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.

Friday, April 15, 2011

What's New in Vermont Agriculture?

Everybody knows what's new in Vermont agriculture. It's the small farm, the niche market, the "artisanal" cheese-maker, the "farm-to-plate" producer growing food sold to the increasing corps of "localvores," a word that did not exist a decade ago and is now part of the everyday lexicon.

As is often the case, what "everybody knows" isn't exactly true.

Oh, it isn't exactly false, either. That "very upstart agriculture," as one local farming expert put it, is thriving and growing in Vermont even more than in most other states.

Wednesday, March 30, 2011

Poverty in Vermont

For all her troubles, Alice is cheerful.

She's sitting at a desk at the Northeast Kingdom Community Action (NEKCA) Parent-Child Center in St. Johnsbury, helping out with some clerical chores.

"I like this," she said. "I'd like to do secretarial work. I think that'll work out."
By her own admission, not all of Alice's employment experiences have "worked out." She tried a fast-food job, she said, and stitching in a shoe factory.