Top Business Leaders Deliver Clean Energy Plan

Keywords: clean energy, business leaders, climate change, american energy innovation council

What do Americans spend more money on – potato chips, or energy research and development? See video below for the answer.

Seven business leaders, founders of American Energy Innovation Council, delivered a Business Plan For America’s Energy Future. The leaders are:

  • Norm Augustine, former chairman and CEO of Lockheed Martin
  • Ursula Burns, CEO of Xerox
  • John Doerr, partner at Kleiner Perkins Caufield & Byers
  • Bill Gates, chairman and former CEO of Microsoft
  • Chad Holliday, chairman of Bank of America and former chairman and CEO of DuPont
  • Jeff Immelt, chairman and CEO of GE
  • Tim Solso, chairman and CEO of Cummins Inc.

The US is the largest consumer of energy in the world. The American Energy Innovation Council makes the case that there is a pressing need for energy innovation, and we need to invest in that innovation.
Energy R&D Spending as a Share of Sales

Though energy is a key strategic component of any countries wellbeing, US energy R&D spending has been in decline.

Energy R&D Spending

Though the US is the worlds largest energy consumer, it spends less on energy R&D than China, France, Japan and Korea.

Energy as a Share of GDP
The council’s recommendations:

  • Create an independent national energy strategy board
  • Invest $16 billion per year in clean energy innovation
  • Create Centers of Excellence with strong domain expertise
  • Fund ARPA-E at $1 billion per year
  • Establish and fund a New Energy Challenge Program to build large-scale pilot projects

The full report can be viewed here, and for more on Bill Gates call for Zero Carbon emissions, see Bill Gates on Climate Change and Renewable Energy.

Farming Wind Versus Farming Corn for Energy

keywords: wind power, wind turbines, corn ethanol, ERoEI

corn field with wind turbines
Farmers can plant crops right to the base of wind turbines (photo: Warren Gretzl, NREL)

If a farmer has 1,000 acres of land, and he/she planted it with corn for making ethanol and erected wind turbines for generating electricity, how much energy will the farmer produce and what are the economics?

Wind Power

A typical wind farm will have about 15 wind turbines per 1,00o acres. Each wind turbine will generate about 500 kW of power (assuming 33% capacity factor). Electricity retails at about 12¢ per kW hour. So 1,000 acres will produce 15 x 500 x .12 = $900 of electricity per hour, which equates to about $8,000,000 per year, representing about 224 trillion BTUs of energy.

Corn Ethanol Power

A typical 1,000 acre corn farm will produce about 7,500 pounds of corn, yielding about 340,000 gallons of ethanol. Ethanol retails at about $1.80 per gallon. So 1,000 acres will produce 340,000 x 1.8 = $612,000 per year, representing about 26 billion BTUs of energy.

Energy Returned on Energy Invested

It takes energy to produce energy. The Energy Returned on Energy Invested (ERoEI) for wind turbines is an impressive, state of the art wind turbines are providing ERoEI of over 50:1.

It takes a lot of energy to produce corn ethanol, which yields a far lower ERoEI of between .8 and 1.65 (see Ethanol’s Energy Return on Investment: A Survey of the Literature 1990-Present by Roel Hammerschlag).

ERoEI

Side-effects of Wind Power and Corn Ethanol Production

Wind turbines are often perceived as an eyesore, marring the land with imposing manmade structures. Flying creatures such as hawks and bats are often killed as they pass through the turbine blades. Wind turbines are noisy, and are best located in rural areas, or at sea. Wind power needs to be located near power transmission resources, it that infrastructure will need to be built.

Corn ethanol yields just a bit more energy than it takes to produce it. It takes about 1,700 gallons of water to produce each gallon of corn ethanol. Corn used for ethanol production is corn not used for food production. As food corn supply is reduced, corn-based food prices rise.

Summary

Given 1,000 acres of land, planted with corn and a typical density of wind turbines, the table below summarizes the annual economic and energy value of corn ethanol fuel and wind turbine electricity.

Wind Power Corn Ethanol
Retail Value $8,000,000 $612,000
Energy Yield 224 trillion BTUs 26 billion BTUs
ERoEI 50:1 1.5:1

Feebates

Keywords: Feebate, Art Rosenfeld, RMI, reducing automobile CO2 emissions, reducing oil addiction

Feebates offer a compelling approach to curbing automobile fuel consumption and CO2 emissions. The concept was pioneered in the 1970s by Jonathan Koomey and Art Rosenfeld (Lawrence Berkeley National Laboratory) and is finding renewed interest around the world.

Feebates are market-based policies for encouraging emissions reductions from new passenger vehicles by levying fees on relatively high-emitting vehicles, and using those collected fees to provide rebates to lower-emitting vehicles.

California is considering adopting a Feebate program. The UC Davis Institute of Transportation Studies recently published their analysis of a Feebate program – Potential Design, Implementation, and Benefits of a Feebate Program for New Passenger Vehicles in California. The report provides a detailed overview and analysis of Feebates and reviews Feebate programs already underway in other countries.

California Feebate UC Davis
(source: UC Davis Institute of Transportation Studies)

Rocky Mountain Institute has a good review of the Feebate approach to reducing oil consumption.

Highlights of RMI’s report Feebates: A Key to Breaking U.S. Oil Addiction

  • The scale of U.S. oil consumption (nearly 19 million barrels per day) combined with its virtual monopoly of transportation energy (97 percent oil-based), creates strategic weakness, economic insecurity, widespread health hazards, and environmental degradation.
  • Feebate is an innovative policy that greatly speeds the development and deployment of efficient vehicles.
  • The California Legislature actually approved a similar “Drive+” law by an astonishing seven-to-one margin in 1980, but Governor George Deukmejian pocket-vetoed it after a mixed initial reaction from automakers, and it’s been bottled up ever since.

The basic idea of a feebate is simple. Buyers of inefficient vehicles are levied a surcharge (the “fee”), while buyers of efficient vehicles are awarded a rebate (the “bate”). By affecting the purchase cost up front, feebates speed the production and adoption of more efficient vehicles, saving oil, insecurity, cost, and carbon.

Though efficient vehicles’ reduced operating costs make them a good buy over the years, consumers’ implicit real discount rates, up to 60-plus percent per year (and nearly infinite for low-income car-buyers), make miles per gallon a relatively weak economic signal: long-term fuel savings are so heavily discounted that buyers, in effect, count just the first year or two—as minor an economic choice as whether to buy floor mats.

In contrast, feebates capture the life-cycle value of efficiency (or the cost of inefficiency) and reflect it in the sticker price. By increasing the price spread between less and more efficient vehicles, feebates bridge the gap between consumers’ and society’s perceptions of the time value of money. This corrects the biggest single obstacle to making and buying efficient vehicles.

Feebates can shift purchasing patterns in the short run and spur automakers’ innovation in the medium and long run. But to do both, a feebate program, like any well intentioned policy, must be properly designed and implemented. As RMI Principal Nathan Glasgow notes, “With feebates, the devil is really in the details.”

Feebate Forum
In 2007, RMI organized and hosted the first Feebate Forum, pulling together 27 experts from the auto and insurance industries, NGOs, academia, and government to discuss feebate design and implementation schemes. Through open dialogue, the group developed a set of design recommendations, barriers, and next steps for feebates.

The participants agreed on the following design goals:

1. Metrics should be based on fuel efficiency or greenhouse gas emissions, and all types of transportation energy can be included—not just diverse fuels but also electricity.

2. The size of the fee or rebate shouldn’t depend on vehicle size. The feebate should reward buyers for choosing a more efficient model of the size they want, not for shifting size. A size-class-based feebate preserves the competitive position of each automaker regardless of its offerings, debunks the myth that consumers must choose between size and efficiency, and doesn’t restrict freedom of choice. Buyers can get the size they want; the efficiency of their choice within that size class determines whether they pay a fee or get a rebate, and how much.

3. Feebates should be implemented at the manufacturer level, so automakers, rather than a government agency, should pay the fees and collect the rebates. This lets manufacturers monitor results and adjust their vehicle mix accordingly, and it avoids any need for taxpayers to foot the bill for any costs. However, a good feebate program should be revenue-neutral, with “fees” paying for “bates” plus administrative costs—a potentially attractive feature. And since the “fees” are entirely avoidable by choice, they’re not a tax.

4. The “pivot point” between fees and rebates should be adjusted annually, so the program is trued up to stay revenue-neutral, and automakers have a predictable and continuous incentive to improve the efficiency of their offerings, spurring innovation.

5. Feebates should be designed for complete compatibility with efficiency or carbon-emissions standards, so automakers aren’t whipsawed between incompatible incentives or requirements. In practice, feebates may drive efficiency improvements much larger and faster than standards require, making the standards unimportant except to prevent recidivism.

France introduced the largest feebate program to date

  • Averaging 133 grams of carbon dioxide per kilometer for the 2009 new light-vehicle fleet, France’s vehicles now have the lowest carbon emissions in the European Union.
  • By comparison, the UK’s 2009 new vehicles emitted, and the EU average is, 146. Between 1995 and 2007 (when the French feebate was introduced at year-end), the emissions rate of new vehicles sold in France was falling at an average rate of 2.25 grams of carbon dioxide per kilometer per yearDuring the first two years of the feebate program, the annual emissions decrease more than tripled to 8 grams per kilometer. Overall, the efficient bonus vehicles’ market share nearly doubled, from 30 to 56 percent, while the inefficient malus vehicles’ share fell threefold, from 24 to 8 percent.

The French program was not size-neutral as RMI recommends for the U.S., and the data show it shifted new-car buyers toward smaller vehicles. The market share of the smallest (economy) cars grew from 44 percent in 2007 to 57 percent in 2009, much as we’d expect for such a fleetwide feebate structure: smaller vehicles tend to have higher efficiency and lower carbon emissions, so unless unusually inefficient, they’ll earn a rebate that’s attractive to many buyers. For the U.S., RMI recommends a size-neutral feebate design to shift the entire market toward lighter, more aerodynamic, and advanced-powertrain vehicles, not just smaller ones.

California is currently considering the introduction of a statewide feebate bill

  • A state program would probably do more to shift the in-state vehicle sales mix than to spur innovative design, since even a market as big as California represents only a fraction of the U.S. auto market. Nonetheless, RMI is following this program closely.
  • In 2008, California’s aggressiveness on fuel efficiency spurred higher national CAFE standards, and a number of other states follow California’s lead on Clean Air Act and related policies. States and regions can make fine laboratories for refining policy innovations that later guide uniform national policies.

Recommended Reading: The Coming Famine

Keywords: Julian Cribb, The Coming Famine, food, water, population, climate change

If you are a regular reader of this blog, you know that we track several core issues that we believe will have profound impact on us all – rich and poor, individuals, communities, business, and government. They are population, energy, water, food, climate change and healthcare. In a sense, food interrelates to all the other issues – it takes tremendous energy and water to produce our food, climate change will reduce food production, and food choices affect our health.

An excellent new book has just been published that clearly and concisely lays out the global food challenges unfolding around us and details what to do about it. The book is The Coming Famine: The Global Food Crisis and What We Can Do to Avoid It by Julian Cribb. The NY Times has an excellent excerpt and leads with this compelling quote:

Lo que separa la civilización de la anarquía son solo siete comidas.
(Civilization and anarchy are only seven meals apart.)

—Spanish proverb

Food, water, shelter and security are the fundamental building blocks of  a persons survival. When those basics are removed, even for a few days, a civilized population can move toward anarchy in a heartbeat.

Maslow's Hierarchy of Needs - from thrive to survive

Rather than highlight the NY Times excerpt, I think it is worth looking at the solid concise description Cribb provides, of the main drivers challenging the supply and demand sides of food production. If you read nothing else in this book, read this and remember it as you  try to make sense of the news stories realted to food that will become more common as the crisis deepens.

Excerpt of The Coming Famine by Julian Cribb

To see where the answers may lie, we need to explore each of the main drivers. On the demand side the chief drivers are:

Population. Although the rate of growth in human numbers is slowing, the present upward trend of 1.5 percent (one hundred million more people) per year points to a population of around 9.2 billion in 2050 — 3 billion more than in 2000. Most of this expansion will take place in poorer countries and in tropical/subtropical regions. In countries where birth rates are falling, governments are bribing their citizens with subsidies to have more babies in an effort to address the age imbalance.

Consumer demand. The first thing people do as they climb out of poverty is to improve their diet. Demand for protein foods such as meat, milk, fish, and eggs from consumers with better incomes, mainly in India and China but also in Southeast Asia and Latin America, is rising rapidly. This in turn requires vastly more grain to feed the animals and fish. Overfed rich societies continue to gain weight. The average citizen of Planet Earth eats one-fifth more calories than he or she did in the 1960s — a “food footprint” growing larger by the day.

Population and demand. This combination of population growth with expansion in consumer demand indicates a global requirement for food by 2050 that will be around 70–100 percent larger than it is today. Population and demand are together rising at about 2 percent a year, whereas food output is now increasing at only about 1 percent a year.

These demand-side factors could probably be satisfied by the world adopting tactics similar to those of the 1960s, when the Green Revolution in farming technology was launched, were it not for the many constraints on the supply side that are now emerging to hinder or prevent such a solution:

Water crisis. Put simply, civilization is running out of freshwater. Farmers presently use about 70 percent of the world’s readily available freshwater to grow food. However, increasingly megacities, with their huge thirst for water for use in homes, industry, and waste disposal, are competing with farmers for this finite resource and, by 2050, these uses could swallow half or more of the world’s available freshwater at a time when many rivers, lakes, and aquifers will be drying up. Unless major new sources or savings are found, farmers will have about half of the world’s currently available freshwater with which to grow twice the food.

Land scarcity. The world is running out of good farmland. A quarter of all land is now so degraded that it is scarcely capable of yielding food. At the same time, cities are sprawling, smothering the world’s most fertile soil in concrete and asphalt, while their occupants fan out in search of cheap land for recreation that diverts the best food-producing areas from agriculture. A third category of land is poisoned by toxic industrial pollution. Much former urban food production has now ceased. The emerging global dearth of good farmland represents another severe limit on increasing food production.

Nutrient losses. Civilization is hemorrhaging nutrients — substances essential to all life. Annual losses in soil erosion alone probably exceed all the nutrients applied as fertilizer worldwide. The world’s finite nutrient supplies may already have peaked. Half the fertilizer being used is wasted. In most societies, up to half the food produced is trashed or lost; so too are most of the nutrients in urban waste streams. The global nutrient cycle, which has sustained humanity throughout our history, has broken down.

Energy dilemma. Advanced farming depends entirely on fossil fuels, which are likely to become very scarce and costly within a generation. At present farmers have few alternative means of producing food other than to grow fuel on their farms — which will reduce food output by 10–20 percent. Many farmers respond to higher costs simply by using less fertilizer or fuel — and so cutting yields. Driven by high energy prices and concerns about climate change, the world is likely to burn around 400 million tonnes (441 million U.S. tons) of grain as biofuels by 2020 — the equivalent of the entire global rice harvest.

Oceans. Marine scientists have warned that ocean fish catches could collapse by the 2040s due to overexploitation of wild stocks. Coral reefs — whose fish help feed about five hundred million people — face decimation under global warming. The world’s oceans are slowly acidifying as carbon dioxide from the burning of fossil fuels dissolves out of the atmosphere, threatening ocean food chains. Fish farms are struggling with pollution and sediment runoff from the land. The inability of the fish sector to meet its share of a doubling in world food demand will throw a heavier burden onto land-based meat industries.

Technology. For three de cades the main engine of the modern food miracle, the international scientific research that boosted crop yields, has been neglected, leading to a decline in productivity gains. Farmers worldwide are heading into a major technology pothole, with less new knowledge available in the medium run to help them to increase output.

Climate. The climate is changing: up to half the planet may face regular drought by the end of the century. “Unnatural disasters” — storms, floods, droughts, and sea-level rise — are predicted to become more frequent and intense, with adventitious impacts on food security, refugee waves, and conflict.

Economics, politics, and trade. Trade barriers and farm subsidies continue to distort world markets, sending the wrong price signals to farmers and discouraging investment in agriculture and its science. The globalization of food has helped drive down prices received by farmers. Speculators have destabilized commodity markets, making it riskier for farmers to make production decisions. Some countries discourage or ban food exports and others tax them, adding to food insecurity. Others pay their farmers to grow fuel instead of food. A sprawling web of health, labor, and environmental regulation is limiting farmers’ freedom to farm.

The collapse in world economic conditions in late 2008 and 2009 has changed the prices of many things, including land, food, fuel, and fertilizer — but has not altered the fact that demand for food continues to grow while limits on its production multiply. Indeed, the economic crash exacerbated hunger among the world’s poor, and has not altered the fundamentals of climate change, water scarcity, population growth, land degradation, or nutrient or oil depletion.

As Cribb astutely points out, as developing nations become more affluent, they consume more protein, in the form of fish, meat, milk, eggs, etc.

Meat Protein Consumption in US and China
(source: US Department of Agriculture)

That protein is produced with grain, and it is an inefficient process:

  • It takes 1,ooo tons of water to produce a ton of grain
  • It takes about 15 pounds of grain to produce a pound of beef
  • It takes about 5,200 gallons of water to produce a pound of beef

Thinking about the Butterfly Effect – the idea that a butterfly flapping its wings in one part of the world, changing patterns in the air, can cause a tornado in another part of the world – we can see that famine in one part of the world becomes a kind of super butterfly. All nations – rich and poor – will feel the impact.

Cripp summarizes the challenge and frames the solution:

To sum it all up, the challenge facing the world’s 1.8 billion women and men who grow our food is to double their output of food — using far less water, less land, less energy, and less fertilizer. They must accomplish this on low and uncertain returns, with less new technology available, amid more red tape, economic disincentives, and corrupted markets, and in the teeth of spreading drought. Achieving this will require something not far short of a miracle.

Yet humans have done it before and, resilient species that we are, we can do it again. This time, however, it won’t just be a problem for farmers, scientists, and policy makers. It will be a challenge involving every single one of us, in our daily lives, our habits, and our influence at the ballot box and at the supermarket.

It will be the greatest test of our global humanity and our wisdom we have yet faced.

Bill Gates on Climate Change and Renewable Energy

Keywords: Bill Gates, climate change, energy, renewable energy, TED, zero carbon emmissions

Many newspapers and blogs are reporting on the Technology Review interview with Bill Gates (highlights below). Though that interview contains some good information, Gates’ presentation at TED was the stake in the ground that set the stage for this Technology Review interview. At TED, Gates called for reducing carbon emissions to zero. The presentation is worth watching. Considering that Gates is one of the most public faces of big business, his statements at TED are noteworthy:

  • climate change is real
  • climate change is the most important challenge on the planet
  • carbon emissions need to be reduce to zero as soon as possible, his goal is by 2050
  • increased investment in energy R&D is essential, and can be done at reasonable levels
  • zero carbon energy production makes business sense

Highlights from Technology Review interview with Bill Gates

On US Investment in Energy

TR: You are a member of the American Energy Innovation Council, which calls for a national energy policy that would increase U.S. investment in energy research every year from $5 billion to $16 billion. I was stunned that the U.S. government invests so little.

BG: I was stunned myself. The National Institutes of Health invest a bit more than $30 billion.

On Carbon Tax

It’s ideal to have a carbon tax, not just a price on carbon, which is this fuzzy word that includes cap-and-trade. You’re using the tax to create a mode shift to a different form of energy generation. And then you just take all the carbon-emitting plants, you look at their lifetime, and you say on a certain date this one has to be shut down and when a new one is put in place, it has to be low-CO2-emitting.

That’s a regulatory approach, and it’s very clear. Innovators are designing things for the power-plant buyers 10 years from now, who are looking at the regulatory and tax environment for the next 40 years. If you said to a utility company executive, which is more likely to stay in place: a cap-and-trade thing, whose price will vary all over the map, that will have some international things that will be shown to be a waste of money? Or a tax and a regulatory framework for plant replacement over the next 50 years? We should have a carbon tax. What we owe the developing world is this: we’re willing to pay high prices for energy plants above coal and drive prices down the curve so by the time they need to buy them, they don’t have to pay the high price.

Which is more likely: a carbon tax with all sorts of markets and options and uncertainties about prices, and traders in the middle, and confusion about who initially gets the most advantage? Or a regulatory thing and a 2 percent tax to fund the R&D so that utilities know they can buy a plant that’s emitting hardly any CO2? Raising energy prices by 2 percent and sending it to R&D activities seems easier in a weak economy than raising them 20 percent. Now, 0 percent is the easiest option of them all, but unfortunately, that doesn’t get us the solution to this problem.

The CO2 problem is simple. Any amount you emit causes warming, because there’s about a 20 percent fraction that stays for over 10,000 years. So the problem is to get essentially to zero CO2 emissions. And that’s a very hard problem, because you have sources like agriculture, rice, cows, and small sources out with the poorest people. So you better get the big sources: you better get rich-world transportation, rich-world electricity, and so on to get anywhere near your goal. If X or Y or Z gets you a 20 percent reduction in CO2, then you’ve just got the planet, what, another three years? Congratulations! I mean, is that what we have in mind: to delay Armageddon for three years? Is that really it?

The U.S. uses, per person, over twice as much energy as most other rich countries. And so it’s easy to say we should cut energy use through better buildings and higher MPG and all sorts of things. But even in the most optimistic case, if the U.S. is cutting its energy intensity by a factor of two, to get to European or Japanese levels, the amount of increased energy needed by poor people during that time frame will mean that there’s never going to be a year where the world uses less energy. The only hope is less CO2 per unit of energy. And no: there is no existing technology that at anywhere near economic levels gives us electricity with zero CO2.

On Renewable Energy

Almost everything called renewable energy is intermittent. I have another term for it: “energy farming.” In fact, you need not just a storage miracle, you need a transmission miracle, because intermittent sources are not available in an efficient form in all locations. Now, energy factories, which are hydrocarbon and nuclear energy–those things are nice. You can put a roof on them if you get bad weather. But energy farming? Good luck to you! Unfortunately, conventional energy factories emit CO2 and that is a very tough problem to solve, and there’s a huge disincentive to do research on it.

I think Gates approach to energy storage and transmission is too brute force. We are early into innovating alternative energy, and already there are some good innovations showing up that provide solutions to wind and sun intermittence. See Using Water Heaters to Store Excess Wind Energy for a good example of innovations that use existing infrastructure for storage and transmission.

Better, Cheaper, and Fairer Health Care

Keywords: healthcare, cost, life expectancy, t.r. reid, Japan, US

Washington Post reporter, documentary film correspondent and author T.R. Reid had a brief piece in Newsweek this week about Japan’s healthcare system. The article expands on an earlier interview Reid did on National Public Radio (NPR) – Japanese Pay Less for More Health Care – which you can listen to here.

To put Japan’s healthcare in perspective with the US and other countries, let’s look at healthcare performance data from the Organization for Economic Co-operation and Development (OECD). Using graphing approaches from National Geographic and Andrew Gelman we plot annual healthcare spending, life expectancy, and number of office visits per person, for a broad range of OECD countries. (NB: The area of the circle for each country is proportional to the number of doctor visits per person, e.g. Japan is 13.4 visits per year, US is 4 visits per year)

HealthcareSpending, Life Expectancy, Doctor Visits
(source: OECD Health Data 2009)

As can be seen, the US spends the most for healthcare, has middle of the road life expectancy, and few office visits. Japan has the highest life expectancy, three times as many office visits, at a third of the cost, compared to the US.

Commentary on the OECD data from National Geographic article The Cost of Care:

The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Lack of health insurance is a factor in life span and contributes to an estimated 45,000 deaths a year. Why the high cost? The U.S. has a fee-for-service system—paying medical providers piecemeal for appointments, surgery, and the like. That can lead to unneeded treatment that doesn’t reliably improve a patient’s health. Says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who studies health insurance worldwide, “More care does not necessarily mean better care.”

Highlights of T.R. Reids article – Japan shows how it’s done: keep quality up, costs down, and M.D.s on board

To gauge a health-care system’s success, it’s standard to consider three points: quality, coverage, and cost. On all three measures, Japan stands at or near the top in every comparative ranking.

Quality: The Japanese have the world’s longest life expectancy and the best recovery rates from just about every major disease. Infant mortality is less than half the U.S. rate. Japan usually leads the world in rankings of “avoidable mortality”—its effectiveness in curing diseases that can be cured.

Coverage: Japan’s health-insurance system covers everybody, including illegal aliens. It pays for physical, mental, dental, and long-term care. The Japanese are the world’s most prodigious consumers of medical care; on average they see the doctor about 15 times per year, three times the U.S. norm. They get twice as many prescriptions per capita and three times as many MRI scans. The average hospital stay is 20 nights—four times the U.S. average.

Cost: And yet Japan produces all that high-quality care at bargain-basement prices. The aging nation spends about $3,500 per person on health care each year; America burns through $7,400 per person and still leaves millions without coverage.

Japan has universal coverage, but it’s not “socialized medicine.” It’s largely a private-sector system. There is government insurance for the unemployed and the elderly, but most people rely on private plans. Japanese doctors are the most capitalist and competitive in the world. But we’re talking Japanese-style free enterprise here; there’s significant government regulation of the private players. Health insurers are required by law to cover everybody, and to pay every claim; the corollary is that everybody is required to buy health insurance. The price for a given treatment is identical everywhere in Japan. Officials say this is designed to attract doctors to rural communities, but that’s not working very well; many small towns on the outer islands have no doctor at all these days.

That fee schedule is the key to cost control in a country where people love going to the doctor. Basically, it shafts doctors and hospitals, paying some of the lowest fees on earth. As a result, doctors work long hours. They are comfortably middle-class, but not in the country-club set. But the savings can be huge in the high-tech realm that drives U.S. bills so high. An MRI scan of the neck region—routinely $1,400 or so in America—is $130 in Japan. Cost cutting like that has stimulated innovation and efficiency. Low fees are taking a toll, though. In a sense, Japanese medicine is the mirror opposite of America’s. We spend too much on health care, but still cover too few of our citizens; Japan provides lots of care to everybody, but probably spends too little to make its best-in-the-world system sustainable.

Reid’s bestselling book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care is available in paperback.