Unfortunately, while clearly aware of this debilitating problem, Congress and the administration have not developed meaningful proposals to solve it. But this is an urgent issue requiring fast, effective action.

According to an October 2009 white paper by Thomson Reuters, the overall American healthcare system wastes $600-850 billion every year. Here's the breakdown:1 * Unnecessary care (40 percent of healthcare waste): This includes defensive medical treatments whose primary purpose is to double cross every "t" and double dot every "i," lest the trial lawyers come calling.

* Fraud (19 percent of healthcare waste): This is willful theft, such as billing Medicare, Medicaid, and private insurers for products and services not rendered.

* Administrative inefficiency (17 percent of healthcare waste): Duplicative paperwork limits the ability of healthcare professionals to spend the appropriate amount of time with sick and injured patients. One study found some nurses must spend one hour on paperwork for every hour of patient care.

* Healthcare provider errors (12 percent of healthcare waste): Mistakes by physicians and support staff are tremendously costly both in terms of dollars and human suffering. Too many errors happen as a result of illegible handwriting and exhaustion with paperwork.

* Preventable conditions (6 percent of healthcare waste): The personal choices made around prevention and treatment of diseases account for at least 50 percent of one's health status. For example, Type 2 diabetes is often preventable with the proper diet and exercise. Nevertheless, Type 2 diabetes now const.i.tutes 90 percent of diabetes cases, accounting for tens of billions of dollars every year spent unnecessarily.

* Lack of care coordination (6 percent of healthcare waste): Better access to more accurate patient records via electronic health records and e-prescribing, with strong safeguards to ensure patient privacy, will improve health outcomes and eliminate unnecessary tests and contraindicated prescriptions.

Additional confirmation of the scale of fraud and waste comes from the Government Accountability Office (GAO), widely regarded as the gold standard for investigating government-run programs. In a January 2009 report on "high risk" programs, GAO experts found in 2007, the Medicaid improper payment rate was 10 percent, or $32.7 billion (FN).2 This contrasts with the average improper payment rate of 3.9 percent across all government programs, according to the Congressional Research Service.3 So Medicaid has nearly three times the improper payment rate of all government. That is one reason the Left can tout low administrative costs for Medicare and Medicaid: they simply write checks without effective oversight. They pay more in fraud than they gain in lean administration.

In the Senate Finance Committee, Republican John Cornyn submitted an amendment to the Senate healthcare bill that made expansion of the Medicaid program contingent on GAO certifying that Medicaid's improper payment rate was at or below the government average. The amendment was defeated on a party-line vote.

Consider this: the federal department that oversees Medicaid cannot even accurately measure the extent of the problem. A letter dated August 26, 2009, from Stuart Wright with the U.S. Department of Health and Human Services Office of Inspector General to Cindy Mann, Director of State Operations at the Center for Medicare and Medicaid Services (CMS), outlined how current data collection methods fail to generate accurate and timely data about the program. As the old saying goes, "You can't manage what you can't measure." The conclusion to the 25-page letter reads:MSIS [Medicaid Statistical Information Statistics] is the only source of nationwide Medicaid claims and beneficiary eligibility information. CMS collects MSIS data directly from States to, among other things, a.s.sist in detecting fraud, waste, and abuse in the Medicaid program. Timely, accurate, and comprehensive MSIS data can contribute to more effective health care fraud, waste, and abuse identification and prevention.

We determined that during FYs 2004-2006, MSIS data were an average of 1 years old when it was released to all users. In addition, CMS did not fully disclose or doc.u.ment information about the accuracy of MSIS data. Furthermore, MSIS did not capture many of the data elements that can a.s.sist in fraud, waste, and abuse detection.4 Medicare's improper payment rate is equally bad. A November 2009 report admitted to $47 billion in improper payments, which is, like Medicaid, roughly 10 percent of that program. Examples included payments to dead doctors and people using Medicare ID numbers with or without the beneficiary's knowledge to run up fake billing.5 An excellent segment on 60 Minutes in October 2009 estimates $60 billion of Medicare spending annually is fraudulent. Steve Kroft warns in the opening that the show will "make your blood boil." The highlight of the piece is an interview with a convicted Medicare fraudster who explains how easy and lucrative it is to steal from Medicare. He made $20,000 to $30,000 a day, and he a.s.sures Kroft that, though he is behind bars, there are thousands of people like him stealing from the program.6 Consider this sampling of recent fraud in our healthcare system:g * Healthcare fraud is luring criminals with easy money and short prison sentences. These gangsters are forgoing violent crime for white-collar scams-bilking U.S. taxpayers out of millions of dollars with little risk. According to a recent a.s.sociated Press article, "A Medicare scammer could easily net at least $25,000 a day while risking a relatively modest 10 years in prison if convicted on a single count. A cocaine dealer could take weeks to make that amount while risking up to life in prison."7 * So-called fraud "trouble spots" exist across the country. Federal agents recently arrested twenty-six people in three different states-Florida, New York, and Michigan-for Medicare fraud totaling more than $61 million. Accusations included faking medical certifications and bribing clinics to join the scams.8 * In 2005, South Florida clinics submitted $2.2 billion in HIV-drug infusion claims to Medicare, which is 22 times more than the rest of the country combined.9 * A Miami doctor falsely listed some of his patients as both blind and diabetic in order to bill Medicare for expensive twice-daily nurse visits. The doctor was arrested within weeks of the release of a DHHS report showing that Miami-Dade country received more than half a billion dollars in funding from Medicare in home health payments-more than the rest of the country combined.10 In 2008, the average cost for home healthcare patients in Miami-Dade ran $11,928 every two months, which is 32 times the national average cost of $378.11 * A La Quinta, California doctor was sentenced to fifteen months in jail and ordered to pay more than $600,000 in rest.i.tution for "subdosing" AIDS patients and billing insurance companies for the full dosages.12 * A Miami man was recently arrested on fraud charges, having submitted $55 million in false claims for bogus HIV and cancer services. He used the money he received to buy Lamborghinis, Bentleys, Mercedes Benzes, and horses. To pose as owners of the fake clinics, he recruited illegal Cuban immigrants who later fled to Cuba when the ruse was discovered.13 * A Philadelphia couple recently billed Medicare more than $1.2 million for power wheelchairs and other medical equipment that patients did not need. A U.S. Attorney said the case "involves breaches of trust at every level-from the medical office employees who sold patients' ident.i.ty information to the people charged . . . who used the Medicare Trust as their personal ATMs."14 Separately, a Michigan businessman fraudulently billed Medicare for $18.4 million by submitting claims for non-existent therapy services. He also paid kickbacks to people for use of their Medicare numbers, another all-too-common fraudulent practice.15 * Owners of an ambulance service in Tennessee billed both Medicare and Medicaid for unnecessary and non-compliant ambulance rides for patients, using the proceeds to buy a Corvette and a Harley Davidson. Examples of their "service" include a patient riding in an ambulance jumping out to get take-out at a restaurant, and ambulances being loaded with a patient in both the front and back-"in effect acting as a taxi, charging the government in excess of $300 per round trip."16 * The Senate Permanent Subcommittee on Investigations identified $60-92 million in Medicare payments for services ordered by more than 16,500 deceased doctors in 2000-2007. Some doctors had been dead for more than ten years.17 * Facilities in southern California allegedly churned thousands of indigents through their sites and billed Medicare and Medi-Cal for costly and unjustified medical procedures. These facilities ran street-level operations, where runners collected indigents for unnecessary hospital services, dropping them back off on skid row by ambulance.18 * In 2005, the New York Times estimated New York state Medicaid fraud reached into the tens of billions.19 That much abuse in a single state implies a mind-blowing amount of Medicaid fraud is occurring across the country. Some cases just in New York: * A Brooklyn dentist billed as many as 991 procedures supposedly performed in a single day.

* School officials enrolled tens of thousands of low-income students in speech therapy without the required evaluation, garnering more than $1 billion in questionable Medicaid payments. One school official sent 4,434 students into speech therapy in a single day.

* Several criminal rings duped Medicaid into paying for an expensive, AIDS-related muscle-building drug that was diverted to bodybuilders at the cost of tens of millions.

* James Mehmet, former chief state investigator for Medicaid fraud, reported that "40 percent of all claims are questionable."

The staggering amount of fraud in healthcare simply does not exist in any other industry. That's because the American healthcare system is mostly third party payer-the ent.i.ty paying the bill for healthcare services is not the patient or doctor. That arrangement necessarily makes the patient and the doctor less concerned with using dollars efficiently for legitimate treatments and less interested in stopping fraud and abuse that may even be occurring in their name.

Another major reason for the abundant fraud is that the healthcare system is paper based. The bureaucrat is relying on out of date paper while the crook is using his Blackberry and iPhone.

HOW NOT TO PAY CROOKS.

We at the Center for Health Transformation published a book in 2009 t.i.tled Stop Paying the Crooks featuring proposed solutions from a diverse group of experts to stop healthcare fraud, waste, and abuse. Here are some of their solutions:1. Patients and taxpayers have the right to know the cost and quality produced by every facility that receives taxpayer money and how and where scarce taxpayer dollars are spent. Thus, all Medicare and Medicaid claims and patient encounter data should be made public on a depersonalized basis. That data is the mother lode of everything you would ever want to know about both programs. We would be able track all the dollars as well as the health outcomes produced by every provider in the country that accepts Medicare and Medicaid-which is nearly all of them.Selected academics have access to Medicare data and have produced excellent reports such as the Dartmouth Health Atlas. Among their many key findings is that per capita Medicare spending by locality is inversely correlated with the likelihood of receiving recommended care.20 As good as the Dartmouth team is, it is not as comprehensive as the collective wisdom of the general public looking at the data and developing new studies, patterns, and solutions.

This data should only be released, however, after being vigorously patient de-identified, as is done in the academic world. Patient privacy must remain paramount.

2. The federally administered Medicare program and the mostly state-administered Medicaid program must improve their sharing of patient data. Their failure to do so results in significant lost opportunities to coordinate care and catch fraud. A 2009 report by the Kaiser Commission found insufficient controls and duplicate claims processing agents that invite fraud and abuse.More than 8.8 million of Medicaid's 58 million beneficiaries are low-income senior citizens who are eligible for both Medicaid and Medicare.21 That is close to 15 percent of Medicaid enrollment, but 40 percent of outlays. They comprise 18 percent of Medicare's enrollment, but Medicare spent even more on their care than Medicaid did. These so-called "dual eligibles" account for roughly $300 billion in annual spending, yet the care they receive is often haphazard, uncoordinated, and reactive because Medicare and Medicaid don't communicate with each other. The result is sub-optimization of patient health outcomes to accompany the waste and fraud.22 3. Outsource the authentication of new Medicare and Medicaid suppliers to Visa, Mastercard, or American Express. After forty years of failure, it is clear the status quo in Washington, D.C., is incapable of managing these programs, so let's turn to experts with a track record of success.The American credit card industry processes over $2 trillion in transactions every year, and there are 800 million credit cards accepted by millions of vendors to buy countless products. Yet fraud const.i.tutes just one-tenth of one percent of the credit card industry. Conservatively speaking, fraud in Medicare and Medicaid is 10 percent, making it 100 times worse.

4. The CMS-855S form that prospective durable medical equipment providers must fill out lacks even a simple, "under penalty of perjury" line by the signature. That little tweak alone would help prosecutors and perhaps even have some deterrent effect. Likewise, we should make the submission of bogus claims a reason for immediately revoking a supplier's billing number.

5. Allow seniors on Medicare the option of traveling to another city to receive major non-emergency surgeries. If a particular set of procedures costs thousands of dollars less in the next state over and the quality outcomes are as good or better, we should allow people the choice of facilities, especially if the individual receiving care can split the savings with taxpayers.The commercial insurer Wellpoint launched a demonstration project that allows customers to travel to India for non-emergency elective procedures like plastic surgery. Surely it's not too radical to take advantage of arbitrage opportunities here in America within the Medicare system.

6. Enhance discovery of third party liability in Medicaid. Simply maximizing self-reported third party coverage by patients could save state Medicaid programs 1-2 percent per year. That is $4-7 billion a year the insurers would legitimately be paying that the taxpayers currently cover due to bureaucratic incompetence. A GAO report shows up to 13 percent of people on Medicaid with other coverage.23 7. Medicare and Medicaid should use private-sector standards for establishing the number of suppliers for a product or service in a defined area. California's Medicaid program has been doing this for nearly a decade in durable medical equipment. While there was some pushback from frustrated potential providers, there were no reports of access to care issues from beneficiaries.In a related experiment last year, the South Carolina Medicaid program told its forty-eight Medicaid beneficiaries with the most number of prescriptions they could thenceforth only get prescriptions from one pharmacy, which they could choose themselves. After eight months those individuals had 40 percent fewer prescriptions, saving Medicaid $320,000.

8. Reduce the administrative red tape and lengthy appeals that cancelled suppliers often exploit. Currently, suppliers can drag out the process for months and usually get reinstated. In 2007 and 2008 the OIG conducted 1,581 unannounced site visits to durable medical equipment providers in South Florida and found 491 either didn't have an actual facility or were not properly staffed. All 491 billing privileges were revoked, 243 of those appealed, and 222 (91 percent) were reinstated. Of the 222 reinstated, 111 later had their billing privileges revoked again.24 The Florida Medicaid program requires suppliers to sign contracts agreeing the state has the right to terminate them at any time "without cause." This has been effective without harming access to care. Any public or private buyer of a service should retain the right to stop buying that service whenever she sees fit.

9. Move to a system of 100 percent electronic remittances. Paper bills and the postage required to mail them cost billions unnecessarily. Furthermore, paper records guarantee the bureaucrats are always many steps and many months behind the crooks. We currently have paper clerks chasing crooks who use iPhones and Blackberries. It is a hopeless mismatch of technologies favoring the crooks over the cops.

10. Use unique ID numbers for Medicare beneficiaries instead of their social security numbers. A stolen Social Security number leaves a person much more vulnerable to theft and fraud.

11. Require more timely updates from states on Medicaid enrollment data. Even senior congressmen, as of April 2010, can only get state-by-state Medicaid enrollment data up to 2007. The latest data available for Maine is 2004.25 Compare that to FedEx and UPS, which track 23 million packages a day in real time, or to McDonald's, which collects data or sales from 37,000 stores worldwide every night. As shown above, the existing data collection system urgently needs to be fixed.

12. Experiment with moving to biometric ID for Medicare and Medicaid beneficiaries. Cards are easily lost, stolen, copied, and forged, which contributes to uncoordinated care and fraud.

13. Recognize the shortcomings of isolated fee-for-service arrangements and follow two of MedPAC's key recommendations: expand the use of risk-adjusted plans in Medicare, and expand the medical home model particularly for people with one or more chronic conditions. Enhanced use of medical homes would be particularly helpful in a Medicare system where specialists are overpaid relative to primary care. The standard fee-for-service model rewards volume first and foremost, with coordination of care, improvement of patient health, and fraud as secondary considerations at best. The same recommendations are appropriate for Medicaid.26 14. Encouraging better data a.n.a.lytics across programs and jurisdictions is a must. The entire healthcare system could benefit tremendously from the same level of inter-agency data sharing that is common in law enforcement, particularly in the tracking of s.e.x offenders. When s.e.x offenders move between states they are required to register immediately with local law enforcement. If they miss their deadline, they are flagged instantly by sophisticated systems pulling information from public sources. Doctors who have been sanctioned for fraud, hospital administrators who have engaged in fraud, DME salesmen with fraudulent convictions, criminal beneficiaries, and others are much freer to set up shop in a new state-or to send a new, unknown member of a fraud ring into the system-without being reported from their prior jurisdiction.

15. Require Medicare and Medicaid to pay closer attention to Medicare ID numbers that show outlier behavior. Individuals who are excessively billing at, say, emergency rooms are likely getting poor, uncoordinated, inefficient care, or their Medicare/Medicaid cards are being billed by fraudulent providers with or without the patient's knowledge. In either case, both the individual's health and the taxpayer's pocketbook would be better served by being instantly identified.

16. Data sharing across departmental jurisdictions and with state and local governments should be done with the same seriousness as in national security. Prior to September 11, the CIA and the FBI rarely communicated. Now they compare intelligence frequently. There are multiple databases of Medicare and Medicaid providers and suppliers along with their disciplinary records.27 But these databases are not as universally comprehensive or as accessible as, say, the National Instant Criminal Background Check System (NICS) used to keep guns out of the hands of criminals. The National Crime Information Center is another law enforcement tool that allows a local officer to have instant, nationwide access to a suspect's criminal background. These systems are not perfect, but they are good examples showing how individuals with criminal records and/or disciplinary actions in the healthcare field can at least be flagged early. This concept was part of President Obama's revised health proposal unveiled on February 22, 2010, based on legislation introduced by Congressman Mark Kirk with bipartisan support. We should utilize data from the Social Security Administration and IRS for these efforts as well.

17. Require cost reports for Ambulatory Surgical Centers (ASC) similar to what is currently required for hospitals by the Centers for Medicare and Medicaid Services (CMS). It is understood there are specific differences between an ASC and a hospital, and the report requirements should be modified to accommodate this.

18. Migrate Medicare and Medicaid beneficiaries into arrangements with personal health accounts in which individuals have direct and immediate financial incentives to engage in behaviors that improve their health. The current system includes nothing to deter patients with Medicare, Medicaid, and most private plans from scheduling as many physician visits as they can. Indeed, a cla.s.sic 2003 New York Times article, ent.i.tled "Patients Line Up for All That Medicare Covers," accurately captures a culture where seniors on Medicare can get as many healthcare services as they can fit on their calendar, regardless of cost to taxpayers or the lack of medical benefit.28 There are myriad ways to structure personal accounts, the least controversial being zero-balance accounts where beneficiaries are paid small amounts of money for achieving improved health status. The vast majority of healthcare spending in the coming decades will be on people with chronic conditions. This means personal choices around care regimens will have a major, long-term impact on quality outcomes and cost. We must continue developing and deploying models of healthcare financing that maximize patient behavior change toward patterns of good health. Ultimately, that is the only way to save American healthcare. Account-based plans are the most effective way to create incentives to accomplish this goal.

The topic of healthcare fraud, waste, and abuse is too vast for one chapter, one book, or even a ten-volume series. But it is crucial for the American people to grasp just how large a problem this is, how much money is involved, and that there are solutions that would drastically reduce the problem without limiting access to medical care.

CHAPTER SEVENTEEN.

Green Conservatism Versus Left-wing Environmentalism With Terry L. Maple, President and CEO of the Palm Beach Zoo More and more people around the world are discovering "green conservatism," a new pathway to environmental stewardship and a compelling conservative alternative to the high-tax, big-bureaucracy, job-killing, and government-centralizing environmentalism of the Left. Green conservatives understand people can vigorously protect biodiversity and deliver cleaner forms of energy in a fiscally responsible way without the heavy-handed intervention and expansion of government. People with green core values who feel abandoned by extreme, big-government environmental positions are vastly more comfortable with the market-based, entrepreneurial approach of green conservatives.

Green conservatives are politically active in Australia, Canada, and the United Kingdom among other nations, and the label is increasingly claimed by an emerging center-right coalition in the United States. When we first applied the term in U.S. politics, we defined green conservatism as: "an optimistic, positive, science and technology-based, entrepreneurial, market-oriented, incentive-led, conservative environmentalism that creates more solutions faster and that will result in more biodiversity with less pollution and a safer planet."

More simply, green conservatism describes conservatives who incorporate green concerns into their ideology.

From the business side, entrepreneurial environmentalists are the new agents of change on the frontlines of a creative environmental movement. Government's role, rather than to dictate, is to incentivize. In homes throughout America, energy efficiency has been facilitated by government rebates and matching funds to encourage investment in efficient appliances, insulation, and technology.

Green conservatives worldwide are broadening their political platforms by including environmental initiatives. In the UK, conservative leader David Cameron has proposed a "smart power grid," incentives for small-scale renewables, sustainable public transit, and technological innovation to cut carbon emissions. In France, a conservative president presides over a nation whose investment in nuclear energy is a model for other European countries.

And in Canada, Preston Manning, founder of the Canadian Reform Party, insists Western Canadian conservatism, with its rural and populist origins, must reconcile its support for strong growth with the necessity of environmental protection.

As doc.u.mented in our book A Contract with the Earth, many U.S. businesses and industries have already adopted sustainable practices for their employees and their facilities. Deploying fleets of electric, hybrid, natural gas, or hydrogen-powered cars and trucks, they are also building new plants that comply with green building practices such as LEED (Leadership in Energy and Environmental Design) guidelines. Combining innovation with LEED-type guidelines is an inspiring public platform for our new movement.

A COMMITMENT TO ENVIRONMENTAL LEADERSHIP.

We believe unwavering political and citizen leadership is the key to effective environmental policies. Quality of life and environmental sustainability with continued economic growth in jobs and incomes must become national priorities. In the 2008 paperback edition of A Contract with the Earth, we proposed that green conservatives could provide leadership for a polarized and stalemated environmental movement:The fact that green conservatism is attracting converts from every political faction renders the movement mainstream. Breaking out from the current stalemate means we must find a way to get things done. An inclusive, bipartisan movement can be built on green conservative principles.1 In contrast, a global, left-wing environmental movement organized around a doomsday theory of climate change is pushing for a ma.s.sive wealth transfer from the West to developing nations, and an enormous increase in bureaucratic control by governments. Meanwhile, UN-designated experts and an alliance of global bureaucrats are lobbying for treaties to enforce international climate change regulations within a system of global taxation. This entire "solution" is a kind of cla.s.s warfare applied to nation states.

With our historical emphasis on free enterprise and national sovereignty, Americans have resisted these extreme measures. But we believe genuine environmental problems, many of them ignored due to the global warming obsession, cannot be resolved without U.S. leadership. Therefore, green conservatives must offer rational alternatives to the extremist positions now dominating the discussion. Pursuing affordable programs of worldwide reforestation, for example, could help capture carbon dioxide while protecting biodiversity-the ultimate win/win conservation strategy.

To lead on this issue, conservatives must determine how a healthy environment is compatible with key conservative political ideas. We can begin by advocating sustainability. Defined as "meeting the needs of the present without compromising the ability of future generations to meet their own needs," this concept is consistent with a conservative political philosophy. "Conservative," after all, comes from the same root as "conservation." Adherence to this fundamental principle will conserve future opportunity for optimal quality of life, economic stability, and human happiness. Ronald Reagan campaigned on these kinds of universal human aspirations.

For the sake of our children and grandchildren, we must act cooperatively to ensure a sustainable world. However, green conservatives are uniquely committed to empowering people rather than government.

The government can play a modest role setting the general direction. An example is the 1969 U.S. National Environmental Policy Act, which aimed to "create and maintain conditions under which man and nature can exist in productive harmony, and fulfill the social, economic and other requirements of present and future generations of Americans." The key connection is the need to achieve and sustain environmental and economic harmony.

Green conservatives must do more than simply say no to the big-government, environmental Left; we need to provide a clear and robust political alternative for local and global environmental stewardship. We must articulate this vision in party platforms, newspaper op-ed columns, community and national blogs, and other electronic media in order to generate a menu of green conservative ideas in the environmental marketplace.h Affiliating with the tea party movement is also a good opportunity to spread green conservatism, since many tea party activists strongly favor a healthy environment but oppose using socialist policies to achieve it.

Big government is not necessary or even conducive to sustainability. As we argued in A Contract with the Earth, business and industry are already greener than government, and they are innovating at a faster pace as well. So we should work with business and industry, local governments, and nonprofit groups to develop stewardship that is fast, focused, and flexible. We should also favor public-private partnerships and gra.s.sroots solutions by local people who understand the issues on the ground. An example is the NEXT network of volunteer organizations and groups that monitor sea turtle nests during their breeding seasons on the Florida coastline.

The sincere commitment of green conservatives to better environmental standards and practices is one of the media's best kept secrets. Green conservatives have to insist on a place at the environmental table. Above all, we should advance rational, responsible, and innovative solutions to help protect the natural resources that support all life on this planet. Effective environmental problem-solving requires the elbow grease and ac.u.men of every political party in America. There are conservatives in both the Democratic and Republican parties; likewise, both Republicans and Democrats can be green.

CLEAN AMERICAN ENERGY.

All nations unarguably require reliable, affordable energy for economic growth. This growth, in turn is an essential requirement for a healthy environment. A broad and green energy menu needs entrepreneurs rather than bureaucrats, incentives rather than regulation, markets rather than command and control, tax relief rather than litigation, and scientists rather than trial lawyers.

Other nations energetically locate and diversify their energy sources, while America shows inefficiency and timidity. Innovative and sustainable, a green conservative energy plan will allow us to lead the world in producing a wide array of sustainable energy technology and clean, renewable products.

Some industries are already moving in this direction. Our automobile industry has strongly committed to hybrid, hydrogen, and electric vehicles. Taking no federal stimulus money, Ford successfully developed a line of fuel-efficient cars that are highly compet.i.tive with Honda and Toyota. Fuel efficiency and cleaner emissions have become a winning green business strategy for Detroit.

But industry can't act alone; the federal government must help-not by getting bigger, but by getting smaller. Namely, the government must remove its restrictions on access to our key energy sources. Perhaps the most inexplicable such restriction is the maze of regulations that effectively prevents the spread of nuclear power-a clean, cheap, zero-emission source of electricity.

Currently, only one nuclear plant is under construction in the United States, while forty-four are being built in other countries.2 Our leadership as a nuclear innovator is fading fast, as other countries pursue ways to overcome historical obstacles such as the waste problem. For example, Norway's state-owned energy company Statkraft is investigating the use of thorium to fuel nuclear reactors. Thorium is considered a greener alternative to uranium and plutonium, as it produces only a tiny fraction of the hazardous waste created by uranium-fuelled reactors.

Aside from being cheap and carbon-free, nuclear power offers other benefits as well. For example, once a plant is operational, nuclear energy is a relatively inexpensive power source for producing hydrogen, which could hasten the development of hydrogen-fueled cars and, ultimately, a low-carbon economy based on hydrogen. Nuclear power stations could also power desalination plants at lower cost to mitigate future droughts.

With all this promise just from nuclear power, imagine the possibilities if we develop environmentally responsible ways to tap America's full energy potential: natural gas, cleaner coal, domestic sources of offsh.o.r.e oil, and a wide array of renewable energy sources such as geothermal, biofuels, solar, and wind power. Other nations are pursuing these technologies, including China, so American innovation must be encouraged by tax incentives and public-private partnerships.

Much of this can be accomplished by eliminating red tape and facilitating active investments in new technology. This could bring about new, clean energy sources most people aren't even aware of today. For example, a new high-temperature technology known as plasma gasification promises to provide a way to burn off landfill waste and provide energy for nearby industries and towns. New to the United States, this technology is already operating successfully in j.a.pan. Gasification technology can also be utilized in the clean coal process by capturing carbon dioxide. Public-private partnerships in research and development will ultimately lead to other effective methods to turn environmental liabilities into community a.s.sets.

Local governments are already developing green conservative programs. An example is Grand Rapids, Michigan, which has rooftop gardens, rainwater cisterns, solar panels, and the highest per capita number of buildings that comply with the standards set by the U.S. Green Building Council. The city plans to draw 100 percent of its electricity from renewable sources, mostly wind power, by 2020. Its residents are predominantly conservative and religious, deriving their environmental values from a Biblically inspired sense of stewardship.

THE BLAME GAME.

The extremist environmental movement a.s.serts that we will soon face global warming-induced environmental catastrophes that can only be avoided by forcing Western capitalist nations, especially America, to adopt devastating energy taxes, ruinous new environmental regulations, and a ma.s.sive wealth transfer to developing countries. This mantra has become so popular, both among the American Left and abroad, that even Osama bin Laden in a recent recording thought he could win support by blaming the West for global warming.

This narrative fails to recognize that capitalist democracies are among the most environmentally conscious nations in the world. As a rule, the more socialist a nation becomes, the more the environment suffers-just look at the environmental degradation that characterized nearly every Cold War-era Communist nation. As we noted in A Contract with the Earth, wealth and freedom generally lead to better environmental practices; forests are declining in poor nations but expanding in wealthy ones.

The international Left relentlessly condemn our alleged overconsumption of energy and services. Sometimes they invoke the spurious statistic of "per-capita use of energy," comparing us unfavorably with China and India. This is absurd. China and India are major industrial polluters and carbon emitters. But simply because their populations are so large, their per capita output is relatively small.

So, in formulating a comprehensive environmental policy, the first thing we should do is to ignore the unfair, anti-American critique of the Left. We must develop our own policy based on conservative principles. Under such a policy, America should be a leader in environmental philanthropy and foreign aid to countries facing environmental challenges. This aid would be given on a case-by-case basis to nations with pressing environmental problems and accountable plans for fixing them. Operating like a sound business, our international environmental aid will depend on prudent management and our national financial situation at any given time.

This system would be an alternative to the current demands for coercive international mandates. Our Const.i.tution requires the people's consent in matters of war and finance; no foreign or world government has the mandate to tax U.S. citizens to combat global climate change or any other environmental danger. In particular, a proposed global carbon tax, calculated and regulated by the United Nations, would violate our sovereignty and must be resisted.

History has repeatedly demonstrated the incredible generosity of the American people, American private enterprise, and American inst.i.tutions. The United States is already a global leader in environmental philanthropy, whether it be responding to the Asian tsunami or the Haitian earthquake. We should prioritize environmental sustainability, both in America and across the globe, but we must not allow the Left to exploit the global warming panic in order to degrade our liberties and entwine us in a new, corrupt, international climate change bureaucracy that would undoubtedly be dominated by dictatorships and kleptocratic governments.

MORE SCIENCE, BETTER SCIENCE, NONPARTISAN SCIENCE: CLIMATE SCIENCE AND THE LESSONS OF Y2K.

We have to be more skeptical of climate scientists and the UN-APPOINTED International Panel on Climate Change (IPCC) given the revelations of the "climategate" incident, discussed in chapter eight. As demonstrated in the hacked emails, some of the world's top climate scientists unprofessionally and unethically tried to silence critics and avoid disclosing their own data.

Sound science depends on constructive criticism and a rigorous system of peer review. That's why the argument that global warming trends are "settled science" is so disturbing. In the academy, debates in every field rage for decades as trends and theories are revised according to new data. With the hockey stick trend in global warming now discredited and scientific climate models yielding hypothetical data at best, we are still debating the meaning of the information we have now. Unshakable predictions of a looming, carbon-induced doomsday look more and more like the anti-climatic Y2K panic.

The rational antidote to global warming hysteria is continued investigation into global climate change. Green conservatives should advocate better climate research through the National Science Foundation and other professional sources. To augment federal funding, privately funded prizes can help incentivize scientific breakthroughs. We could also offer prizes for breakthroughs in climate modeling, metrics, and measurement technology. Furthermore, we need fiscally responsible green conservatives who understand the need for more and better climate science to carefully scrutinize UN proposals, such as a recent demand for more than $60 billion to measure climate variables.

The American people should also continue to rely on the National Academy of Sciences to monitor progress in global climate change research. This is an incredibly intricate, fluid topic, notwithstanding the Left's bogus claims that the science is settled. In fact, a 2010 article in the journal Nature by Olive Heffernan predicted that improving technology will cause scientists to admit to even greater uncertainty about the effects of climate change. The debate will really heat up when the next major IPCC report, due in 2013, moves beyond projected climate scenarios to consider explicit predictions.3 Although environmental radicals refuse to acknowledge it, we can prepare now to adapt to almost any future change in climate. Consider the argument made by Nigel Lawson in his book An Appeal to Reason: The only rational, practical and cost-effective policy response to global warming is to adapt to it if and when it occurs-that is, to act to prevent, or mitigate, any adverse consequences, while taking full advantage of the many beneficial consequences. This is manifestly the case, not least because the projected adverse consequences are simply the relatively marginal exacerbation of problems that already exist.4 Green conservatives should be skeptical, prudent, and smart. We must demand complete objectivity from our scientists and our policymakers. Our country is blessed with the world's best graduate schools and a critical ma.s.s of brilliant scientists and engineers. If carbon overload should lead to major problems, our continuing investment in science and technology will give us the best chance of averting or adapting to the consequences.

A GREEN CONSERVATIVE PLATFORM.