went to undergraduate and medical school at West Virginia University.
How did you get your start working on pandemics?
I started by working in internal medicine for the United States Army and later became a preventive medicine physician. From 2005 to 2007, I was the chief of preventive medicine at Tripler Army Medical Center in Honolulu. While I was in that job, I wore two other hats, one as the public health emergency officer, PHEO, for the Pacific Regional Medical Command, and PHEO for Joint Task Force-Homeland Defense, which covered all the U.S.-affiliated islands in the Pacific. I was up to my neck in pandemic planning.
At the time we were planning for Influenza A H5N1, the “bird flu”, the highly pathogenic avian influenza we worried would become the next pandemic virus. Fortunately, it never acquired the characteristics to spread easily from person to person. While it had a very high mortality rate, it didn’t spread easily. I understood what was at stake from the very beginning of this current pandemic.
This has transpired, largely as I hoped it would not.
How so?
I had hoped that our government would have been more proactive in seeing the danger and expressing that to the American people, and that did not happen. Now we have to make really hard decisions about what price we're going to pay. In places like New York City, Seattle, Boston, we are reaching the capacity of our healthcare system and may soon overrun it.
How will this affect rural communities, like yours in West Virginia?
We have to consider how we can prevent the spread to rural areas of the United States. Where we are in West Virginia, we serve people from all walks of life, but are primarily in underserved areas. We have clinics in formerly very heavy coal producing areas, and we deal with a lot of chronic illnesses like heart disease, lung diseases, and diabetes.
The Kaiser Family Foundation recently did a study evaluating at-risk populations for a pandemic.
West Virginia had 51% of its population over the age of 20 at risk for complications. The national average is 41%.
We are not only dealing with individual human beings that have chronic medical illnesses, but also Hepatitis B and C, and HIV cases related to intravenous drug use. In addition to these problems we now have to address a pandemic that strains our own internal capacity. What's most concerning to me is that we are working with very high-risk populations for complications from coronavirus.
How do you prepare for a pandemic in the face of that reality?
As the medical director, my effort in the last couple of weeks has been almost solely focused on preparing Cabin Creek Health Systems for a pandemic, which includes 11 sites in Kanawha County. We've been preparing to try to segregate people with respiratory symptoms away from other patients, moving toward deferring visits that do not require an in person visit, and trying to shift more to telephone and telemedicine to care for patients. We will still need to see patients in person for a variety of issues.
Yesterday I was in clinic for the first time in a while and actually swabbed someone for COVID-19. He had been on a cruise with two other family members with upper respiratory symptoms. I tested him for COVID-19 after donning personal protective equipment and administered the nasopharyngeal swab. We will find out the results in a few days.
This has been the pressing issue for me: worrying about a pandemic with the background of people in a state that ranks first in almost every bad category of health indicators, and usually bottom three for every good category of health outcomes.
It's a real challenge because our population is sicker than most.
If it hits here the way it does in other places, we're soon going to be out of ICU capacity and hospital bed capacity. There may be difficult triage decisions made for people to access care.
One advantage I think we have is that we are rural. People either live on ridge tops or they live in the hollows and that tends to create its own capability for social distancing. Whether you're in rural America or urban America, you're going to do pretty well if you practice social distancing. The question is whether or not we have the discipline to maintain social distancing, and biting the bullet on economic damage that it is going to do.
The case number is currently low in West Virginia. How are people responding in a place that is not visibly taken by the virus?
https://dhhr.wv.gov/COVID-19/Pages/default. | 39 Total Positive Cases as of 11:47PM PST 3.24.20
First of all, we don't really know how many cases there are. This is a huge blind spot everywhere in the United States, and here in West Virginia as well. While we know we have eight cases [on 3.21.20], I think everybody in public health understands that the real number of cases out there is much, much higher.
We are really like soldiers on a battlefield in a fog. We know the enemy is out there, but we don't know their strength in numbers.
I think many people here, from what I can gather from social media, are still in disbelief that this is as bad as it was because of messaging that came from some conservative media sources and the message that was coming from the White House for some time. I think the lingering effect of that is that there are many people who don't take it seriously. Two days ago, I went to a supermarket and I still saw people walking out with rolls of toilet paper under each arm, which I can't comprehend because there is no toilet paper shortage. And instead of just getting in and out with their toilet paper, I saw people congregating in the parking lot having discussions, which is an anathema to what we should be doing right at the moment.
Right. There is something strange about going to a store right now, without knowing what the future looks like – even with all the information I have, I pause and think, do I need more stuff?
Definitely. That attitude can be very contagious.
When we look to countries ahead of us chronologically, how can we use their experiences as a model?
If we stop and take a look around the world and how different people handled it, we're going to find success stories that could help lead us to a better place. One is China.
China of course, made the fatal flaw of suppressing the information on the virus, and we're all suffering because of it.
Because they have much more authority to enforce disciplined public health measures than we do in Western democracies, they were able to clamp down very rigidly on their population. This sort of radical social distancing and enforcement of quarantine seems to have worked in China. I think they may be out of the woods, depending on how they manage the subsequent waves of disease that are inevitably coming. While there may be no more new domestic cases, China is very connected to the rest of the world and can import cases.
Then you have South Korea. South Korea was an early leader in terms of number of cases and number of deaths. The Korean CDC is a capable and intelligent organization. They rapidly deployed testing kits and identified the people at risk and tested them. Whoever was positive, was isolated immediately. This is very widespread, population-based testing, an aggressive management of the disease seems to be flattening the curve in South Korea. They seem to be a model we can follow. In general, South Korea looks a lot more like Western countries politically, than they do a rigid, authoritarian country like the People’s Republic of China.
If we want to really get a hold of this, we have to expand testing radically.
Part of this is buying time everyday so we can slow the spread and allow industry to catch up, to allow research to catch up, and to implement widespread testing. This will really make a major difference in our response.
What can we expect given our current reality?
My concern is what frequently happens when you start to get success is that you become complacent. I anticipate we will eventually succeed in controlling this in some manner or another. The reality of the situation is going to hit home, even for the people who are still out there in denial. I anticipate that over the summer months, the disease will wane and give us the sense of security that we've kind of got this thing under control.
I really worry about what's going to happen in the fall if we let universities reconvene and schools reconvene.
People from all over the country are going to descend on campuses and share their viruses, which happens every year. This could reignite the whole situation. That’s why we really need to have a much tighter testing regimen in place by fall. We can buy time through the summer months and become very aggressive about developing testing, including point of care testing. There's a difference between what we're doing now with testing, which is the nasopharyngeal swabs and sending it off to a lab for evaluation, and things like the rapid flu test, which we can do in an office setting in about 30-45 minutes. We have a similar test already for influenza. In those cases we test, keep the patient in the office and tell them whether or not they have influenza. A similar test for coronavirus would be ideal. I believe it could be a prerequisite that the student body and the faculty would have to be tested and be certain they were negative before returning to campus.
Coronaviruses are not new to the United States. There are at least three other coronaviruses that show up in our communities and present like a common cold. What we are concerned about here is the more pathogenic and dangerous COVID-19 virus. We need a test that could be easily administered, and then we need to be able to isolate the positive cases that do come back away from the population.
In some ways, it's like when you think you've put out the forest fire, but those smoldering embers lying in wait can help reignite the fire all over again. My greater concern over the long term is that we become complacent and that this disease makes a resurgence in the fall months.
Data is finally emerging, but I feel like data is only as useful as the person interpreting it. How are you reading what comes out of China, Italy, or South Korea?
Data is also only as good as the people collecting it, and what they are collecting.
The Chinese data and the South Korean data especially, are the best gauges for what the real case fatality rate is.
There's a lot that comes into play here. So again, South Korea has done much broader testing, they're identifying the less symptomatic cases, as well as the extremely ill cases. The last time I looked, the fatality rate was 0.8%.
Italy on the other hand, is not doing the broad-based testing. It could be that their case fatality rate is in fact higher because they can't deliver the level of care required to every person coming in because they're making triage decisions – literally who's going to live and die. Because they are in this dire situation where they have outstripped their capacity, people who might have survived previously are no longer given that opportunity because there's not enough intensive care unit beds, ventilators, and intensive care unit staff. We have to look at all the data from a wide variety of angles.
What is the real number? I'm looking at the South Korean model as the most accurate, even though it's probably not perfect. If we can drive the case fatality rate down to 0.8% that means: a), we're doing enough testing and b), we're maintaining our capacity to care for those who are extremely ill.
What else do we need to pay attention to right now?
One is that we have to plan ahead for vaccine distribution. We know when this vaccine is finally produced, we are not going to have enough for everybody, and it's going to be available gradually as production increases. People like health care workers and first responders are going to be among the first in line. People at highest risk of disease are going to be next in line. We have to begin to communicate those priorities well in advance, in order to prevent public panic.
Think about people trying to get vaccine when you see people hoarding toilet paper.
The communication has to be clear.
One of the most touching things I saw in relation to pandemic preparedness was a mass vaccination on Saipan in the Commonwealth of the Northern Mariana Islands. In 2007 and 2008, the Department of Defense received an excess of flu vaccine they were planning on paying a company to destroy. At the same time there were people in places like the Pacific US territories that weren't getting enough. I thought, we have this need in the Western Pacific, so why not use it? I was able to get it shipped out and used as part of the community's pandemic planning.
How do we plan for a mass vaccination?
Ultimately, that's going to come down to planning at the local level. That means local health departments and hospitals and other health organizations will have to collaborate with law enforcement to set up mass vaccination sites that may include drive-through vaccination clinics where you are.
Got it.
I wanted to mention that at the end of this, we have to ask ourselves, “How could we let our public health system fail the way it did?”
When it comes to a pandemic, you see how the system has failed because it was underfunded and under-resourced at the federal, state, and local levels for many years. We often boast that we have the best healthcare system in the world. That myth is busted if we are failing even the doctors, nurses, and other staff on the front lines of this pandemic without adequate personal protective equipment. How could this be allowed to happen when we knew that a pandemic would eventually hit?
I was just listening to NPR on the way to talk to you and I heard somebody talking about how a pandemic bears a similarity to earthquakes, another periodic natural event. If you live in Los Angeles, you know that the big one is coming sooner or later. We knew pandemics were coming. It was inevitable. And yet we were so ill prepared for this.
This is a societal failing to undervalue public health.
We have to reimagine how we view health. We have typically viewed health through the lens of health care, when we know about factors called the social determinants of health that account for 80% of a population’s health. I'm talking about things like employment, economy, education, housing, transportation. All of these things play together in the health of people. The growing homeless problem you have in Los Angeles, in San Francisco, and even here in Charleston, West Virginia is a nationwide phenomenon, and these are people who are at high risk for all kinds of bad health outcomes. We are together only as healthy as the least healthy among us. They are the weak links in the chain of health. We have to have the view that we are interconnected.
We need to be prepared for the next pandemic that will inevitably come, and look at health from a holistic perspective. At the social services, at education. All of these things are crucial determinants of health for our nation and for our planet. If we fail to do that, then we have fundamentally failed to learn the lessons of this pandemic.
You’re so right about LA – it's cognitive dissonance. It's too big to wrap your head around. Right now there’s no looking away. Hopefully we use the opportunity as you suggest.
You nailed it. This cognitive dissonance is so true. We can't ignore it, and we're all paying the price for all of the weaknesses in our chain of health, in our chain of healthcare, and in our failure to plan for the inevitable. I think it's just such a profound quote from Tom Friedman who said, “We have to manage the unavoidable to avoid the unmanageable.”
And I thought, wow, that's really the whole pandemic in a nutshell. We have to face what's clearly in front of us. We can no longer look away, otherwise, we are setting up future generations for a failure on the scale that we see today.
interviews
In Conversation with Harvey Michaels
by Harvey Michael
February 28, 2019
Harvey Michaels is an MIT Sloan Lecturer on the emerging Energy and Climate Solution Economy for the Sloan Sustainability Initiative, in collaboration with the International Urban and Regional Studies Program (SPURS). Harvey also directs the Energy Democracy Project in affiliation with MIT’s Climate CoLab, Media Lab, and Energy Initiative, where he served on the faculty team for The Future of the Grid research study.
frank’s goal is to introduce our audience to new themes and nuanced ways of approaching those themes. In looking at some of your work and collaborators, I see a few names we’ve already featured, which is nice! I would love to start by hearing your definition of energy democracy.
There are a few key definitions for energy democracy. The one I really focus on is that there are opportunities wealthy people and companies have, related to energy, that people who are lower income, and have less personal power, don't have. Part of it is to be able to find ways to open the provision of support in the energy field – and that differs by person, differs by circumstance, and where you are in the world. It opens options you would have if you had personal power to people of less power.
To me, that's the overall definition. Having democratic access to the good things some people have related to energy. That differs depending on the environment you're looking at. I see three particular directions for that. One of them is energy access among people who don't otherwise have it, and providing them with light, accoutrements of comfort, and access to television, where currently they may have no grid at all. Which is what you're really seeing with Shazia.
That, to me, is a distributed task to access. The idea of energy democracy is you don't really need to wait for the government to do it for you, and the utilities to do it for you. In some way, you can do it yourself.
Then, you've got the Isaac Baker view, which is prevalent among more developed, but low income areas in the United States. If you really want solar as a low income person, it's hard to get. You tend to pay more for energy than high income people do. There's less opportunity to get involved in the sophisticated energy management opportunities big businesses and wealthy people have. To get paid when they use energy, and get credits for working around utility system peaks to charge up their Teslas at low-cost kilowatt hours. Things like that are less commonly available to low income people. You spoke with Solstice, you spoke with Isaac Baker, so you've heard some of those messages. Essentially, equitable access to solar, but there's also equitable access to other elements of it.
We touched on two of the three. The first one being access in areas that are off-grid. The second one being access to solar and low-cost kilowatt hours, and other benefits by people who are low income but on grid. Then, there's a third one, which is the original use of the term energy democracy, which is that there's some community management of the energy system that's focused on community values, local jobs, and more equitable treatment of people in the community.
Rural neighborhoods in Puerto Rico are now creating their own energy systems, and the National Rural Electrical Cooperative Association, which covers a lot of the United States, has actually composed a system that was built by farmers to serve their local communities. It's supported by a federal program that started during the depression for them to meet their own needs in a way that serves them best.
A lot of the energy democracy initial conversation, which is now about a decade old, began with the Recovery Act during the Stimulus Program, after the 2009 almost depression we had. Where money became available for cities and states to fund local green jobs. One of the objectives of the energy democracy movement was to have this thing done at a local level, that trained and created career paths for people at the local level who needed jobs.
Is there a specific way you approach bringing new people in to this idea?
It's circumstantial – maybe that’s a catch phrase for all of these things. The example which is extremely current, deals with the objective that a lot of cities have, this includes New York and Boston, and many other cities in the United States, to become carbon-free cities.
They are basically saying that you have to stop using natural gas for your hot water, and you have to stop using gasoline for cars.
But consider the implications of it, particularly on low income people in old homes of limited means. To say, "Well, if you want to drive, you're going to have to get an electric car.", and number two, the natural gas line that serves your triple-decker in Boston, is going to, within a few decades, get shut down, creates an equity issue. If you're a wealthy person in the city of Boston, you live in a million dollar condo, and the city of Boston puts those restrictions on you, it's no big deal. If you're someone of limited means in a low income neighborhood of Boston, the Carbon Free Boston plan sounds really scary.
Part of it is finding ways to improve the ability of people of limited means to be able to deal with those coming restrictions. I was involved with lobbying the Carbon Free Boston plan, finding ways to make this work for people, and make it so they have equitable opportunities to switch to electric sources. It is one of the challenges of energy democracy that is very real. They get concerned, and this minority groups, labor unions, public housing authorities...
That's one place where the conversation related to energy democracy is very rich.
In a scenario where you're trying to create equity where it doesn't already exist, how does government, whether that's local, state, or national, need to be involved? Or, how can they be involved in creating that equity?
That's a great question. There are lots of really long answers to that question, so let me give you some of the top thumbnails. One of them is that electric utilities actually collect a lot of money for the purpose of inducing energy efficiency in the customers that they serve. I don't know if you've heard of that before, but the utilities in many states, and this isn't only the obvious candidates, like Massachusetts, California, and New York, but in 32 states, they have programs where utilities are actually charging more for their electricity to collect money, which then they use on energy efficiency programs.
One characteristic of those programs, is a lot of that money goes to suburban single family homes, and to MIT, and industrial companies, and doesn't go to serve the needs of the community, where everybody is paying for these programs on their electric bills. As principle of energy democracy is saying that the community should be strongly engaged in deciding how that money will be spent in their community. If you're in the Codmen Square neighborhood of Boston, which I'm involved with, which are 100 to 120 year old triple-decker framed buildings that didn't have insulation, and generally have two renters and an owner on the three floors of the building – there's nothing in those programs that are really well suited for who they are, and what their building is, and what their financial circumstances are. What they need is extremely different than what a large suburban home in the Boston area may want, which is help with getting a charging device for their Tesla.
They are different worlds, there's no differentiation, and there's no real support. Energy democracy says the first and primary focus of these things should be equity, and providing equitable and necessary support to the people, based on their ability to purchase things.
So, you say, "Well, why does anybody want these things?" The people who live in these triple-deckers in Boston have very large energy bills, particularly heating bills, in relation to their income. In many cases, they may be getting a gas bill that, for a single month in the winter, is $500 or more. Being able to pay those bills is burdensome to them. This creates a crisis. Having something that serves them, first and foremost, ends up being an important thing, that a local management of local values and needs would be able to address.
That's a general area of energy democracy, which is essentially local participation in how programs that are administered on a federal, state-wide, or utility-wide program, serve the needs of a local community.
Another is that energy democracy should mean you can pay less for your electricity the way wealthier people and big businesses pay less for their electricity per unit, per kilowatt hour, than lower income people do. Sometimes there's tiered pricing. As you use more, you pay less per unit. But the bigger reason is that there's special ways to avoid the high costs of electricity, and lower income people don't have access to it.
At MIT, and in a large business, you can regulate when you use electricity, and you pay a lot less if you regulate when you use electricity. At the home level, you don't have those signals, you don't have those opportunities. To give you range on it, almost all the time electricity cost on a time-based measurement is a lot less than what we pay. A few hours of the year, it costs 10 times more than the average price that you pay. If you don't have any way to manage that, you pay a mix of the two, which is a lot, as compared with what a more sophisticated, larger, wealthier organization would be able to do – control when they use their electricity and pay less.
One of the problems with this, is that if you're not able to get access to those low-cost kilowatt hours, electric heat and hot water are very burdensome, and if the case is that you'll eventually have to move to electric heat and hot water, that $500 gas bill will go up, and it's already too high.
The other thing is, we have to move from our gasoline cars to hybrid or electric cars, and one way to make that affordable is to make the electricity less expensive. It's easy with an electrical car, if you have a way to get it properly priced and measured, because there's only a few hours a day and only some days of the year when electricity is really expensive. But people don't know, and they don't have the ability to avoid those hours and charge up during low-cost hours, off-peak hours, which are much cheaper.
The fact that there are communities that don't have the power to have the programs for energy efficiency, and solar energy work for them is a problem.
The Green New Deal is the big push towards addressing climate change right now. Do you feel like they're using the right language to incentivize the elements you’re outlining?
I have some concerns. I love the political energy the Green New Deal is generating. I think I do, so that's a really good thing. One aspect of the Green New Deal is that it mixes in a lot of the Bernie Sanders agenda with climate change. That might be polarizing and pushing large segments of American society away from supporting something, which I think in their hearts they support, which is climate agenda.
One of the things we managed to do, almost in a bipartisan way, is have substantial incentives for solar energy. We have substantial incentives for electric vehicles that were bipartisan. They became state and national laws because they didn't align themselves entirely with a place in the political spectrum.
Right.
To me, I think climate change is a bipartisan, cross-cutting, national issue, and I'll talk to that a little bit more in a minute. But, even if climate change is something that a segment of the US is not going to support by name, support for the things that are related to it, like high efficiency standards for automobiles, incentives for solar energy, tax incentives for solar energy and wind energy, and electric vehicles, are things that are supported broadly by the American public.
My biggest concern with the Green New Deal, is we basically say, "If you're for those things, then you have to also be for things like Medicare for all, free college education." Without making an opinion about those, my concern is that we we're losing climate votes, potentially, by doing that. We're losing support for policies we already have, and need to sustain by doing that. That's my concern.
Some of my students have been involved in the Sunrise Movement, which created the Green New Deal. I love that they're activists. I wasn't allowed to go to the meetings because I'm over 30. They started with their own segments here, and they generated this thing, and it's gotten a remarkable degree of traction. It's all good, in that the conversation is good. My concern, my message to them, when they're willing to listen, is that there actually is consensus around climate change, and it's important to speak in a way that doesn't push anyone away. That's my concern.
Do you think we move towards renewables through the grid? Or do we separate from the grid?
I think they can combine. If you're in a place that doesn't have access to the grid, that's a different thing. The thing that is interesting from an energy democracy standpoint is whether or not we can create technical and business models to allow the micro-grid, mini-grid community based projects to essentially become community utilities that never needs an essential grid. That are working with the neighborhoods by themselves, maybe supported by things like blockchain, and peer to peer systems, so that there can be sharing of my neighborhood with your neighborhood when I have excess power and you need it, I'll sell you some. When you have excess power in your battery and I need it, you'll sell me some. And have a world that works like that, rather than the world that is autocratic, and top-down.
The thing that's interesting is that with new technology that actually can work, and it may be better in a lot of ways: it may be less expensive, it may create more local jobs, it may make it easier for people to deal with shortages when it's a problem that's discussed locally and the decisions are decided about whether or not, when there's a shortage, they're going to keep electricity going to the hospital, or air conditioning at the wealthy person's house.
Those things can then happen locally. A place where there's a real sharp point on that is rural Puerto Rico, now that the system has been destroyed. In rural areas there's a lack of local power, that Puerto Ricans feel generally. They feel like they have no say over their lives to a great extent.
Having this local approach to actually build up grids that work within themselves for the most part, and do some trading at the margins with other grids that are nearby, is a very workable change from the typical system that we have for the grid now.
The real question is, where billions of people in the world are, is the system when they grow up something different than just local renewable business going away and the wire showing up? They may say, "Well, we care a lot that it's solar. We don't really want it to be replaced with these natural gas power plant-centered grid." Those are the kind of decisions they'll make, and I think it's important to recognize that it's not only possible that that will be the case in places where there is no grid now. It's possible that they'll be islanding off of these micro-grids, as examined and discussed within Boston, and New York, where there is plenty of grid service now. Having something which is more autonomously managed and managed locally.
In places where there is an established grid, how do you see it moving forward?
Historically there's been two models. There's been one where there's a large electric utility system, and the city is just some of the customers for that system. And, there have been models where the city actually owns and manages the electric utility system that serves that municipality.
There are thousands of municipal utilities around the United States. As I mentioned, there are these things which are sort of like municipal utilities, called rural electric cooperatives, which serve the needs without being part of a large central utility. What these organizations typically do, is produce some of their own power, but mainly they buy power wholesale, in competitive markets, then manage the local wires, pipes and distribution systems. They're accountable to the people they serve. This is called municipal utilities, but that's always been there. That's been there for a long time, and if you look into municipal utilities, for the most part, they are viewed as doing a better job to their customers than non- municipal utilities.
The thing that is now practical, that was less practical before, is something where there is community involvement without it actually being a community managed utility. One of the examples is communities running the energy efficiency program, or choosing the nuances of the energy efficiency programs that are being offered to the customers in their area.
For example, Eversource, a big utility in a few states up here, was approached by the entirety of Cape Cod. They said, "We want to run our own energy efficiency programs for Cape Cod, so we'd like you to give us the money you collect from the Cape Cod electric rate players, and let us run the programs instead of you. We're going to make programs that are more useful for the people of Cape Cod." That's a big area.
I had a student practicum in environmental policy and planning that designed a program with Eversource's agreement. An actual support to my class, to create a program for the typical student housing in Cambridge, of which there was nothing. Eversource offered nothing to help a typical low level grad student apartment in Cambridge improve energy efficiency and reduce the carbon footprint.
They designed something and Eversource ended up doing a specialized program for Cambridge that was partially managed by the city of Cambridge. Getting this local involvement in things that had been administered at the state or utility level is an important part of doing energy democracy.
How does the US speed this process up? How do we move towards energy democracy quickly to achieve the goals we've set for ourselves as a country?
There's really two major things that need to happen to stop burning fossil fuels, thus putting carbon in the atmosphere. It's not only that, but it's mostly that we burn stuff and that's the reason we have a climate problem. We don't even have to stop burning all of it, but we have to stop burning about 80- 90% of it. We can still use some of it, at least for another 50 years or so, but the issue is how do we use so much less?
It's just the best deal in town. Coal isn't going away because of some politics, coal is going away because you can't dig up coal and burn it, and produce electricity for as little as you can with solar and wind energy. The good news, is that one is just going to happen. We are going to stop using fossil fuels for our electricity. That's taken care of. Secondary though, which is much harder, we have to stop using natural gas and gasoline. That's natural gas for our heat and hot water, gasoline for our cars, and diesel for our buses. Those things are much harder to do, and the economics are more challenging.
How are we going to get from here to there? You can make these things work when you have a very energy efficient building, and when you have access to low-cost electricity, the way wealthier people do. Making it easier for people to make their buildings efficient, and making their electricity cheaper per kilowatt hour.
The real question is whether or not they're going to do this because they want to do it, or there's real good value in doing it, or whether they're going to do it because they have to do it. For a lot of people, they're going to do it because they have to do it. If you're in China and you want to drive a car, it has to be electric. It's not a choice that you have. You could have no car, or you can have an electric car. While we don't do that here, Boston's proposing doing that eventually. To drive inside the city limits of Boston, you need to have an electric car.
In California, they put some pretty major restrictions on people who sell cars, to say they have to be selling a lot of electric cars. There are these things that are happening by force, and then that means, what do you do? There's things in the Carbon Free Boston report which are also part of energy democracy, which is to make MassTransit better, have electric buses, make it easier to ride bikes, do things like that so people don't need cars, and don't need to drive as much. Giving people good options.
This is the one that's kind of news. When you print this, you might not have seen it in a lot of places yet. It's inevitable that the gas lines in a lot of cities are going to go dark. There will be no natural gas in the pipes. This is because as we make some progress towards these goals, and we start using less gas in the pipes, the cost to maintain those pipes with the limited amount of gas flowing through those pipes, is going to be too high. You may have heard some news about gas lines exploding in Northern Massachusetts. The typical amount people pay for natural gas is a large portion sustaining the gas pipes themselves.
Anyone who looks at this realizes it's inevitable that the world’s going to come out and say, you know what, we can't afford to come out and do the replacement that our gas pipe system needs: they've rusted, they're leaky, they're putting dangerous natural gas into people's basements, they're leaking methane into the atmosphere, and they will announce that the gas lines turn off.
The necessity of energy democracy is to create affordable ways that don't raise, and hopefully lower the cost of energy for people of limited means. That can be done by properly applying efficiency, creating new technology, having smart homes so you control when you use your electricity, and pay less that way. Having policies that make it easier for people to do this, having community involvement so the programs that are offered locally make sense for the kinds of people and the kinds of buildings that are in that locality.
Those are the elements of having energy democracy turn into an equitable climate solution.