Thursday, June 21, 2012

Vermont Sidewalks

Compared with the other 49, Vermont is a healthy state. Vermonters live longer, have a lower infant mortality rate, and are more likely to have health insurance than most other Americans.

It is even (compared with the other 49) a thin state, with only (if "only" is the right word) 58.5 percent of the people (and 26.7 percent of the children) overweight, and 23.9 percent obese.

But when it comes to health and fitness, "compared with the other 49" sets a low bar. Compared with the rest of the prosperous world, Americans in all states are more likely to be overweight.

Furthermore, Vermont's earns its (relatively) good rating on keeping its weight down largely because the folks in Chittenden County are thinner, with "only" 20.3 percent of adults considered overweight (this from the Center of Disease Control and Prevention in 2009). Rural Vermont is fatter. In six counties, more than 25 percent of adults are overweight or obese. Orleans County tops the list at 28.8 percent.

The experts and plain old common sense agree that while there are several reasons people are overweight, two of the biggest are that they don't eat well and they don't exercise enough. Many Vermonters exercise regularly; some of them exercise obsessively. But it seems that the most common form of exercise is performed relatively little in this state: walking.

Again, experts and common sense agree that there is more than one reason why so many Vermonters appear averse to getting from here to there by putting one foot in front of the other, then repeating the process. But part of the answer has to be that in much of the state, there's no place to walk, at least not safely. There are no sidewalks.

"If you build it, they will come," said Nancy Schulz, Executive Director of the Vermont Bicycle & Pedestrian Coalition, using the old movie line to point out that if towns build sidewalks, people will walk more. If not, they won't. Maybe Chittenden County residents are thinner because they walk more. Maybe they walk more because they have more sidewalks.

Actually, all nine cities and most of the larger towns in the state have at least some sidewalks. And by some measurements, Vermonters actually walk more than most other Americans.

According to a study for the Washington-based Alliance for Biking and Walking, 6.7 percent of Vermonters walk or bike to work, the second highest ranking in the country after Alaska.

But satisfaction with Vermont's present level of physical fitness and its rank in the walking world would be "settling for mediocrity," said Chapin Spencer of Local Motion, the Burlington-based organization that supports more sidewalks and bike paths.



Besides, that high ranking could mask a more sedentary reality. It's no secret that Vermont is chock-full of people who care about both their health and the environment. Many of these people have the kind of flexible job schedules that makes it more convenient for them to walk to work, and most of them live in sidewalk-endowed cities. It's in the rural towns and villages where walking is both difficult and rare.


A statewide survey by the Center for Rural Studies at the University of Vermont found that only 42.3 percent of the state's towns have any sidewalk at all. The best sidewalk coverage was in Chittenden County, the study found, where three quarters of the municipalities had sidewalks. At the other end of the spectrum, only 18.2 percent of n Addison County towns had sidewalks.

That figure probably overstates the extent of the sidewalk shortage, less because the survey was taken seven years ago – there hasn't been much sidewalk building since – than because it included the tiniest rural towns, gores and unincorporated hamlets, even those that have nothing resembling the kind of settled town or village center where sidewalks make sense.

But there aren't that many of those tiny towns in the state. So it seems that at least half of Vermont's towns and villages lack sidewalks, including some that had sidewalks a few decades or even a century ago.

"West Charlotte and lots of other Vermont towns had sidewalks 100 years ago that don't have them now," said Jim Donovan, who pored over some old maps in the course of leading the unsuccessful effort to get Charlotte to approve construction of a sidewalk along Ferry Road. "As far as we can tell, the sidewalks came out when the town widened and paved the road."

Because there is no sidewalk, Donovan said, "a lot of people will drive to one spot and then get back in their car and drive to another two blocks away."

That's common behavior in small towns all around the state, where it is inconvenient and unsafe to walk, say, from the general store to the Post Office, even if they are only 50 or 100 yards apart.

And would walking 50 or 100 yards (meaning 100 or 200, assuming round trips) now and then really matter when it comes to losing or gaining weight?

Could be. The data, while not conclusive, are persuasive. In general, where and when people walk more, obesity rates decline. And vice versa. One study showed that people who rode a bus to work were far less likely to be overweight than those who drove; apparently the short walks to and from both ends of the bus ride mattered.

A study published in 2006 in "Pediatrics," the journal of the American Academy of Pediatrics, found that, for children, "reduced access to facilities…was associated with decreased (physical activity) and increased over- weight." (That study was about physical activity facilities in general, not just sidewalks; but the conclusion would seem to apply to sidewalks).

According to the Alliance for Biking and Walking, based on official statistics from the Centers for Disease Control and Prevention and state health departments, "between 1966 and 2009, the number of children who walked or bicycled to school fell 75 percent while the percentage of obese children rose 276 percent."

As the saying goes, correlation is not causation, and the kids of 2009 were also eating more fast food than their counterparts in 1966, and probably spending more time in front of a screen and less on the playground. But all that walking and biking back then – and sitting in school buses now – must have had an impact.

Officials obviously think so, which is why both state and federal governments are trying to convince more children to walk to school. Part of that effort requires convincing more towns to build or improve sidewalks, so the kids can get there and back safely, and providing some money for them to accomplish the task, mostly through the Safe Routes to School program financed by the U.S. Department of Transportation.

Patti Coburn, the program's Vermont coordinator, said the state gets $1 million a year, most of which goes for building sidewalks. That's a lot of money, but, she acknowledged, not nearly enough to build all the sidewalks that could convince more parents to let their children walk to school.

Still, as the recent example of Charlotte shows, there is substantial opposition to building sidewalks in Vermont. To begin with, they cost money, both to build and to maintain, and while it isn't a huge amount of money (the Charlotte project would have cost $70,000 at most, Donovan said) without federal or state aid, "the burden falls mainly on local municipalities, so mostly on the property tax," said Local Motion's Chapin Spencer.

"I would argue," said Nancy Schulz, "that the tax money going to fund health care is going to go through the roof because obesity leads to so many chronic diseases." Weighing the cost of sidewalks against the alternative of higher health care costs makes the sidewalks a money-saver, she said.



That could be, though quantifying it would be a daunting task. Either way, a project financed by the local property tax is immediate and easily perceptible to the taxpayer. Health care is financed over time, and mostly by the Federal Government, where it is obscured by a host of expenditures ranging from defense to National Park rangers.

Besides, money is not the only reason some Vermonters don't want sidewalks. Some are also concerned that installing sidewalks would alter the character of a rural town or village.

"It was a lot more than just the money," said Tom Nola, the Charlotte retiree who led the forces voting down the sidewalk proposal there. "Charlotte is a rural town and it does not make any sense to have sidewalks."

Sidewalk advocates acknowledge that even where there are sidewalks, some people, including those who live only a few blocks from their work or a store, would rather drive. It just seems to be their default position.

But Schulz insisted, "if we provide places to walk, people will walk."

To a considerable extent, rural Vermont's lack of sidewalks is the consequence of decisions made decades ago, and not easily reversible. With the development of regional school districts, fewer schools were built in the settled village centers, more out on the highway. No one is proposing miles of sidewalks along rural roads.

The sidewalk question, then, is about more than just sidewalks. It's about how communities are envisioned and designed. For decades, Vermont and most of the rest of the country envisioned and designed communities around the automobile. But as Chapin Spencer said, "our vision for our community's shifts over time." He and others hope the shift includes recognition that maybe it would be a good idea, once one has driven to town, to walk from the library to the post office to the market, an idea that would seem even better were there a sidewalk.

Friday, April 20, 2012

Vermont's Trout Rivers After Tropical Storm Irene

Vermonters, Deb Markowitz noted, are notably self-reliant, which is good. As might be expected of self-reliant people, they are well equipped. They have tools. They have energy. They have know-how. Some of them even have heavy earth-moving equipment. In and of itself, that’s also good, noted Markowitz, the Secretary of the Agency of Natural Resources.

In the days after Tropical Storm Irene flooded so much of Southern and Central Vermont last summer, some of those self-reliant, well-quipped Vermonters “thinking they were helping,” she said, took their bulldozers and bucket-haulers into the rivers to scoop out gravel, straighten out banks, and otherwise “improve” Vermont’s rivers.


Not so good.

In this case, the know-how of these self-reliant Vermonters had to do with running the machinery, not with the science of riparian zones, nor with what fish need to thrive. As a result, scientists say, the fish populations – already degraded by the flooding – are likely to stay degraded far longer.

As will the satisfaction of the thousands of Vermonters and visitors who try to catch those fish. A dredged-out stretch of stream is an aquatic wasteland where fish can neither feed nor hide. Those well-meaning, self-reliant Vermonters may have played havoc with one of the state’s most celebrated past-times, not to mention one of its more important tourist attractions.

“In some places, people over-did it,” Markowitz acknowledged.

Perhaps even in lots of places, at least if 406,000 feet, or 77 miles of stream is considered lots of places. That’s how much ended up “with major degradation of aquatic habitat resulting from post-flood stream channel alteration activities,” according to a report by biologists at the Fish & Wildlife Department, part of Markowitz’s Agency.

That’s a small percentage of Vermont’s total river length of roughly 7,000 miles, Markowitz said. But it’s almost 10 percent of the 800 miles of river affected by Irene and its floods. And that official estimate may be low. After examining the list of degraded river in the F&W report, Kim Greenwood, the water program director at the Vermont Natural Resources Council, said it missed a few spots she knows of that were badly torn up by earth-moving equipment.

The controversy over the “managing” – and over-managing – of Vermont’s streams last year has smoldered rather than flared, partly because the administration of Gov. Peter Shumlin was at first divided over the question in a peculiar and – potentially at least – politically embarrassing manner, one its officials would just as soon not discuss.

The peculiarity is that while the scientists at Fish & Wildlife were dismayed when they saw or heard about free-lance gravel-removal and bank-straightening, one prominent state official was not.

“We’ve got to get in here and get this work done,” said none other than Peter Shumlin at the time. “Irene left a mess behind and it’s got to be cleaned up.”


Irene did leave behind a mess that had to be cleaned up. In emergencies, such as clearing a road for medical vehicles, rescuing people whose homes were cut off from services, or clearing debris that might endanger a bridge or overpass in case of another heavy rain, a certain amount of digging in the rivers was no doubt necessary.


But Kim Greenwood, a scientist with a degree in aquatic resources, said some dredging was still going on more than a month later, after the roads had been open and the stranded people had been rescued.


“It went far beyond what was necessary,” she said, adding that at first the state sent a mixed message.

“The Governor was definitely not helpful,” she said. “He sent the message, ‘go ahead and dig.’”

After complaints from within the Agency of Natural Resources and from leaders of Trout Unlimited and other fishing groups, Markowitz stepped in, ending the emergency period in which towns or individuals needed only spoken permission from ANR staff to send heavy equipment into rivers.

Now the Governor does not mention dredging, but no one is denying that there was too much of it and that it was not good for the rivers or the fish. The regular trout angling season began last weekend. Markowitz said she both saw and heard about anglers catching some nice trout. Nature, she said, is “very resilient,” and Vermont can boast of some good fishing spots.

But not as many as before the front-end loaders and the trucks went into the streams.

“Where aquatic habitat has been severely altered through…channel widening and straightening, complex habitat features will need to re-establish before improvements in fish and aquatic populations can be expected,” said the F&W report.” While relatively short reaches of impacted streams may recover in a matter of years, the recovery of longer reaches may take decades…”

State officials, though, might be less conflicted and less likely to be in denial abut what happened last September than many a dweller of the river valley areas where most of the dredging took place. Or at least so it seemed to two anglers trying to find stretches of river that had been dredged and other spots where they might catch a fish.

According to the F&W report, no watershed was more heavily “managed” than the White River’s, and no branch had more work done it than the Third Branch, which basically parallels Route 12 north of Bethel. More than 55,000 feet of the Third Branch were damaged by “post-flood channel alterations,” the report said.

But the reaction from the locals was, in effect, “dredging? What dredging? Nobody saw any dredging around here.”

Finally one person, who will not be identified to avoid causing him/her any trouble, said the river had been heavily altered, and specifically referred the anglers to the spot where Camp Brook enters the Third Branch, which had been made wider and deeper by dredging.

“If you want some other spots,” came the advice, “ask the town manager, Delbert Cloud.”

“Dredging? There was no dredging,” said Delbert Cloud. “If there’s any problem with dredging, ask ANR.”

Told there was not necessarily a problem at all, Cloud said, “there was dredging all up and down these rivers. The governor said to.”

Perhaps some of the same people who so enthusiastically brought the earth-moving equipment into the rivers last fall now see the errors of their ways.

The river where Camp Brook entered it was indeed wide and deep, and seemingly dead. Catching a fish can never be guaranteed, but this was a stretch of river in which an experienced angler wouldn’t even bother to cast. It was straight, deep, devoid of any obstruction or variety.

Fish & Wildlife Commissioner Patrick Berry said the Vermont division between those who would “manage” rivers and those who would leave them alone does not reflect the familiar (clich├ęd?) “woodchuck-versus-flatlander” split which characterizes some environmental battles. In this case, he said, the traditionalists in the rod and gun clubs agreed with the scientists.

“There was an outcry from the angling community” over the dredging Berry said.

But some Vermonters – no doubt like some people everywhere – appear convinced that rivers should look neat and orderly, should flow evenly over an even bed, should be straight and unobstructed, bordered by banks uncluttered by dead trees or big boulders.

The scientists say the opposite condition is closer to the truth, that a healthy river with a healthy fishery curves this way and that, is shallow here and deeper there, is obstructed by fallen tree trunks and boulders, and flows over a bed rich in vegetation, sustaining the aquatic insects which in turn are eaten by fish.

Deepening a section of river with a bulldozer, they say, might reduce flooding right along that section. But it will also increase the river’s velocity, making flood conditions worse downstream.

Above all, the scientists say, a river’s flood plain should remain as intact and as natural as possible. Starting with its state capital, much of which covers Winooski River flood plain, Vermont has developed along its riversides, covering up thousands of acres of flood plain.



“Downtowns are not going to move,” said Kim Greenwood. Settling along rivers is “part of our legacy.” People live near rivers because they love them, she said, but development along riverbanks increases the need to keep as much flood plain elsewhere in its natural condition. Flooding is natural, and a river will recover from it. Recovery after a scouring by earth-moving equipment takes longer.

There are indications that many Vermonters – officials and ordinary citizens alike – have learned a lesson from last September’s activities, and that in the next big flood (and few doubt that there will be one), river bulldozing will be limited to real emergency conditions. There have been no expressions of regret from Shumlin. But Markowitz acknowledged that before Irene hit, the state “didn’t have a system in place” to deal with controlling what could and could not be done after the water receded.

Next time, she said, it will.

Friday, February 24, 2012

Vermont Firefighters

Being a firefighter, Tim Girard was saying, isn't easy.

"There's a background check, and you have to do training," said Girard, a officer of the Swanton Village Fire Department and the President of the Vermont State Firefighters Association.

And nobody, he said, does it for the money. Even though the Swanton firefighters were among the few in the state who get a small hourly wage, "you're not going to do it to get rich," Girard said. Some are attracted by "seeing the trucks go out, the firefighting gear, the red lights and sirens." For others, there's the "satisfaction of helping the community," whether by putting out a fire or helping a homeowner with water in her cellar, and….

BEEP!

So much for that. Even sitting there in his blue dress uniform, Girard was not in the Swanton Firehouse primarily to get interviewed. Firefighters fight fires, and that alarm was alerting Girard and the two other department members in the building that they had work to do.

In about a minute, all three of them had on their firefighting garb – waterproof overpants and long coats, heavy boots, brimmed helmets. In one more minute, up drove a pickup truck, yellow light flashing, of another member of the Department. Then another. And another. Maybe five minutes after the alarm sounded, the fire truck pulled out of the garage, headed for the fire.

Not, this time, in Swanton. Or even in the United States. The Swanton Department, Girard said, is part of the Franklin County International Firefighters Association, a Mutual Aid system that includes the Canadian towns just across the border, the site of this fire.

"We were lucky in the timing," Girard said later. The call came late in the afternoon, when enough members were home from work so a big enough crew could assemble quickly.

That's usually not a big problem for Swanton, whose fire department has 30 members on its roster, sufficient even though Girard said, "we're always looking for more."

Not every volunteer department in Vermont – or elsewhere for that matter – is in such good shape. There is a firefighter shortage in Vermont that is only likely to get worse over the next several years.

At last count, Vermont had 5,746 firefighters, the vast majority of them volunteers, according to the Department of Public Safety's Division of Fire Safety.

That's not enough. There are 249 departments, and to be fully effective, fire experts say, even a small department should have 25 members. Do the math. There should be at least 6,225 firefighters. That's "only" a shortage of 479. But that still puts the state's overall deficiency at close to eight percent, and the shortages are not evenly balanced, being worse, Girard said, in "the very small towns."

Firefighting officials are not in denial about the problem. "A lot of departments do not have enough people," said Michael O'Neill, the Executive Director of the Division of Fire Safety.

Thanks to Mutual Aid systems, this does not mean that homes and businesses in small towns are in danger of being reduced to ashes before the fire trucks arrive. Fire protection is one of the basic necessities of civilized society – public fire departments go back at least to 19th Century Britain – and is likely to be provided one way or another.

But one way might be more professional – and therefore more expensive – fire departments.



There's nothing mysterious about why Vermont's volunteer fire departments are short of volunteers. Both O'Neil and Girard point to the same social changes that have made it more difficult to recruit men (and, these days, some women) to join fire departments.

A few decades ago, Vermonters were more likely to own their own farms or to work in one of the many factories or shops right in town. If the siren sounded, they were only a few minutes away from the firehouse.

Now, many of those farms, factories, and shops are gone. People are working farther from home, many of them driving a half hour or more to work. When the siren goes off, they are too far away to respond in time.

Furthermore, in the rural areas, there simply are not as many people in what might be called their firefighting years. Vermont's population is rising – if slowly – but largely because of in-migration – the state has one of the lowest birth rates in the country – and many of the newcomers are retirees. Younger newcomers tend to flock to Burlington, which has a fully professional fire department, or its environs, where the firefighter shortage is not as acute.

Though firefighting officials hope that recruitment will pick ups as the economy improves, all indications are that the social trends holding down the number of volunteers – an aging population, job sites increasingly scattered -- will not just continue but accelerate. Finding enough firefighters could get more difficult in the future.

This does not mean fire officials can't do anything about the problem. They can, and they are doing it. For one thing, they are recruiting more actively. "Aggressive promotion," is what O'Neil calls it, and it includes holding open houses at fires stations and visiting high schools. But there's no simple "magic bullet" solution to the shortage, O'Neil acknowledged. "If there were, somebody would have found it," he said.

Firefighting has changed a lot since the days, as Girard put it, when "you just rode in the truck and put the wet stuff on the red stuff." Technology has made the job both a lot safer and a lot more complicated.



But it has not, O'Neil said, really reduced the need for people to do the work.

"The reality is that most of the advances have improved safety," he said, "but they have not necessarily improved efficiency."

One obvious answer to the manpower problem is more centralization. It's a subject Vermont fire officials discuss delicately. As with the question of Vermont's many school districts, O'Neil said, "no one wants to give up local control."

Girard noted that many rural rescue services have started hiring full-time dispatchers, a step some volunteer fire departments might have to consider as the number of people who have the time and inclination to sit in the fire station all day dwindles, perhaps to zero in some small towns.

At some point, as costs rise, several nearby small towns could decide to share that full-time, paid, dispatcher, which could be a step toward consolidating fire departments, and perhaps toward hiring a few more full-timers. Possibly, O'Neil said, a county-based firefighting system of fewer, larger, and perhaps more professional departments, looms in Vermont's future. At this point, no one seems to know much more that might cost.

Despite the shortages, O'Neil said, "Vermont is a pretty safe place," much safer, in terms of fire protection, than it used to be. Not that long ago, he said, "we had the highest fire death rate in the country." Now Vermont has one of the lowest, thanks to education and regulation. Firefighters held fire-prevention lessons at public schools. Laws passed under Gov. Howard Dean require all homes sold or re-rented to have hard-wired smoke detectors. As a result, there are fewer fires – prevention, after all, is the most effective fire fighting – and when there is a fire in a house, its residents are more likely to have time to escape.

Still, that house is more likely to burn to the ground unless an adequately staffed fire truck can get to it fast enough. Finding enough volunteers willing to face the hardships, inconvenience, and in some cases danger to ride on those fire trucks remains a challenge.

Thursday, December 15, 2011

Vermont's Renewable Energy Goal



Can it really be done?

Can Vermont - can Vermonters - get 90 percent of its - of their - energy from the wind, the sun, the rain (and maybe some wood chips) by 2050?

That's only 38 years away, meaning Vermont would have relatively little time to figure out how to replace a lot of oil, natural gas, and uranium and even some coal as the source of its lights, its warm houses, and its getting from here to there.

But that's what the state's ambitious "Comprehensive Energy Plan" calls for.

[Download the Vermont Comprehensive Energy Plan]

"We intend to set Vermont on a path to attain 90% of its energy from renewable sources by mid-century," says the plan, officially a draft but slated to be put into final form within days.

In its own words, the Plan is "comprehensive…requiring action in all sectors regarding all energy sources."

A big job, but, according to the plan, not really optional.

"It is imperative," says the plan, "that we take more control over our energy future."

"Imperative," to be sure, does not necessarily mean "feasible," and the state could "take control" and still fail to meet that 90 percent by mid-century goal. Already, there are critics who argue that the goal is not only unattainable, but not even desirable. They also ask just how much it will cost.

They have a point. The Plan doesn't say how much it will cost. But then, the critics don't say how much it will cost not to move toward less reliance on coal, oil, and gas. Over the next 38 years, burning all that stuff is likely to get a lot more expensive, not to mention dirty. The "challenge of climate change" and the obligation to reduce greenhouse gas emissions lie behind the Plan's call for switching to non-polluting renewable sources.

A price tag is not the only thing the Plan lacks. Anyone looking for a specific, mathematically precise outline explaining just how the state can reach its 90 percent goal will be disappointed. This is a plan as strategy not as detailed diagram, a general roadmap rather than a precise blueprint.

"The point of a plan is to move in the right direction, to set a goal that appears to be both ambitious and achievable, and to make sure you continue to move in that direction" said Elizabeth Miller, the Commissioner of the Public Service Department, the Plan's creator.

Not that the Plan is nothing more than a warm and fuzzy wish list. Its pages - 19 in the Volume I summary, 368 in the more detailed Volume II - are chock full of graphs, tables, and statistical analysis. The authors used models to try to calculate likely energy use, living patterns, and costs over the next few decades.

But models are created by using assumptions about the future, all plausible but none certain, and many beyond Vermont's control. The section about using less energy for transportation, for instance makes clear that success would depend on federal policy and on how much progress the auto industry makes on developing electric (or part-electric) autos. "We must make significant changes in the types of fuels our vehicles use and in the infrastructure that we rely upon to move around," the Plan says.

On its own, Vermont can't do that.

"That's why we model," Miller said.  "All models are wrong, but some are useful. The point of modeling is to set policy. A model is not a crystal ball."

It can't be, she said, because there will be so many changes in technology, the economy, and human behavior over the next few decades that any effort at precise prediction would be foolish. That, she said, is why the Plan's authors rejected suggestions to set interim "sub-goals," for instance, "to say by 2023 we have to be producing 17 percent of our electricity with biomass, three percent and with wood chips." Conditions will change over time. Does that mean there shouldn't be a goal? No. We need to move in the right direction."

Furthermore, even when the Plan is declared final, it won't really be…final. It's a work in progress. As new technologies are developed, as national policy changes, as new economic models are accepted, the Plan will continue to be re-adjusted.

Some of the criticism is very specific. Fuel oil dealers, who obviously want more homeowners to heat their homes with the product they sell rather than being served by a natural gas pipelines, are unhappy that the Plan suggests expanding a natural gas pipeline. Some business groups fear that the focus on renewables and climate change will mean less emphasis on controlling costs, leading to higher utility bills. They are especially unhappy that the Plan assumes the impending closing of the Vermont Yankee nuclear power plant, which now produces about a third of Vermont's electricity for a low price and without polluting the air.

"Rate-payers would be forced to buy an expensive source of power…(based on) an artificial construct," said Guy Page, the communications director of the Vermont Energy Partnership. Referring to the state's insistence that electric utilities buy a certain amount of power from wind projects, even though that electricity is more expensive, Page said, "That's an un-level playing field. Wouldn't it be better to build in renewables on a level playing field?"

In energy, though, there has never been a level playing field. All fuels and systems have been subsidized for more than a century. Nuclear power, which Page and his allies support, is perhaps the most government-subsidized industry in the history of the world. Its original research and development was the Manhattan Project; it still relies on government loan guarantees and a legal cap on its liabilities.

Another specific complaint against the Plan comes from some environmentalists unhappy that the draft version would have ended an eight-year ban on large-scale wind energy projects on state-owned land.

"This land was protected for a reason," said Will Wiquist, the executive director of the Green Mountain Club.  Much of it, he said, is among the state's "most fragile high-elevation lands," and should not be developed.

After Agency of Natural Resources Deb Markowitz said she thought the current policy "works and is consistent with the goals of the energy policy," the plan was "modified," Miller said (by email), to provide that," all renewables continue to be allowed consideration on state land where appropriate."

That would seem to tolerate smaller wind installations, such as the single tower that just went up on state-owned land at Burke Mountain, but not "industrial" wind projects such as the controversial development being built on Lowell Mountain.

The broader criticism of the plan was articulated by University of Vermont economist Art Woolf, who said, "There is no estimate out there of what this thing's going to cost." The Plan, Woolf said, is "looking at the positives and totally ignoring anything that might cause a problem. It only looks at the benefits, not the costs."

For instance, Woolf said, meeting the Plan's goals for using less gasoline would require many more Vermonters to drive cars powered by electricity. Right now, at least, those cars are far more expensive than gasoline-powered autos.

"If I bought $40,000 Chevy Volt (I'd have) $20,000 less to spend than if I bought a standard Chevy," Woolf said. Thousands of Vermonters reducing their disposable income by $20,000 each, he noted, would be a substantial drag on the state's economy.

The Plan hardly avoids the matter of cost, which is mentioned hundreds of times, almost always with the goal of holding it down. But as Miller acknowledged, there is no total net cost estimate of how much money - or whose - it would take to get from here to there.

But it would be close to impossible to provide a detailed cost estimate for the same reason that the Plan does not provide that specific, precise blueprint for achieving its goal: too many variables. For instance, Miller said, "there are…unknown…market forces that will allow vehicle penetration and pricing to change…Those are acknowledged in the plan and rough estimates are provided to allow Vermonters to understand the challenges and benefits."

It may be significant that both Woolf and Miller used automobile transportation examples. Thanks to controversies over Vermont Yankee and the Lowell Mountain wind project, electricity has dominated Vermont's energy debates. But Vermonters us far more energy driving their cars than lighting their homes or running their clothes dryers.

"Transportation accounts for the highest share of overall energy use," reports the Plan, and adds more to greenhouse gas totals than anything else Vermonters do. In Vermont, transportation essentially means individuals driving their cares, usually all alone, and the Plan suggests that the state consider not only cleaner-burning, more fuel-efficient cars, but some more profound (if gradual and cost-effective) alterations in how Vermonters live: more public transportation, more carpooling, walking or biking to work or shop where practical, and - perhaps to make it practical - more people living in "compact centers."

As the Plan says, "the simplest way to reduce emissions from motor vehicles is to use them less."

To some extent, the difference of opinion here is one of attitude as much as analysis. The writers of the Plan appear optimistic that energy technologies will improve fast enough to help them meet their goal. Others are less certain.

"I'm skeptical that anybody knows what energy technologies will be available," Woolf said.

Or course, nobody knows. Up in Canada, Joshua Pearce, adjunct professor of York University's Department of Mechanical and Materials Engineering, said  solar photovoltaic systems are near the "tipping point" where they can produce energy for about the same price other traditional sources of energy.

But professors have made such projections before, and solar energy remains more expensive than power produced from coal or gas.

Considering Vermont's demographics, at least half the people of the state probably won't be around in 2050 to find out whether Vermont can really succeed in reaching that 90 percent goal.

But there's also the matter of how to define success. If by then Vermont gets 85, or even 75 percent of its energy needs from renewables, will the Plan have been a failure?

Wednesday, October 19, 2011

Vermont's Doctor Shortage

It is 2025, and somewhere in rural Vermont a child gets hurt.

Big deal. Kids get hurt every day. This kid's mother drives him to the hospital emergency room or perhaps to the office of the family's own health care providers.

Either way, they walk in and are…given a number and told to sit down. It will take awhile. There aren't enough doctors.

Good thing this kid isn't so badly hurt that he needs emergency surgery. In that case, they'd have to rush him to Fletcher-Allen in Burlington or Dartmouth Hitchcock over in New Hampshire. The nearby hospital hasn't had an emergency surgeon on the staff for decades. To put it bluntly, by 2025, Vermont will not have enough doctors.

Actually, according to most experts, Vermont already doesn't have enough doctors. Or at least it doesn't have enough primary care physicians in most of the state.

"We're probably short 25 FTEs (full-time-equivalent) when it comes to family practitioners," said Dr. Charles MacLean, a primary care physician who is also Associate Dean for Primary Care at the University of Vermont's College of Medicine, where he heads Vermont's AHEC (Area Health Education Centers). AHEC was created by Congress 40 years ago to try to increase health services in poor and rural areas.



Twenty-five is not a big number, but according to the State Health Department there are only 492 primary care physicians to begin with, so Vermont is already about five percent short of the family practitioners it needs.

"The number of primary care physicians falls short of the number needed to care for all Vermont residents," said a report released in August by the Association of American Medical Colleges. The report found shortages "in all counties," but Dr. Harry Chen, Vermont's Health Commissioner, said, "there is a maldistribution of physicians," with doctors "more available" in Chittenden County and a few other pockets of the state.

Elsewhere, then, the shortage would be greater than 5 percent.

That shortage is likely to grow, and not only for primary care physicians. The doctors said they also expected shortages in general surgery and mental health care, where the state needs more doctors but also more physicians assistants, nurses, and other therapists.

Vermonters are getting older, and older people need more medical services. Furthermore, Vermont doctors are getting older, meaning many of them will be retiring. Furthermore, if the new national health care law is not repealed, more Vermonters will be able to afford health care. And if the projected state health care plans take effect, even more people - especially lower-income Vermonters who tend to have more health problems - will have access to the system.

If the system can accommodate them.

"If we cover everybody," said Dr. MacLean, "the shortfall would probably double." The potential shortage of primary care physicians, he said, could be "severe."

In Vermont, at least, the medical establishment does not disagree.

"We have a shortage of physicians especially in primary care, and also general surgeons and orthopedic surgeons and it's only going to get worse," said Paul Harrington,  the Executive Vice President of the Vermont Medical Society. Harrington listed the same three reasons - older doctors, older patients, more patients with health insurance - to explain why the doctor shortage would get worse.

So what, exactly, is Vermont doing wrong?

Probably nothing. The doctor shortage is a nationwide problem, worse in many other states than in Vermont. According to the Organization for Economic Cooperation and Development, the United States has 243 physicians per 100,000 people, substantially lower than the 298 average for all OECD countries. One of the few countries with fewer doctors per person is neighboring Canada, which has only 218 physicians per 100,000 people. France, whose health care system is considered the world's best by many international health care experts, has 337 doctors for every 100,000 people.

States in the U.S. don't compile statistics allowing a precise comparison with the OECD's. For Vermont's 630,000 or so people, Harrington said, about 1,880 physicians practice in the state.

Both Dr. MacLean and Dr. Chen said that the physician shortage was less severe in the New England and Northeastern states than in most of the rest of the country, especially the Southeast.

That would seem consistent with the answer given by the two doctors to the question of why the doctor shortage is worse in rural areas than in and around cities. To some extent, they acknowledged, money might be a factor; perhaps doctors earn more in metropolitan areas. But mostly, Dr. MacLean said, in and near cities is simply "where people want to live."

Or at least where doctors want to live. Being educated, physicians tend to have high- (or at least middle-) brow taste. They want to live and raise their families where there are good schools, gourmet restaurants, theaters (and not just for movies), concerts, and like-minded neighbors, all more common in larger cities or university towns. In Vermont, Burlington is both. Many out-of-staters come to Vermont to attend UVM's highly-rated College of Medicine, fall in love with the state and the city, and never leave. Enticing a young doctor to open a practice in Burlington is easy; convincing one to move to the Northeast Kingdom or the White River Valley is not.

So the state and the doctors are trying harder. Dr. Chen described a process a bit like a college coach who is tipped off about a hot basketball prospect in eighth grade and keeps tabs on him through high school.

"We take a multi-faceted approach," Dr. Chen said. "For instance, if someone who's interested in being a doctor grows up in the Northeast Kingdom, we'll follow them (through college and medical school) and focus incentives" designed to make it more appealing for the young doctor to open a practice or join a hospital near his or her home town.



Those incentives include partial loan repayments, which the state has been making for some young doctors with the help of money from both the federal government and private foundations.

Student debt is no small consideration for young doctors, many of whom emerge from their 10 or more years of training (college, medical school, residency) owing $150,000 or more, and almost 30 years old before starting their careers. It's one reason many young physicians choose a specialty such as cardiology or ophthalmology, where they can earn twice what a family practice primary care doctor earns.

There is some dispute about the root cause of the nationwide doctor shortage. Some critics argue that over the years the American Medical Association has deliberately held down the number of medical school openings to control the supply - and therefore prop up the price - of providing health care.

The AMA was formed in 1847, partly because some of the then 400 medical schools were diploma mills churning out unqualified graduates. Today's 133 medical schools graduated 16,838 students in 2010, a small increase over the 15,676 who graduated in 2002. Thousands of applicants, many of them presumably capable, are turned away every year for lack of space.

Whatever the reason, US doctors do earn substantially more than their counterparts elsewhere. According to a chart posted by economist Greg Mankiw, physicians in the U.S. earned an average of just under $200,000 in 1996, roughly twice the average income of a Canadian doctor and almost four times the average in France.

Another reason for the doctor shortage is that even if there were more medical school graduates, there aren't enough intern slots to handle them. One reason for this is federal budget cuts. Most of those intern positions are funded through Medicare, and in the 1990s Congress started cutting back on those expenses.

One way or another, Vermont's ability to attract new doctors will depend on how the new Green Mountain Care Board chooses to revamp the state's health care system under the sweeping law the Legislature passed earlier this year. At the Medical Society, Paul Harrington worries that if the Board does not heed the recommendations of "the physicians actually providing care, it will create a system with too much uncertainty to attract new doctors."

Dr. Chen, though, thinks that "medical students overwhelmingly support" Vermont's effort to change a "clearly dysfunctional" health care system, and that the kind of system envisioned by the new law can attract young physicians from around the country.

Thursday, August 25, 2011

Wilderness in Vermont

Vermont, as almost everyone knows, is a nature lover's delight. Green both in its politics and on the ground, the state is chock full of farm land, forest land, wild land, lakefront land, riverside.

WHOOPS! Let's back that one up a little.

Farms, forests, lakes, all true enough. And lots of green space.

But wild land? Not so much.

Thursday, June 16, 2011

Subsidizing Transportation

Hop into your car. Get behind the wheel, start 'er up, and pull away.

You're in control. You're the classic (cliched?) free American, out there on the open road, going where you please, alone with your thoughts or whatever radio program/CD/podcast/app you chose. Yeah, you have to obey the speed limit (sort of) and stop at red lights and stop signs. For the most part, though, you're independent, sovereign, autonomous. Right?

Wrong. Actually, what you are is: government-subsidized.