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The comment says, “In the world of rising demand, what resources will be run out of?” but actually it is the other way around, we face peak demand rather than peak resources, for fossil fuels at least. There is plenty of most other resources as well. A few things that we can run out of but there are alternatives to most of them that we can transition to. If we continue the current rapid transition to renewables, Carbon Tracker is predicting a peak demand for all fossil fuels in the 2020s.N.B. I’ve done a video talking about this answer here:Others think this may happen later, BP and Shell have published reports with scenarios in them that correspond to what BP calls “Rapid transition” and Shell calls “Sky”. Both are rather similar.Shell’s scenario is Paris agreement compatible but only at the 2 C level to reach zero emissions by 2070. With that scenario they project that we will have a supply gap if they do not continue to invest in new oil fields.They do come to a smilar conclusion of a peak after 2025, for oil at least:For example, our Sky scenario shows that demand for oil starts to decline globally after 2025 but still grows in some countries, including India and China until the middle of the century.Shell energy transition report 2019BP predict oil consumption will level off around 2040 but that it will peak before then if we keep to within 2 C. BP Energy Outlook 2019 editionAFAIK BP and Shell are the only oil companies so far to publish forecasts that take account of the Paris objectives as a possible scenario.Whatever ones views on when we will peak with fossil fuels, we no longer think in terms of actually running out of oil or gas, because there is plenty of it. There is only enough conventional oil and gas for a little over half a century at current production but there is enough coal for 150 years and enough shale oil for 1300 years.The question rather is when we will reach peak demand as we transition to renewables. We have already reached peak demand for coal. That happened in 2014, there has been a rise again for the last couple of years but we haven’t returned to the 2014 peak. This shows that it’s nothing dire has to happen when you reach peak demand of any particular fossil fuel.However the politial climate has shifted so that we may well be able to target 1.5 C through the easiest path of zero emissions by 2050. Also renewables are falling in price far faster than was expected.If we have a 1.3% growth in energy demand and 17% growth in solar and wind then according to them, fossil fuels should peak by 2023.With global energy demand expected to grow at 1-1.5% and solar and wind at 15-20% a year, fossil fuel demand will peak between 2020 and 2027, most likely 2023 Fossil fuels will peak in the 2020s as renewables supply all growth in energy demand - Carbon Tracker InitiativeCarbon Tracker warn about the risk to investors“The 2020s will be the decade of fossil fuel demand peaks, as one bastion after another is stormed and overwhelmed by the rising renewable tide. This will inevitably lead to trillions of dollars of stranded assets across the corporate sector and hit petro-states that fail to reinvent themselves.”Fossil fuels will peak in the 2020s as renewables supply all growth in energy demand - Carbon Tracker InitiativeSee also 2020 Vision: why you should see the fossil fuel peak coming - Carbon Tracker InitiativeIt’s not just them warning about this, it’s mainstream. Mark Carney, governer of the bank of England, François Villeroy de Galhau, governor of Banque de France, and Frank Elderson, chair of the Network for Greening the Financial System wrote an op e.d for the Guardian warning about this.Their op ed presents a strongly worded message taht companies and industires that fail to adjust to the new world of CO2 emission reductions will cease to exist.To help with the transition and protect industry and investors from the risks they have created a Network for Greening the Financial System (NGFS).The impact of climate change has compelled governments to act. Catalysed by the Paris agreement, governments around the world are putting policies in place to limit the global rise in temperatures to 2C, and preferably as close to 1.5C as possible. The actions undertaken by individual countries will deliver a collective transition to a low-carbon economy. But this transition brings its own risks. Carbon emissions have to decline by 45% from 2010 levels over the next decade in order to reach net zero by 2050. This requires a massive reallocation of capital. If some companies and industries fail to adjust to this new world, they will fail to exist.The prime responsibility for climate policy will continue to sit with governments. And the private sector will determine the success of the adjustment. But as financial policymakers and prudential supervisors, we cannot ignore the obvious risks before our eyes.That is why 34 central banks and supervisors – representing five continents, half of global greenhouse gas emissions and the supervision of two-thirds of the global systemically important banks and insurers – joined forces in 2017 to create a coalition of the willing: the Network for Greening the Financial System (NGFS).The financial sector must be at the heart of tackling climate changeFor details:Press Release: The NGFS publishes an overview of climate-related impact assessments on financial stability and announces new members and observersOil companies particularly are under increasing pressure from their shareholders to work on plans compatible with the Paris agreement to keep temperature rises well below 2 C.Most oil giants still fighting shareholder pressure to address climateIn the short term, one of the top priorities is to reduce Flaring emissions which produce methane, a potent short lived gas. This is relatively easy to fix, and the Zero Routine Flaring by 2030 is endorsed by 32 governments and 36 oil and gas companies.Long term the oil companies are amongst the companies that most need to diversify and transition to stay in business. And their shareholders also know that.They have started to invest in renewables but so far the invesments, though relatively large, billions of dollars, are only a small fraction of their total investments in new oil field prospecting and such like.Oil giants face shareholder pressure on climate emissions, greenhouse gas targets | DW | 20.05.2019Many have also joined the Oil and Gas climate change initiative.Our Members - OGCI - Oil and Gas Climate InitiativeThey are working to reduce methane flaring, and increase carbon capture and storage and utilization.Policy & Strategy pageOTHER RESOURCESI will cover other resources at the end of this answer. But in short, Lithium is not the problem it is made out to be, as there are alternative sources already being developed, Molybdenum is an issue but it can be solved. Antinomy can be replaced with other flame retardants. Water is not a problem, there is plenty of it, and we can always make more with desalination for desert regions, we can also export it. There are many local issues such as making sure that India and China get decent water supplies from the Himalayas, but these can be solved.PLENTY OF FOSSIL FUELS IN THE GROUNDAlthough we are not going to use them, I’ll do a quick look at the amount of coal, oil, and gas in our reseves. About 140 years worth of coal, 53 years for conventional oil and gas, 1300 years for shale oil:Coal first:Global Energy & CO2 Status Report: CoalAs of 2016. the world was using 7.8 billion tonnes of coal a year.CoalThe world coal association estimates that there are 1.1 trillion tonnes of coal reserves worldwide.Where is coal found?That’s enough for 140 years of coal.Oil demand has already peaked in the middle East and is more or less stable in Europe and AfricaGlobal Energy & CO2 Status Report: OilThere are deep reserves of oil that cost more and more to extract, and meanwhile the cost of renewables are falling rapidly, so it’s a case of diminishing returns.In 2015 world oil production was 4.461 billion tons a year. Shale oil amounts to 6,050 billion tons. That’s enough for over 1,300 years of current production.There are 239 billion tons of recoverable conventional oil, enough for 53 years of production at current rates.OilNatural gas demand continues to rise.Global Energy & CO2 Status Report: GasProven natural gas reserves are 187.1 trillion cubic metres. Annual production 3.5386 trillion . That is equivalent to 53 years of production.GasSo we have enough conventional oil and gas at full production rate like now for another 53 years and long before then we should have transitioned to nearly all renewables. As for shale oil, nearly all of those 6,050 billion barrels of oil need to stay in the ground to stay within 1.5 C of global warming.STRONG GROWTH IN RENEWABLESRenewables are growing strongly. Currently they represent 45% of world electtricity generation growth.25% of global power is now produced by renewables.TCEP: Renewable powerGlobal Energy & CO2 Status Report: RenewablesThis shows current forecasts - we need to increase renewables fasterTCEP: Renewable powerRAPID PRICE DROP FOR RENEWABLESHowever the cost of renewables is falling rapidly. This is for the UK, 50 - 60 degrees North and even here the cost of solar -PV power generation has reached the same levels as the most efficient fossil fuels and is predicted to fall below them in the next few years. Onshore wind is also equal or below the best fossil fuels.The price drop for solar is especially remarkable, a drop from 2012 to 2022 from 27 to 4 cents per kilowatt hours.Before 2015, only four years ago, solar power couldn't compete even with the most expensive of fossil fuels without government subsidies.RENEWABLES GROWING FASTER THAN ANY OTHER FUEL IN HISTORYRenewables are penertrating the global energy system more rapidly than any fuel in history according to BP.They do two a number of scenarios to guide their policy planning.The Rapid Transition (RT) is a 45% fall in emissions by 2040 while Energy Transition (ET) is what happens if we do nothing to combat climate change, emission grow but slowly because of growing population and increasing industrialization but offset by increasing natural transition to renewables.Their RT is roughly equivalent to the 2 C Paris goal.However the UN and many countries are moving to target 1.5 C, and also want to follow the easiest route to get there. We may not achieve that right away with our 2020 pledges, but we have until 2030 to increase pledges to acheive it. If this is done, then it will be a more rapid transition than BP’s RT, a 45% reduction by 2030.It’s looking increasingly likely that we do this, with the UN calling for that as the target and UK already aiming for it, and other countries likely to soon, many of the smaller countries do already. You an expect the growth to be faster even than for their RT if we succeed in this.With the “Rapid transition” then the oil (green) peaks well before 2040:For details see BP Energy Outlook 2019 editionBut if we target 1.5 C then the transition will be faster than their Rapid Transition.As I said in the intro the Shell Sky scenario sees oil peak by 2025 (Shell energy transition report 2019). Carbon Tracker has all fossil fuels peak in the early 2020s.PEAK OF CO2 EMISSIONSCO2 emissions continue to rise but we are expected to reach peak CO2 emissions soon.Tracking Clean Energy ProgressMany countries have already reached peak CO2 emissions.In 2018 emissions continued to rise in China ( 2.5%) and India (4.8%), though per capita emissions in India remain at only 40% of global average.They rose by a small amount in the US but remain at around the 1990 levels.They fell in Europe by 1.3%, in Japan, and Mexico,Global Energy & CO2 Status Report: CO2 emissionsThe UK emissions are rapidly falling, on tarck for an 80% reduction by 2050, but with its recent commitment to zero emissions by 2050 then this line will dip down even faster.However China is the key to world emissions. It is rapidly industrializing and for the time being it is increasing emissions because it uses coal fueled power staions.HHere the height of the graph shows the per capita emissions, horizontal axis is population, the area sows total emisisons ,China has largest area of all. Worldwide CO₂ emissions for 2016China and India are amongst the most affected, and are strongly motivated to do their darnest to address climate change, and are showing by action that this is a top priority for them.China is currently targeting a 20% non fossil share by 2030, and there were reports that it is expected to target 35% of electricity from renewables by 2030 according to drafts for its next plan, the “Renewable Portfolio Standard”.The world's largest solar farm, from space The 850-megawatt Longyangxia Dam Solar Park. It is built right next to a big hydropower dam - because then in the day when the sun is shining the power comes from the solar powers and the dam ramps down.At night then the dam then releases the water it held back during the day. This more than doubles the power output from the hydro electric and because the hydro can store power until it’s needed, like a giant battery, this means there is no curtailment - it never produces more power than is needed.China together with France also made a series of pledges on 29th June 2019They agreed to on the importance of zero emissions, to update their pledges in 2020 as a progression beyond the current pledges, the importance of maintaining biodiversity, and the need to fully fund and support the $100 billion Green Climate change fund and advanced technology transfer to developing countries to help them mitigate climate change as well as adapt to it.Carbon brief's comment on this is here: China pledges to strengthen climate planAnother study finds that China is already on its way to peak emissions earlier than it pledged to (its current pledge is to peak before 2030). This was based on a study of its cities. Bejing peaked in 2007.This study found that the decarbonization of Chinese cities depends on their GDP, that as the GDP increases, decarbonization is easier (a pattern found in other countries too).If the country as a whole progresses in the same way as the cities, China's emissions may peak between at 13–16 gigatons of CO₂ per year between 2021 and 2025, approximately 5–10 years ahead of the current Paris target of 2030.That study is here China’s CO2 peak before 2030 implied from characteristics and growth of citiesCarbon Brief's comments on that study are here: China’s emissions ‘could peak 10 years earlier than Paris climate pledge’RAPID TRANSITION FROM COAL TO RENEWABLESThe number of completed coal fired pants has dropped by more than half since 2015.Global 'collapse' in number of new coal-fired power plantsThis shows how the currently operated coal-fired power plants will decline if used at the current average rate for average 40 years lifespanDetails in Boom and Bust 2019 TRACKING THE GLOBAL COAL PLANT PIPELINEThe world has to follow the solid black line to stay within 1.5 C by the easiest route. But that’s not a problem. Renewables are already competitive with coal. The main problem China and India face is that Renewables have a very high start up cost and then pay back over their lifetime with very low running cost.Also the start up cost for a new renewables plant keeps decreasing year on year, so if you postpone construction by a few years you save millions of dollars on the cost of your power plant and it is more competitive economically.The new coal fired power plants cost less to build and are more expensive to run. So it is natural for them to build many of them early on as they transition to renewables and then not use them to capacity. It’s not as silly as it seems. They can also use carbon capture and storage with coal fired plants.For details see:New study does NOT conclude that we have too many fossil fuel power plants and vehicles to stay within 1.5°CCLOSE TO PEAK CHILDWe are already close to peak child, for five year olds and 15 year olds, the same number of children in the world more or less in 2019 as in 2009.When will the world reach 'peak child'?Our population continues to grow due to remarkable increases in life expectancy.Increase from 52.568 in 1960 to 72.223 in 2017 or 19.655 years world life expectancy at birth increase in 57 years.Life expectancy at birth, total (years)Life ExpectancyA lot of that increse is due to reduced infant mortality but the life expectancy at all ages is also increasing, for instance for England and Wales, which has good data:More graphs hereLife ExpectancyEXPECTED TO LEVEL OFF AROUND 2100 - OR PERHAPS EARLIER, BY 2050This shows how though the population continues to increase, the growth rate is plummeting and we are expected to level off around 2100.Chart from: World Population GrowthBy region, the population is expected to peak in Asia long before 2100, around 2050:Chart from: World Population GrowthJapan’s population peaked in 2010 and is now decreasing as fast as it increased, down to 1960 levels.Here is a page about the Aging of Japan - Wikipedia - it is already decreasing. Reduced by well over a million from a high of 128.06 million in 2010 to 126.71 million in 2018. Japan Population | 1950-2018 | Data | Chart | Calendar | Forecast | NewsGenerally worldwide, the most prosperous countries tend to have either very slow population growth or declines. For example, in Europe, nine countries report population declines, with Latvia having the steepest decline. That’s due to migration in part Latvia's rate of population decline still among EU's worstChina’s population is expected to fall rapidly with middle of the range estimates, down to mid 1980s levels by 2100, again like Japan falling as rapidly as it is currently rising.The main increase is in Africa and that’s projected to dominate the world population with a population greater than Asia with World Population Division projectionsOlder figures from 2014. Most of the population growth is in Africa by the end of the century by these figures, with everywhere else leveling off by then, the least developed countries are the ones that grow most rapidly, so that's a reflection of the situation in AfricaHowever, they project an increase of Nigeria’s population from 0.2 billion to not far off 0.8 billion, two thirds of the population of India in less than a third of its area. A population density much higher even than India How likely is that?Improvements in education, especially of women, lead to lower birth rates.If you factor that in then the population can peak anywhere from 2050 onwardsSee The human core of the shared socioeconomic pathways: Population scenarios by age, sex and level of education for all countries to 2100Future fertility and hence population growth will depend on female education.In the median assumptions scenario (SSP2) world population will peak around 2070.By 2100 world population ranges from 6.9 (SSP1) to 12.6 billion (SSP3).See The human core of the shared socioeconomic pathways: Population scenarios by age, sex and level of education for all countries to 2100OTHER RESOURCESSee alsoThis expands on some of that, and goes into other things such as resources and energy return on energy invested for fossil fuels compared to renewablesDebunked: Soon we won’t be able to feed everyone because the world population is growing so quicklySee also24 ways the world is getting better - good news journalists rarely shareWe can feed everyone through to 2100 and beyondNo Scientific Cliff Edge Of 12 Years To Save Planet (or 18 Months) - Can IPCC Challenge 'Deadlines Make Headlines' Misreporting?This debunks a myth about renewables - we have plenty of space for them, and they do not take away good agricultural land or land for conservation, not if done properly. Solar panels raised above the ground can be mixed with agriculture, they can be built on house roofs, on brown fields, on low conservation value areas of desert, or floating on canals, lakes and other waterways (especially useful in hot dry conditions as they help reduce water loss through evaporation).One particularly useful synergy comes from putting floating solar on hydro dams, where it also helps to reduce evaporation and can double the power output of the hydro without any curtailment because of the way the hydro can rapidly respond as peaking powerDo renewables for power generation take up more land area than fossil fuels? Well - not really!And if you are concerned by effects on wildlife, it’s true that there can be effects, but this just means they need careful siting. The concerns are real and they do need care, but they are based mainly on very early examples of each, built before the problems that could arise for such installations were fully understood.Wind farms and solar farms need to be sited carefully to protect wild birds, bats and insects - but biggest risk by far is … the domestic cat! Responsible for 63 extinctions, wind farms for 0 extinctionsWHAT ABOUT ENERGY RETURN ON ENERGY INVESTED (EROEI)?The days of easy to extract oil is over and the “Energy returned on energy invested” is going down. But renewables give a high return too, hydropower is most of all, over 100.Here are some estimates for the US from 2014. For solar photovoltaic, then it depends a lot on the type of solar panel used, the EROI is going down as they become more efficient and require less by way of materials to make the panel with many different technologies for them. As you can see, for the US, then photovoltaic is already better than shale oil (fracking) and wind turbines are right up their with oil and gas:From this paperHere an EROEI would mean you put as much energy into producing the power than you get out of it. For it to be worth doing normally you want to be putting in less energy than you get out. But this is a controversial way of measuring things. For instance it doesn’t include environmental impact, if you are getting more energy than you put in but what you are doing is impacting on other things then how much do you offset for that?It’s discussed by Carbon Brief hereEnergy return on investment - which fuels win? | Carbon BriefThe graphic they use there is from an article “The True cost of fossil fuels” from 2013 that is no longer available on the web for some reason. Broken url on the Scientific American website. Jstor entry here: THE TRUE COST OF Fossil Fuels and this is a higher resolution version of the extract they show:The image itself is here Renewable EnergyThough the article doesn’t exist any more even in the Wayback machine, the notes by the author Mason Inman on his graphic are available here:Behind the Numbers on Energy Return on InvestmentThere is no real hard limit to how much we can produce from renewables on Earth, we can supply power for many times our population from the Sahara desert alone. It’s a matter of how to do it in the most efficient, practical way possible.This image shows how much of the Sahara desert would be needed to supply all Earth’s electricity requirements if it was covered in solar panels. This is for 2005, and the power requirements from all forms of power would require five times this area:“The red squares represent the area that would be enough for solar power plants to produce a quantity of electricity consumed (as or 2005) by the world, the European Union (EU-25) and Germany (De). (Data provided by the German Aerospace Centre (DLR), 2005). To replace all energy consumption (not just electricity), areas about 5 times as large would suffice.” Fullneed.jpg - Wikimedia CommonsYou can also get renewables from space. Japan particularly is exploring this as it imports a lot of electricity, has very little by way of natural sources, and has space technologyJapan plan to set up vast thin film mirrors in space. It’s potentially economic because you can use flimsy mirrors that would blow apart in the lightest breeze on Earth.In space you can spread these micron thin flimsy mirrors spread out to capture all the sunlight falling on square kilometers of mirrors,to capture sunlight and focus it on a collector to convert to power and beam back to Earth .It would collect the power in Geostationary orbit and beam it back to Earth using either microwaves or laser light.Whatever method they use, they would use lots of small harmless beams and a pilot beam on the ground that the tiny microattennas in space focus on individually, to deliver the energy. If one of the microantennas for some reason malfunctions or the pilot beam gets disrupted, it’s harmless.Research on the Space Solar Power Systems (SSPS)NUCLEAR FUSIONThen Nuclear Fusion is a potential total game changer but we can’t predict this. It probably won’t be until the 2050s before we have the first fusion power stations, but still, it may make a big difference in the second half of the twentieth century.DEMOnstration Power Station - WikipediaThe ITER - the way to new energyITER ... and then what?They think they know how to make a commercial nuclear fusion power plant. This would be clean energy with no proliferation risk.They have to demonstrate that the fusion process works in the ITER first, and then about 20 years later they would have DEMO operational.DEMO will be operational around 20 years after high power burning plasmas are demonstrated in ITER Roadmap executive summary.It would start producing electricity about 20 years after the ITERRoadmap- EUROfusionOTHER NUCLEAR FUSIONThere are many other types of nuclear fusion being explored including laser fusion. One of the most interesting is the Polywell. It uses electrostatic confinement fusion. This is nuclear fusion that a hobbyist can quite literally do in their shed or garage if they are very knowledgeable. But it normally requires far more power than it outputs in fusion energy.A homemade IEC fusion reactor created by a high school student, William Jack, clearly showing the plasma and poissors emanating from it.The challenge is to make this energy efficient, and the Polywell design just possibly may be able to do it. The US Navy was interested in the design and put several millions of dollars of funding into it.Polywell - WikipediaIt has not quite got there yet, but it may still work.If it works then these could be very small cheap reactors small enough to power a village through nuclear fusion. A full scale reactor would be a few meters in diameter. Far smaller than the huge power stations of the ITER.Polywell Fusion An Almost There Cheap Clean Alternative EnergySo far none of these have quite panned out but it is possible for something like this to appear “from left field” as it were and transform the energy sector.WATERWe are not running out of water, we can’t. Desalination is already economic in places where there is water scarcity such as Israel.There is plenty of water, it’s a distribution issue with some already being exported, there are ways to do it and though there have been local conflicts over water supplies it’s not going to lead to major warsDebunked: Water warsAcceleration Of Himalayan Glacier Loss Is Due To Warming - Billion Need Climate Resilience On Rivers Like Yangte, Ganges & IndusHELIUMThere is plenty of helium just now because of reduced demand in the pandemic, fewer helium balloons and less industry.Helium shortage has ended, at least for nowThere are helium deposits, just that to date there has been plenty of helium as a biproduct of extracting fossil fuel. But if your aim is helium then there are places where it accumulates by itself not mixed up with fossil fuels, this was found in 2016:Huge underground helium reserve discovered in TanzaniaThese reserves will be useful when we have greatly reduced fossil fuel extraction later in the twenty first century.COBALT AND LITHIUMFor cobalt there is plenty of it but it doesn’t sell for a high enough price to be worth mining except in the Congo where it is a byproduct of copper mining. There are several new facilities planned there that will easily cope with the demand, the problem is the political stability of the region.In other places it is mixed with nickel rather than copper, and nickel isn’t valuable enough to mine in enough quantities to get enough cobalt. However nickel prices may well go up because of its value for batteries and if so more would be produced and cobalt supplies increase.Battery manufactureres are also looking at changing the Nickel :cobalt:manganese mix to 8:1:1 instead of 1:1:1 which increases energy density, while shortening battery life.The Truth About the Cobalt Crisis: It’s Not a Crisis, YetFor lithium, currently most of it comes from the Salar de Uyuni - WikipediaSalt production UyuniHowever there are other sources of it, in particular, extracting it from geothermal brines using a sorbent.A greener way to get lithium?There’s another process that is already in use for extracting lithium from waste water from waste water from shale oil mining and other oil and gas mining using an evaporation and crystallization system described here:Successful Independent Verification of the MGX Lithium Extraction TechnologyThis is already in commercial use.MGX Minerals advances rapid lithium extraction technology | MINING.comThis article doesn’t cover those latest developments, but gives an overview of Lithium production:How Does Lithium Mining Actually Work and Will We Have Enough?RARE EARTHS"Rare earth" minerals are not actually rare. They are similar in abudance to, say, copper. The main thing is the environmental cost of extracting them. The US has a rare earth plant itself that it mothballed and has re-opened recently and there are many other rare earth deposits around the world that could be used if China stopped exporting them, though the prices would likely go up because of the environmental regulations.Rare earth elements aren’t the secret weapon China thinks they areChina has more or less cornered the market and it would take a while to set up another equally large supplier if they stopped - it's the problem of the equipment and factory though not of the actual ore, and the environmental regulations.Seems unlikely that China will carry through with this, but if they do then it would lead to the US finding new suppliers for new equipment (equipment they already have would be okay), Seems Australia is next largest producer at present worldwide. Some mud off Japan's coast is an excellent future source.Asia Times | If China cuts rare earth supplies, what can the US do? | ArticleThe main risk is just of an increase in cost of rare Earths.OTHER MINERALSSome minerals at least are so abundant we can’t run out of them any time soon. Others we may need to conserve / recycle / find alternatives.What if we ran out of minerals?In some cases they may be harder and harder to extract. E.g. there is plenty of phosphorous, indeed, tectonic processes are moving as much phosphorous up to the surface as we are using up.In more detail, we have enough phosphate rock resources for 300 to 400 years and what's more tectonic processes are contnuously exposing more reserves than we use! If I understand right, at the end of those 3- 4 centuries we will have enough new reserves exposed by tectonic processes to keep going. No reason to run out ever as far as I can tell.Here are some experts saying there is no phosphorous crisis.Pedro Sanchez, director of the Agriculture and Food Security Center at the Earth Institute, does not believe there is a phosphorus shortage. “In my long 50-year career, “ he said, “once every decade, people say we are going to run out of phosphorus. Each time this is disproven. All the most reliable estimates show that we have enough phosphate rock resources to last between 300 and 400 more years.”In 2010, the International Fertilizer Development Center determined that phosphate rock reserves would last for several centuries. In 2011, the U.S. Geological Survey revised its estimates of phosphate rock reserves from the previous 17.63 billion tons to 71.65 billion tons in accordance with IFDC’s estimates. And, according to Sanchez, new research shows that the amount of phosphorus coming to the surface by tectonic uplift is in the same range as the amounts of phosphate rock we are extracting now.Phosphorus: Essential to Life—Are We Running Out?Animals excrete nearly the same amount of phosphorous they eat - and it can't be lost to the air, not much lost to oceans normally. It's mainly an issue because we move things around and we don't get as much returning to the land as was extracted so have to replace it using phosphates. With more recycling back to the ground, then we wouldn't need phosphate fertilizer.Also there is a lot we can do to reduce the amount of phosphorous that gets into waste and into the sea eventually as pollution that causes dead zones in the sea. That’s more of an issue than running out of it. There’s a lot of progress there - farmers tend to apply too much phosophorous and the excess washes away. If they analyse the ground and apply targeted amounts based on what is needed, they save money, less phosphate rock is used, and less gets washed off into the sea to cause algal blooms and dead zones and this is happening now that we have easy ways to rapidly measure the phosphate content in the field.But there is plenty of it.Phosphorus: Essential to Life—Are We Running Out?This article is by Theo Hankens who did a doctoral thesis on the subject, he identifies the top ten scarce minerals and roughly how long they would last at current rates of mining:An update on mineral depletion: do we need mining quotas?There antimony can easily be replaced by other flame retardants. The others can be recycled, but little of that is going on. Molybdenum is especially hard to replace by anything else (Elements in the spotlight: molybdenum ).Molybdenum can withstand much higher temperatures than steel, and is corosion resistant and is expected to be used much more in a greener future.It’s use is growing considerablyThis article suggests stockpiling molybdenum, to keep the price higher to encourage recycling.To achieve the necessary reduction in molybdenum extraction, primary molybdenum mines would need to be closed and some of the molybdenum produced as a by-product of the copper mining would need to be stockpiled for use by future generations. It should be noted that copper is also a relatively scarce mineral resource, and its extraction might also need to be reduced to become sustainable. As long as molybdenum production continues to exceed sustainable production, it is important to stockpile molybdenum, to avoid the price for molybdenum being so low that it hampers sufficient molybdenum recycling.Molybdenum resources: Their depletion and safeguarding for future generationsWe can also get them from seawaterWe already get magnesium from sea water. The Japanese at one time developed a way to get uranium from sea water at $140/lb when the market price was $120 /lb. It's a quarter of that price now so it's not economically viable at present.Singapore has looked into extracting metals from the brine that's left over after desalination. Every million litres of sea water produces 1,300 kg of magnesium, 900 kg of sulpur, 400 kg of calcium and 400 kg of potassium. which could in principle be recovered.Lithium can also be recovered from brines.Over 40 minerals and metals contained in seawater, their extraction likely to increase in the futureWe can also get resources from space too (though molybdenum is rare in space as well), space mining for some of the rarer metals such as platinum which would be worth the high costs of returning it, then later prices can go down as it gets easier to export materials from space to Earth.There is some evidence suggesting a possibility of vast reserves of platinum near the lunar south pole. If so then it would depend on how much platinum there is but some iron meteorites have very high percentages of platinum enough so that it could be worth exporting to Earth:From Wieczorek et al, the North and South poles are marked N and S. Notice the magnetic anomalies clustered around part of the rim of the South Pole Aitken Basin. This is thought to be the result of an impact by a 110 km diameter asteroid. Wieczorek et al hypothesize that the magnetic anomalies trace out the remains of the metal core of this asteroid. If so these could be rich ores, including iron, nickel, also platinum and other platinum group metals (gold, rhodium etc). See page 16 of Crawford's Lunar Resources: A ReviewDennis Wingo suggested in Moonrush that the platinum especially could be worth exporting to Earth for use for fuel cells, as an application that could be high value and yet need a lot of platinum.The Moon and asteroids have vast reserves of aluminium, titanium, thorium, potassium, phosphorous, rare earth elements, and many other materials that we could also use once we have low cost transport to / from the Moon.I know that probably seems far in the future today, but there are various advances that may make it much easier to travel to / from the Moon in as soon as a decade or two than it is today.This is from my Case For Moon First and focuses on the Moon:Thorium and KREEP (Potassium, phosphorus and rare earth elements), and some uraniumMetalsThey may well be an important part of the future resources mix but they are not required as we have plenty resources on Earth for everyone through to 2100.GDP - DOESN’T HAVE TO PEAKYou often get people saying that economic growth will have to stop on a finite planet, that our GDP has to peak. But others say there is no need at all for this.However you measure it we need to bring everyone up to the standards we expect in the West. We need to value nature services and biodiversity more as we do so.Maybe GDP is not everything but a future world where we have everyone in good living conditions, good health, nature working well, biodiversity preserved, energy produced using renewables worldwide, needs a big growth in world GDP from what we have now.This does not mean we need to use more and more resources. If it's a circular economy, recycling, reusing, increasing energy efficiency, then we can use less and less resources while continuing GDP growh.For more on this see mySustainable continuing economic growth on a finite planet - how is that possible?ySEE ALSO(this includes material from my MOON FIRST Why Humans on Mars Right Now Are Bad for Science )See also my answer to What is the impact of global warming on agriculture?Debunked: Soon we won’t be able to feed everyone because the world population is growing so quicklyWe can feed everyone through to 2100 and beyondNo Scientific Cliff Edge Of 12 Years To Save Planet (or 18 Months) - Can IPCC Challenge 'Deadlines Make Headlines' Misreporting?This Is How You Save A Million Threatened Species - And Make Biodiversity Great Again - The Solutions In The UN IPBES ReportDebunked - that we are in the middle of the sixth mass extinction

For an in-depth analysis of the roots of our healthcare cost problems, please read the article pasted in below.Twenty-Eight million Americans are without health insurance while the OECD, a group of comparable rich nations, enjoy universal healthcare with a much lower per capita costs.We’ll make the case we can successfully attack the sources of the problem which is, for the most part, the high prices of providers and drugs. While certain insurance-related inefficiencies add costs to our system, the high price of insurance is a reflection of a very costly healthcare system. We’ll also show Americans overall don’t consume more healthcare and don’t get better care or quicker services.We also consider how much of the difference in per capita US spending vs. OECD countries may be explained by social, demographic, and health behaviors. As we address these differences, we will identify factors driving up our healthcare costs and measure only the extra costs the U.S. incurs or saves. In some cases, we may have better outcomes. For instance, U.S. obesity is higher but we smoke less and are younger on average. We’ll attempt to net it out where possible.How much is our overspending?The US spent about $3.4 Trillion dollars on healthcare in 2018 funded by co-pays, deductibles, private insurance, the VA, and Medicare/Medicaid. With about 326 million people in the U.S., that works out to about $10,348 per person. We spend approximately double or $5,179 per person more than the OECD or $1.7 Trillion more than we should when compared to our OECD peers.$1.7 Trillion/yr in excess spending exceeds our Federal Defense and Welfare budgets combined and even more than the government collected in personal income taxes in 2016.In addition, 99.9% of the OECD population has public or private health insurance. The US covers 91.2% leaving over 28 Million people uninsured.Since our excess healthcare spending exceeds personal income taxes and many comparably rich nations provide universal healthcare equal to ours in terms of health outcomes, it makes sense to examine how we can benefit from adopting the existing practices which would work best in the U.S.We have nothing to lose by being open-minded.Is U.S. healthcare better and do we enjoy better access to services?The U.S. does not have better health outcomes or an access advantage from its comparatively expensive healthcare system. U.S. life expectancy is 78.8 years vs. 81.2 years for the OECD overall.The charts below show appointment wait times, the number of physicians, physician visits, and hospital utilization in the U.S. are not equal to the OECD average!Life ExpectancyWait times are not a U.S. advantageWait TimeSources of excess costsExcess spending must result from higher unit cost or more healthcare consumed (higher utilization), or a combination of the two.Keep reading to find out which it is.Social factors which may lead the higher healthcare usage/costs.This section will examine some societal/lifestyle factors which are commonly cited as reasons our healthcare outcomes are worse than other 1st world counties.Violence, Accidents, & Suicide are not the problem.You may hear America is a more violent country and has a higher incidence of auto accidents and suicide which results in lower life expectancy, making our healthcare system look bad by comparison.An analysis by Ohsfeldt and Schneider in their book, The Business of Health: The Role of Competition, Markets, and Regulation: stated “ death rates among adolescents and youth can have a dramatic impact on estimated life expectancy. In that light, it is important to note that some specific cultural aspects of American society largely outside the purview of the health care system contribute to rates of death from injury, both unintentional (accidents) and intentional (homicide and suicide). Rates of death from injury are usually high in the United States compared to other developed countries, which affects the apparent underperformance of the U.S. health system”However, Ohsfeldt later acknowledged a simplistic statistical method was used for his “little book project.” which yielded incorrect results. They should have recalculated life expectancy after removing those who died from these causes from overall the mortality statsWhile there are higher death rates for younger people from these sources, they have no meaningful impact overall on US death rates due to their relatively small numbers. Violence, accidents, & suicide are not the reason we have lower life expectancy than the OECD.ObesitySome correctly note that the US has a higher incidence of obesity than the OECD, (U.S. 38.2% vs OECD 18.5%). The total U.S. healthcare cost of obesity has been estimated at $316 Billion. Higher U.S. obesity rates result in extra U.S. healthcare costs of about $154.69 Billion.Defensive MedicineBased on studies conducted by The National Center for Biotechnology Information, the total cost of the legal system to the healthcare system including defensive medicine is about $80 Billion/yr. It is likely some defensive medicine actually has health benefits. There are legal costs associated with healthcare systems in OECD countries too so our excess costs should be less than $80 Billion/yr. Since no reliable data was found on the legal costs imposed on OECD healthcare systems, we will assume the entire $80 Billion is a source of extra US costs.Where is the Higher Utilization?If obesity, defensive medicine, and other social factors such as the opioid epidemic are driving US healthcare costs higher, then Americans should be consuming relatively more healthcare. But the evidence suggests we do not utilize more healthcare per capita than the OECD average which suggests these factors are not significant enough to be the source of our spending gap vs our OECD peers. So let’s look at some other U.S. cost drivers.Admin costs and complexityU.S. healthcare suffers from the highest admin costs in the world. A New York Times article reports “One obvious source of complexity of the American health system is its multiplicity of payers. A typical hospital has to contend not just with several public health programs, like Medicare and Medicaid, but also with many private insurers, each with its own set of procedures and forms (whether electronic or paper) for billing and collecting payment. By one estimate, 80 percent of the billing-related costs in the United States is because of contending with this added complexity.”A JAMA study reports “Administrative costs of care (activities relating to planning, regulating, and managing health systems and services) accounted for 8% in the US vs. a range of 1% to 3% in the other countries.” The net administrative burden is costing the U.S. about $204 Billion annually, but as the JAMA study notes, absent the Byzantine insurance payer system the U.S. has, the administration cost gap would be inconsequential.Cost Differences Due to Social/Lifestyle FactorsExcluding the inefficiencies generated by higher admin costs which will be dealt with later, this is how US vs. OECD extra costs add up:Keep in mind, we have not addressed the potential positive cost impact of social factors which might favor the US such as our lower tobacco and alcohol use, a lower percentage of people over 65 and a higher percentage of people under 21.Primary Sources of Excess SpendingIt’s the prices Stupid!In a January 2019 article in Health Affairs, the authors updated a study they conducted in 2003 and concluded “ A 2003 article titled “It’s the Prices, Stupid,” stated “we found that the sizable differences in health spending between the US and other countries were explained mainly by health care prices. We used (OECD) Health Statistics to update these analyses and review critiques of the original article. The conclusion that prices are the primary reason why the US spends more on health care than any other country remains valid, despite health policy reforms and health systems restructuring that have occurred in the US and other industrialized countries since the 2003 article’s publication. On key measures of health care resources per capita (hospital beds, physicians, and nurses), the US still provides significantly fewer resources compared to the OECD median country. Since the US is not consuming greater resources than other countries, the most logical factor is the higher prices paid in the US.”Drug PricingDrugs commonly cost 3X more in the U.S. than in our OECD peers.According to a Wall Street Journal article, “ Drug prices in the U.S. are shrouded in mystery, obscured by confidential rebates, multiple middlemen and the strict guarding of trade secrets.” The article continues “The state-run health systems in Norway and many other developed countries drive hard bargains with drug companies: setting price caps, demanding proof of new drugs’ value in comparison to existing ones and sometimes refusing to cover medicines they doubt are worth the cost.” and “ The government systems also are the only large drug buyers in most of these countries, giving them substantial negotiating power. The U.S. market, by contrast, is highly fragmented, with bill payers ranging from employers to insurance companies to federal and state governments.”Inexplicably, with 29% of spending for U.S. retail prescription drugs, Medicare has huge negotiating power it can’t use by law. The Medicare Modernization Act of 2003 states the secretary of Health and Human Services “may not interfere” in negotiations between pharmaceutical companies and prescription drug insurance plan providers.That Medicare can’t negotiate drug prices is unique among federal health programs. As a contrast, Medicaid has mandatory drug rebates & the VA requires drug providers to charge the lowest price paid by any private-sector buyer. The VA pays 40 percent less than Medicare Part D, according to a study published in Health Economics.Aside from the large buyers like the VA and Medicaid, no single insurance company has the market power to achieve prices competitive with our OECD peers.Note the drug price differences in the U.S. vs other countries as a result of these policies.Drug InnovationThe US spends about $350 Billion a year on prescription drugs. Assuming we only pay twice the world average (for the exact same drug), that would mean we are spending $175 Billion more as a nation than our OECD peers. A common fear of the US paying lower prices is that the drug companies will not have any funds for R&D. However, in 2017, Pharmaceutical company R&D amounted to about $90 Billion or about 50% of excess U.S. drug costs.Medical Procedure PricingThe cost of medical procedures is much higher in the U.S. than our OECD peers as well. Again, here are some examples.Why are Drug and Procedure prices so high?Our OECD peers organize their healthcare markets in a variety of ways from the government-run National Health Service in Britain to having different levels of private/public healthcare providers funded by different schemes blending varying levels of private insurance and public financing of the healthcare costs. What the OECD systems have in common is they are very involved in setting national standards and negotiating systemwide healthcare prices which lets them benefit from their concentrated market power.The U.S. is an outlier in its high reliance on private insurance and fragmentation of negotiating power. This is the main driver of the cost gap!Barriers to a Free MarketIn a free market, prices settle where supply and demand are in balance. If prices are too high, supply will exceed demand and prices will be forced down. If prices are too low, demand will exceed supply and there will be shortages forcing prices up. Normally you’ll not observe much price deviation for most products from competing suppliers. For instance, gasoline will not cost $2/gal at one station but $7/gal at a station across the street.While most markets have some minor imperfection, most are not significant and are of small consequence. An example is switching costs. If you rent an apartment for $1,000/month it will not be worthwhile to move to an equal apartment to save $10/month. The cost and hassle of moving (switching costs) can result in minor price variations for the same apartment.But healthcare markets have imperfections which have a big impact on prices.For example, the information asymmetry between health providers and health consumers is very high. Examples include:Hospitals don’t provide reliable advance pricing for a consumer to make an informed choice based on cost or quality.By and large, patients have no realistic way to competently determine which health services they should consume and what it should cost. Even hospitals have this problem. According to a Harvard Business Review article, “There remains in most hospitals unwarranted variation in how physicians treat common problems. It is not unusual for there to be two- to three-fold variation from physician to physician in how efficiently they treat a given medical condition.”More and more, healthcare systems are forcing insurance payers to abide by non-disclosure agreements which keep competitive healthcare providers lower prices hidden from patients.Patients have no way to know in advance if their healthcare services will be in-network. Surprise bills occur when patients go to a hospital that is part of their insurer’s network but then treated by a specialist or doctor who is out of the network — often leaving them with large, unexpected bills.Drug chains often must abide by PBM “gag clauses” prohibiting pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than the co-pay associated with their health insurance plan.Normally, as the price of a good rises, demand for that good drops. In healthcare, the consumer often is not in a position to bargain on price due to lack of price information, provider choice constraints imposed on them by their insurance carrier and/or lack of choices in a geography, and by the often urgent need for care as demonstrated in this cartoon.As discussed below, the continued concentration of healthcare providers in many communities limits provider choices for consumers and restricts price negotiating power by insurance payers and consumers alike. The barriers to entry are very high for new hospital systems. In addition, healthcare systems force their physicians to direct referrals to more expensive in-house services, reducing choice for patients and physicians alike.Let’s examine some evidence of free market dysfunction resulting from information asymmetry, price opacity, and weak buyer negotiating power by observing examples of common healthcare price behavior.Price Variations locally and by payer type.For evidence of market dysfunction and the lack of free market prices, note the extreme price variations for these procedures in the same city.In Philadelphia, a hospital-based MRI can vary by 600%!In Tampa, a knee replacement can cost from $10,000 to over $30,000.https://www.nytimes.com/interactive/2015/12/15/upshot/the-best-places-for-better-cheaper-health-care-arent-what-experts-thought.htmlIn a study of 937 hospitals nationwide for Knee Replacement surgeries, the prices paid for by private insurance varied by 600% compared the much more stable and lower pricing enjoyed by Medicare exercising its considerable pricing power.https://www.nytimes.com/interactive/2015/12/15/upshot/the-best-places-for-better-cheaper-health-care-arent-what-experts-thought.htmlThe next graph shows hospital list prices (what you get charged without insurance), compared to private insurance payment rates, and Medicare Reimbursement rates. The graphs above and below show how much less Medicare pays for procedures given its stronger bargaining position.https://healthcarepricingproject.org/“The marketplace is just not working,” said Gerard Anderson, a health-care economist at Johns Hopkins University. Insurers that must negotiate reimbursement with health-care providers for plans offered by employers pay roughly 50% more than Medicare on average, he said, and those rising costs are “the main culprit for why the U.S. spends so much on health care.”Provider Concentration & Price Transparency“About 77% of Americans living in metropolitan areas are in hospital markets considered highly concentrated, ranging from Modesto, Calif., to Trenton, N.J., according to a Wall Street Journal analysis of 2016 data from researchers at the University of California, Berkeley.”“If you’re the single hospital system in an area, you essentially can set your price, because you’re a monopoly,” said Patrick Conway, the chief executive of Blue Cross and Blue Shield of North Carolina. “We literally have to have them in network.”According to a Wall Street Journal article, “Dominant hospital systems use an array of secret contract terms to protect their turf and block efforts to curb health-care costs. As part of these deals, hospitals can demand insurers include them in every plan and discourage use of less-expensive rivals. Other terms allow hospitals to mask prices from consumers, limit audits of claims, add extra fees and block efforts to exclude health-care providers based on quality or cost.”As Cigna’s chief medical officer, Alan Muney stated: “No hospital system should be able to exercise market power to demand contract agreements that prevent more competitively priced networks.”The article continues, “ Restrictive hospital-insurer contracts have helped prevent even big employers, including Walmart Inc. and Home Depot Inc., from moving forward with plans they were exploring to try to lower costs and improve quality for their workers.”“Hospital care is the largest single component of health-care spending in the U.S. It accounts for more than $1 trillion a year — roughly three times what is spent annually on prescription drugs, the third-largest category. The second largest is physician and clinical services, many of which are now provided by hospital systems as well.”Same Hospital, Different PriceAccording to a working paper for the National Bureau of Economic Research by Questrom’s Keith Ericson, along with Northwestern University’s Amanda Starc and the University of Pennsylvania’s Stuart V. Craig, insurer pricing negotiations for “allowed amounts” at individual hospitals can lead to variations of up to 13 percent across insurers for identical procedures at a single facility. They found statistically significant variations in price for the procedures across insurers. In some cases, these insurer negotiated rates meant that the price of identical procedures at the same hospital might vary by hundreds or even thousands of dollars.Because individuals frequently pay out-of-pocket costs for a procedure, these variations can have a real impact on what consumers pay.Possible Good News on Price TransparencyThere are efforts underway now in Washington to compel insurers to publicize the negotiated rates they pay for medical services. The requirement could affect insurers providing coverage in the private-employer market, where about 158 million people get their health insurance.Additionally, doctors and hospitals would give patients their total price of care before they get services or treatment whether or not the health-care provider is in the patient’s insurance network.Predictably, providers are not happy. One executive stated a broad proposal requiring price disclosure wouldn’t give consumers an accurate picture of out-of-pocket costs under their insurance plans while another said a disclosure requirement could violate contracts between providers and insurers.Provider Concentration Restricts Physicians choices as well.According to a Wall Street Journal article, “Hospitals have gained more power over doctors with a wave of acquisitions of practices and hirings in recent years, and hospitals are getting more aggressive in directing how physicians refer for things such as surgeries, specialty care, and magnetic resonance imaging scans, or MRIs.”“Patients are often in the dark about why their doctors referred them to a particular physician or facility. Increasingly, those calls are being driven by pressures to keep patients within a hospital system, even if an outside referral might benefit the patient, according to documents and interviews with doctors, current and former hospital executives and lawyers.”“Insurers have been working to steer patients toward doctors’ offices and other non-hospital locations for many types of care because they are generally less expensive. The same service often costs twice as much or more when delivered in a hospital setting, compared with a doctor’s office, according to an analysis of dozens of medical services performed for The Wall Street Journal by the nonprofit Health Care Cost Institute.”“Patients often pay more out-of-pocket as a result. A study released earlier this year by researchers at Yale University and elsewhere found that patients whose doctors worked for hospital systems were 27% more likely to get their lower-limb MRIs at a hospital, and their scans cost $277 more on average, with about $90 of that extra amount being added to the patient’s out-of-pocket cost.”Primary care doctor employment by hospital systems has grown 57% by 2016 in just 6 years.The price increases simply as a result of where the health service was performed. The forced shift of referrals to in-house hospital facilities is driving prices higher.Let’s make it simpleThe primary source of higher US healthcare costs is higher pricing per unit driven by weak payer negotiating power, anti-competitive market behavior, high provider market concentration, and an inelastic demand curve. In addition, the proliferation of payers leads to much higher admin costs systemwide.Social issues, defensive medicine, and high patient utilization are not primary cost drivers.Suggestions on how to proceedLet’s be clear, there is no easy answer.To start, I suggest we carefully study the pros and cons of the different OECD healthcare systems. We should adopt the best practices of these different systems to cover everyone, make a big dent in our costs, and use the benefits to gain better healthcare and economic outcomes.My initial thoughts are:What sets the US apart from its peers is the weak negotiating stance of the payors. We should create a national program to negotiate prices, allowed drugs, procedures, and justify the value proposition of newer medical technology which would put our healthcare pricing on par with our OECD peers. This is the norm in the developed world.Eliminate limited provider networks. All patients would be able to use any provider. As a consequence, surprise out of network billing would disappear.NDA’s restricting pricing information would be eliminated creating more transparency.The restrictions placed on health care employees referring patients to competing facilities would be outlawed.The claims process and forms should be standardized across insurers in order to reign in administrative costs.Coverage would expand to include all citizens.A small amount of the large savings would be directed to improve social factors which would lead to a healthier population and even lower healthcare costs.Create a mandatory citizen-owned savings plan funded by citizen and employer contributions that would be used by citizens to pay for their normal medical consumption and larger expenses as they arose. This plan would be backstopped by a government-funded program. The idea is to create a national mindset where citizens expect both an efficient and effective healthcare system. This concept has been proven in Singapore where their healthcare costs are about 75% less costly than ours with similar healthcare outcomes.The above steps would results in more competition among providers, greater price transparency, and insurance companies competing to offer claims services at the lowest cost to consumers and/or employers.Won’t taxes rise?Universal coverage could be funded without raising income taxes due to large potential savings.Disclaimer: The following funding discussion is meant to demonstrate we have the flexibility to finance universal healthcare and not raise taxes. It is not meant to be the actual solution we should follow! That will take some study.We are outspending or OECD peers by $1.7 Trillion/Yr for reasons given above. Ideally, we’d try to be as efficient as the OECD average but let’s assume we only achieve $1.2 Trillion in savings which leaves total spending at $2.2 Trillion/Yr or $500Billion/Yr higher than the OECD average.In 2017, federal and state governments spent $1.775 Trillion dollars on healthcare between Medicaid, Medicare, the VA, and other programs. If we hit our $2.2 Trillion spending target, we need to find $425 Billion from other sources to close the spending gap.According to the Centers for Medicare & Medicaid Services (CME), here is how healthcare was funded in 2017:The U.S. private sector spent $1.549 Trillion on private health insurance plus out of pocket payments in 2017. If we assume government spending stays constant, then private sector spending would have dropped from $1.549 Trillion to $425 Billion in 2017. Private sector spending would be $1.124 Trillion/YR lower while everyone would have health insurance.Another Thought — Let’s Look AheadOne could argue the assumption above that providers will lower healthcare costs without a great deal of disruption may be a tad optimistic. Perhaps a more realistic goal would be to arrest large projected costs increases in the future.You may be aware there is a movement on the left to implement ‘Medicare for All’ (M4A) which in essence provides Universal Insurance for all Americans. M4A was 1st proposed by Senator Sanders during his Presidential bid for the 2016 election. The proposal is not well defined and like the funding proposal above, is aspirational.M4A stirred a lot of controversies. The Mercatus Center, affiliated with George Mason University, published a widely reported study stating M4A would increase government expenditures by $32.6 Trillion over the 10 year period from 2022 to 2032. The study used healthcare cost projections from the CME as a baseline and assumed certain cost savings in drugs, provider reimbursements, and admin costs but higher utilization to re-forecast healthcare costs under M4A.There are two important things to note about the Mercatus study.The study actually showed National Healthcare Expenditures (NHE) dropping by $2 Trillion over the 10 year period. Since Mercatus assumed the government would pay all the bills, the headlines reported government costs would go up which would be true. But private insurance and out of pocket costs would go to zero, offsetting higher government spending by $2 Trillion while today’s uninsured would be insured.Interestingly, the Mercatus Center is highly intertwined with the Koch Brothers and other libertarian groups. The close relationship with these groups does not mean the study is incorrect but one could comfortably conclude the study was not biased in favor of M4A.Taking the Mercatus Study at face value, you get everyone insured for $2 Trillion less.Should we accept the study as it stands?The truth is, nobody really can know. But we are still left with the fact right now, many advanced countries are delivering healthcare now for 1/2 of what we do. So we know it can be done.Let’s look at the projected increases in NHE from the CME the study uses as a baseline which is the top line on the table below.The study projects NHE costs will rise at a 5.95% annual rate. But the Federal Reserve Board projects 10-year inflation to be 1.73%. If we re-project the Mercatus NHE forecast to equal expected inflation, we would achieve additional savings of $8.81 Trillion over the 10 year forecast period plus the $2 Trillion in savings already projected by the study.By containing price growth to inflation coupled with the Mercatus Study savings, the U.S. would enjoy about $1.1 Trillion in annual savings each year, not far off from our targets.The big difference is the Healthcare industry would have to adapt to an environment where their revenues would grow with inflation. They would have to get creative with efficiencies and cost-cutting. This would put them on par with the rest of American industry.How funds would be collected would need to be worked out, but private insurance premiums and out of pocket payments would drop much more than any payments required to fund the system.The outcome of intelligent healthcare reform could have far-reaching consequences. For instance, much of our healthcare insurance is employment-based. Imagine how worker productivity, competitiveness, and worker mobility would be improved if our companies could shed most of their health benefit costs. Exports, wages, and profits would surely rise too.Additionally, if the price barriers were reduced, consumers would be more likely to seek preventative care. This could have a negative cost impact as we might experience higher utilization of these services but it may also have a positive cost and health impact as we head off bad health outcomes based on lack of preventative medical care.The biggest unknown would be the transition. Any meaningful change to the U.S. healthcare system would be highly disruptive to the status quo. A great deal of care would have to be placed on making the transition as smooth and smart as possible. But if we consider the US to be special, we should be up to the task of getting to the OECD average cost per capita.