Bringing Medicare Into the Digital Age

The United States spends $696 billion on Medicare – so reforming the existing plan distribution model couldn’t be more vital. The process should be as straightforward and stress-free as possible, and that way is through embracing technology.

Medicare’s annual enrollment period (AEP) began on October 15 and ends next Wednesday, December 7. Millions of older Americans are now embarking on the headache-inducing process of choosing a Medicare plan. They are trying to select from among thousands of different plan options in the hope of making the right choice for their healthcare needs.

Nearly 64 million Americans today are Medicare beneficiaries, and in the coming years, the number will likely grow to encompass 20 percent of the U.S. population.

However, despite the large number of Americans using Medicare, the current system for enrolling in Medicare could not be more broken.

Systemic Medicare Issues are Longstanding But Solvable 

  1. Most older Americans currently make their Medicare choices with a salesperson over the phone. The phone is a terrible communication setting for choosing a complex product, especially one that must align with your individual health needs and preferences. It is impersonal and a lousy medium for separating out detailed differences between alternative options; and it’s totally ill-suited for explaining the complexities associated with Medicare.
  2. The situation is made worse by the salespeople themselves who make calls and answer the phones when older Americans respond to Medicare ads.
    Medicare salespeople are incentivized to sell specific plans, not to help older Americans find the right plan for their own distinct needs. These salespeople are often undertrained, seasonal employees who want to secure the sale as fast as possible to generate more sales, which results in rampant mis-selling. Even if they wanted to select the most applicable plan for beneficiaries, it would be impossible for those salespeople to master the thousands of plans available with the thousands of different options within them.
  3. Since this entire process is conducted over the phone, older Americans must share extremely sensitive personal information – such as Medicare IDs – with these undertrained and often temporary workers, putting their personal data at increased potential risk of loss.

All of these reasons beg the question: why, in 2022, with numerous ways to streamline the process to make it easier for beneficiaries and carriers, are we still enrolling folks in Medicare like it’s 1989?

Evaluating Medicare’s Positioning in Today’s World

I came to work in health insurance having spent much of my career in property & casualty (P&C) insurance. At the time, I thought P&C was backward from a technology standpoint. But if P&C was a decade behind the cutting edge in technology, Medicare is a further 10 years behind that.

The result of this horrible distribution model is that, according to a 2021 Medicare literacy survey, a widespread lack of knowledge exists among beneficiaries when it comes to basic Medicare terms and available benefits. Three out of four Medicare beneficiaries from the survey described the program as “confusing and difficult to understand,” while half did not even know when the AEP began.

So, if the current system of selling plans via the phone is leading to general misunderstanding and frustrations, what can be done?

One answer might be regulation. Recent legislation – the Inflation Reduction Act, in particular – does address some longstanding issues that have plagued the Medicare system as a whole. Particularly, the act requires the federal government to negotiate prices for some high-cost drugs covered under Medicare. But this is not enough, seeing as many of the provisions under the Inflation Reduction Act that would lower out-of-pocket spending for Medicare beneficiaries do not actually come into effect until 2026. In a broader sense, we cannot expect legislation alone to fix other major issues, such as efficiency. For example, although Medicare premiums for Part B (the part of Original Medicare that covers doctor’s visits and outpatient care) are declining, other parts of Medicare are simultaneously becoming more expensive, resulting in overall costs actually increasing for beneficiaries.

Medicare Needs to Digitize for the New Generation of Older Americans

Medicare needs to catch up with other industries and embrace technology to help Medicare recipients now. Older Americans want more plan choices with options that better suit their lifestyles and an easier enrollment process. And today’s older Americans are not what stereotypes would cast them out to be. Gone are the days when older Americans need the help of their grandchildren to even find the internet browser on their computer. Most Medicare beneficiaries today know how to navigate the internet, and many welcome new technological advancements: over 76 percent of older Americans noted they are comfortable using the internet to choose their Medicare plans.

Online-based platforms can start making the enrollment process more efficient by allowing older Americans to take ownership over their Medicare plan selections. These tools, like the platform we built, Hella Health, can also serve as truly independent advisors. We provide older Americans with the relevant facts and costs upfront, so they are free to make an educated decision – instead of being pressured to pick a plan over the telephone. Digital platforms can empower people to make a choice that works for their particular situation among countless options.

Medicare enrollment should not be a nightmare. We spend $696 billion on Medicare – so reforming the existing plan distribution model couldn’t be more vital. The process should be as straightforward and stress-free as possible, and that way is through embracing technology.

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Climate Tech, Compassion, and the Innovation Crucible: Highlights of TE22

Our recent three-day excursion into the future of innovation at TE22 brought together concerns about democracy, a semi-obsession with global warming, confusion about the metaverse, and predictions of an AI/robotic society. But we found general optimism that yes, there would be tools for all these challenges.

Maria Ressa told us freedom is at stake.

“Online harms turn into real world harms,” said 2021 Nobel Peace Prize laureate Maria Ressa. ”The weaponization of the legal system, or as my lawyers call it ‘lawfare’, is something…I hope doesn’t come to America. But the polarization of politics, the addiction to the technology, all of these things we share around the world.”

Ressa was scheduled to be our opening speaker at the recent Techonomy 2022 conference in Sonoma, California.  But she had to withdraw to attend to urgent filing of a final legal appeal to the Supreme Court of the Philippines in Manila. Ressa, journalist, activist, and thorn in the side of vindictive dictator Rodrigo Duterte, has been on trial on multiple spurious charges. She faces prison time of up to seven years in just this case, even as she also faces numerous other charges in separate cases.

Ressa sent a special video message to the conference, whose theme was “Innovation Must Save the World,”  expressing her grave concerns about the impacts of technology on our emotions, brains, and society. She also said this case will “basically determine whether I still have my freedom.”

Everything is interconnected.

The legendary Dr. Larry Brilliant (who gifted me a primo mask backstage, btw) is uniquely qualified to discuss how public health, the economy, geopolitics, the climate, and indeed everything, are profoundly interconnected. His overarching message: problems of all kinds must be addressed wholistically, cooperatively, and compassionately. Among his many accomplishments Brilliant, alongside a valiant corps of public health workers, decades ago helped lead the fight to eradicate smallpox, as an employee of the World Health Organization.

Brilliant joined David Kirkpatrick on stage at TE22 to discuss the connection between climate change and global health. He said the key thing to remember is that the fundamental causes of climate change are also antecedent causes of Covid–clear-cut rainforests, rising temperatures, changing seasons, famine, drought, and floods. “All of these things at the same time destroy animal habitat and put animals and human in each other’s habitats,” Brilliant said, “and that’s why we’ve gotten over the last ten years a cacophony of these viruses…SARS, MERS, Lyme disease, West Nile, Ebola, and now you have Covid…The major culprit is modernity. The most invasive species is us.”

(For a more detailed account of Brilliant’s inspiring appearance, read Meredith Salisbury’s report.)

Climate tech (like our precious planet) is hot, hot, hot.  

It’s not just wind farms and carbon capture anymore. Every company must become a climate company and every industry is ripe–overdue–for innovation. Among numerous speakers, Techonomy 2022 hosted leaders from biomanufacturing, solar power, sustainable aviation, next-generation nuclear power, electric vehicles, and climate investing. They all said climate tech is the future and is not a choice.

Mike Schroepfer is all in on climate. As the former longtime chief technology officer of Meta, he learned a thing or two about how to scale technology and organizations. (His direct reports at Facebook, now Meta, grew from 150 to 35,000 during his time there.) Now he is applying that knowledge to his new passion:  hyperscaling climate technology.  “If we’re going to solve these problems, we need to build lots of stuff. We’re going to need a lot more solar, wind, batteries…we’re going to need to decarbonize everything, electrify everything. And that’s going to require a lot of scale up…and we’re going to have to do it really quickly.” He believes that “hyperscaling,” heretofore applied by advocates like entrepreneur and investor Reid Hoffman to software businesses, can apply to hardware systems as well. We face the need for a build-out of sustainable infrastructure that is of unprecedented urgency.

The Environmental Defense Fund’s Kristin Tracz shared her optimism about the historic climate funding in the recently-passed U.S. Inflation Reduction Act. That and other recent “Biden bills” are expected to yield major innovations in the fight against climate change. Separately, IDA Ireland’s Maeve Cowley and Dr. Lorraine Byrne of Trinity College’s Advanced Materials and BioEngineering Research center said on stage that enlightened regulation, urgent R&D, and public/private collaborations have led to a thriving sustainable innovation ecosystem in Ireland and in Europe more broadly.

The metaverse is still up for debate. 

What is it? What does it look like? What should we call it? What are the use cases for individuals, businesses, and governments? If a “tree” falls in a “forest,” does it make a sound? Will we ever have legs?

Even more than for most nascent but promising technologies, there is excessive confusion and debate about the metaverse. But everyone agrees it will be–for better and/or worse–transformative and consequential.

The debate grew “spicy” at a Techonomy breakfast roundtable on the metaverse hosted by veteran tech journalist Robin Raskin. Unity CEO John Riccitiello said avatars are overhyped and often irrelevant. And Games for Change President Susanna Pollack pointed to the potential for learning and peace.

In response to a question in his main stage interview about the criticism Meta has faced for spending billions on cutesy avatars, Mike Schroepfer said: “All of that money is going towards long term R&D for the actual technological enablers for things I’ve seen in the lab, which is not a cartoon avatar, but someone that looks like a real, 3D person who’s talking to me in real time, who happens to be across the country…And you literally have this experience of ‘Oh my gosh. This is the closest thing I’ve ever had to being here in person without having to travel to see you.’”

(For a detailed account of the debates over the metaverse that prevailed at the conference, see Robin Raskin’s just-published report.)

To make progress in the world, we must also make progress within ourselves.

At the conference’s opening plenary, Esther Dyson, Vivienne Ming, and John Hagel tackled the ticklish topic of how to harness human nature to accelerate innovation. Silicon Valley icon Esther Dyson, who now focuses with her Wellville project on community-based health solutions, says the tech industry itself suffers from addiction. She argues that tech and venture capital’s addiction to big exits and big profits is fostering a culture of short term thinking and a dearth of socially-minded leadership. Author John Hagel says at the core, fear is what holds people back, but that we can learn to tame it and use fear as a tool. Neuroscientist Vivienne Ming’s research counterintuitively found that access to unlimited information, which we all have these days at the tips of our fingers, is sapping creativity and slowing innovation. Her antidote: we must go deeper and keep searching for novel answers. And even when we succumb to things like scrolling Instagram, our welfare and creativity depends on making sure we also ensure we periodically sit back and think deeply.

In a different session that took a similar theme, Autodesk CEO Andrew Anagnost made the case for what he called “innovation without ego.” Too often, posited Anagnost, tech industry CEOs focus more on notoriety and wealth creation than societal stewardship. This leaves leaders always searching, often in vain, for the elusive next big thing. Executives must put stakeholders and long-term vision first, he said.

Keep an eye on advancements in AI and robotics.

Ken Washington, former CTO of Ford and now Amazon’s VP of software engineering, spoke with Worth Magazine’s Dan Costa about how robots can evolve to improve the world. Amazon’s new home robot Astro, for example, is one adorable first step into the coming age of robotics. Amazon envisions home robots that improve safety and security, help people stay connected and eventually assist them with aging in place. And perhaps keep things tidy?

Tekedra Mawakana, CEO of Alphabet’s self-driving car division Waymo, explained the complex challenges her company faces of perfecting driverless vehicles. When lives are at stake, she says, progress must be well-researched and deliberate. But Waymo’s progress is coming along nicely. The company is currently expanding into some neighborhoods in Los Angeles.

Serial entrepreneur Dan Neely and  Nina Schick, author of Deep Fakes: The Coming Infocalypse, discussed the promises and dangers of generative AI, which creates surprisingly-compelling and convincing images, video, and audio in response to spoken or written prompts. With the public now able to whip up AI-generated images at will and whim, Neely launched a new company, Vermilio, at the conference. It aims to help solve challenges of IP ownership and image authenticity posed by the generative AI revolution.

These conversations shouldn’t stop here. Our world is at a critical juncture and all businesses across all industries must innovate to drive climate solutions, health, and equity for all. Join us this spring in Silicon Valley for the second annual Techonomy Climate conference, where we will dive even deeper into the tech we need to save our planet.

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Larry Brilliant at TE22: Global Warming Drives Health Threats

At Techonomy 22, noted philanthropist and public health expert pulled no punches as he weighed in on the Covid-19 response, the dangers of global warming, and more.

At Techonomy 22 in Sonoma, Calif., this week, scientific experts drew a straight line between global warming and global health crises. One notable voice in the conversation was Larry Brilliant, a doctor, epidemiologist, and philanthropist, who spoke with Techonomy’s David Kirkpatrick about his friendship with Steve Jobs, the world’s disastrous response to Covid-19, and more. View the full session video here.)

1. Global warming and global health are inextricably linked

“We’re having a tremendous amount of spillover,” Brilliant said, noting that viruses are jumping from animal hosts to humans “at five times the rate that [they] did 50 years ago.” As the Earth gets warmer, he said, animals from the south are migrating to the north. Mosquitoes are able to survive — and infect people — in more of the world, including areas that were once too cold for them, exposing an additional billion people to potential infection. With animals, insects, and people living in the same territories, he said, there is more opportunity for us to encounter dangerous new pathogens.

Other climate-related factors contribute to health threats as well. More people in lower-income areas are eating so-called “bush meat” from wild animals because they can’t afford other foods, a practice that is known sometimes to expose people to dangerous microbes. Even in wealthier areas, Brilliant said, more people are keeping exotic animals as pets, and at least one outbreak of dangerous virus has been traced to such practices. Meanwhile, increased flooding driven by a warmer planet brings salt to more land, threatening arable land and bringing famine for animals and people.

“The major culprit is modernity,” Brilliant said. “The most invasive species in the world is us.”

2. ‘Every country has done a terrible job’ with Covid

Somewhere between 5 million and 15 million people have died so far from Covid, said Brilliant, who served as a science advisor for the movie Contagion. “Every country has done a terrible job,” he said, arguing that the age of modern medicine should have kept us from competing with death rates seen in the 1918 flu pandemic.

Even cutting-edge mRNA vaccines are simply playing whack-a-mole with the rapidly evolving virus, according to Brilliant. “We’re fighting the battle of the last variant,” he said.

While he expressed hope that the virus responsible for Covid will eventually evolve to cause only a mild cold, as some previous coronaviruses have done, Brilliant isn’t counting on it. He’s still masking up in crowded indoor venues, including at the Techonomy 22 event.

He also called out vaccine manufacturer Moderna for not setting up facilities in Africa to make and distribute their Covid vaccines. “I think they failed that test,” he said.

3. He witnessed the world’s last case of smallpox

It doesn’t take long to list all of the viral and bacterial pathogens that have been eliminated from the human population: it starts and ends with smallpox. “It’s the only disease ever eradicated,” said Brilliant, who was part of the World Health Organization that traced the final cases. Brilliant recalled being in Bangladesh with the world’s last smallpox victim, a little girl who represented the end of an unbroken chain of transmission that went back to Pharoah Ramses V, he said.

“It felt so wonderful to be able to participate in [eradicating smallpox],” Brilliant said.

4. If his life was made into a movie, nobody would believe it

Brilliant’s career path has been filled with twists and turns. He became famous in the late 1960s as the doctor who delivered a baby on Alcatraz when a group of Native Americans took over the island off San Francisco in a protest. He was cast in a movie, after which he spent several years at an ashram in the Himalayas. But his guru repeatedly tried to get him to leave. “I would sit there and I would meditate and he would throw apples at my testicles,” said Brilliant, adding that the ashram’s leader was the one who convinced him to work for the WHO. It was during his time there that he met Steve Jobs, with whom he developed a lifelong friendship. Brilliant told the story of Jobs, barefoot, coming to a local WHO office in the early 1970s seeking Brilliant, because he believed it would give him access to air conditioning and a salad

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EU Proposes Immediate Loss and Damage Fund, Emissions Peak Before 2025

A dramatic new offer from the plenary floor at COP 27, in which rich countries would immediately set up a loss and damage fund in exchange for a pledge to peak greenhouse gas emissions before 2025 and phase down oil and gas as well as coal, may have changed the tone and salvaged the outcome of climate negotiations that seemed hopelessly deadlocked just hours before.

A dramatic new offer from the plenary floor at COP 27, in which rich countries would immediately set up a loss and damage fund in exchange for a pledge to peak greenhouse gas emissions before 2025 and phase down oil and gas as well as coal, may have changed the tone and salvaged the outcome of climate negotiations that seemed hopelessly deadlocked just hours before.

The proposal from European Union Vice-President Frans Timmermans, literally an eleventh-hour pitch delivered Thursday at 11 PM local time, “came after days of sluggish talks in Sharm El-Sheikh, bogged down by fights over how to compensate developing countries bearing the brunt of climate change through flooding, droughts, and other disasters,” Bloomberg News reports.

“The European Union offer would include a commitment to immediately establish a new loss and damage response fund with details worked out over the next year as well as a commitment to examine debt and reform the mulitlateral development banks,” the news agency writes. “There also would be a pledge to ensure all financial flows are aligned with the Paris Agreement commitment to keep global warming to 1.5°C.”

In return, “countries would vow to peak global emissions before 2025 and phase down all fossil fuels—not just coal, which was spelled out in the Glasgow climate pact last year. That would come with some accountability, in the form of an annual report on progress toward implementing the phase down of unabated coal power.”

The idea “went down well with vulnerable countries and most other rich nations,” says Climate Home News. “China and Gulf states pushed back, while the U.S. kept quiet.”

But the deal isn’t nearly done, at least not yet. Early Friday local time, when the Egyptian Presidency finally brought forward a first attempt at an official conference declaration, or decision text, the draft “fell short of beefing up language on a phasedown of fossil fuels—a key condition for the EU and an indication that Timmermans’ offer may not yield the breakthrough he sought,” Bloomberg writes. The text did include a first reference to the “unprecedented” global energy crisis triggered by Russia’s invasion of Ukraine.

The drama was just one part of a complex, interwoven process that looks certain to go on through the weekend, well past the scheduled close of the conference later today. It wasn’t yet clear whether the EU’s intervention would fundamentally shift the direction of the negotiations or heal the deep frustration and disappointment percolating out of news reports from Sharm el-Sheikh.

As recently as Thursday, Egypt stood accused of letting crucial negotiations at COP 27 fall into dystopian disarray.

“Diplomats from rich and poor countries, observers from non-profits, and activists meeting in Egypt for the UN-sponsored climate talks are finding themselves in the unusual position of agreeing on something: This is chaos,” Bloomberg reported. “There is collective exasperation among attendees at the COP 27 summit over the status of talks.”

“With time running out for countries to agree on a road map for tackling climate change,” the Washington Post wrote, “rich and poor nations continued to disagree on an array of issues, including compensation for harms caused by a warming world.”

The blame is falling squarely on the Egyptian COP Presidency for “failing to anticipate and address some of the thorniest issues facing negotiators” and taking a “haphazard approach to organizing the high-stakes negotiations,” the Post added in a separate dispatch, citing a half-dozen interviews with veteran negotiators or observers at the annual conference.

No Text to Negotiate

For days, there has been talk and speculation about the COP 27 “cover decision”, the summary document that captures the major points of agreement among delegates representing 195 countries and multiple negotiating blocs. Against the urgency and front-line impacts of the climate crisis, negotiations at a UN summit come down to this—any progress takes the form of legalistic text to be negotiated, then finalized, with every bit of syntax and punctuation subject to scrutiny and debate in a process where all decisions must be made by consensus.

Those discussions take time, and usually begin earlier in the conference. This year, delegates woke Thursday morning to a 20-page draft, described by some as disorganized and disjointed, containing “the political statement outlining the goals and commitments that all climate negotiating parties are supposed to agree upon,” Bloomberg writes. “The presidency’s document confused delegations and was mistaken as a draft of the final declaration until Egyptian officials clarified it was just a collection of ideas.” It “came out late in the process, lacked key demands by some countries, and included statements that outraged others,” the news agency adds, citing interviews with several delegates and observers.

Bloomberg News says the draft “was slammed by developing nations seeking more ambition from the closing text, setting up a showdown at the two-week summit.” The news story has a rundown of the contents of the draft cover decision and the early critiques.

Carbon Brief Deputy Editor Simon Evans was out shortly after the document landed with a Twitter thread that summarized the contents, noting that key substantive issues like tougher emission reduction targets, climate adaptation, loss and damage, and many others remained unresolved.

With less than 48 hours remaining before the conference was due to end, “this is not a text that has been discussed by countries but elements reflecting what Egypt has gathered from consultations with countries. Formal negotiations on the text are yet to start,” Climate Home News writes. “If Egypt wants to secure a successful outcome, it urgently needs to bring the discussion into negotiating rooms.”

“It doesn’t feel like one single coherent vision pushed by the presidency but more a text that weaves together lots of ideas they’ve heard—many will get shot down from various groups,” said Tom Evans, a climate policy advisor at the E3G climate think tank. “There’s lots in there that all sides will dislike.”

The delayed release of such a preliminary text means that “this will be quite a long and difficult journey—I’m not sure where these talks will land,” European Commission First Vice President Frans Timmermans told media yesterday. Yet “if this COP fails we all lose, we have absolutely no time to lose.”

“These last two days are to take decisions,” said Manuel Pulgar-Vidal, the former Peruvian environment minister of Peru who led the COP 20 climate talks in Lima. “This COP has to deliver and we are not seeing that yet.”

“There should be a clear road map by those who are emitting a lot to start reducing their emissions,” said Zambian environment minister Collins Nzovu. “We are headed completely in the wrong direction—driving very, very fast into a ditch.”

COP President and Egyptian Foreign Affairs Minister Sameh Shoukry was quick to declare that the 20-page document was just a draft, not a final destination.

“Whatever circulation you might have seen is still a work in progress and I don’t think one should jump to any conclusions,” he said. “We are still in a phase of deliberations to see how best to provide a cover decision that responds to the interests of parties and doesn’t provide any form of backtracking or relinquishing of any previous commitments.”

No Language on Fossil Fuel Phasedown

One notable omission from the Thursday draft of the cover decision was India’s proposal that the COP endorse a phasedown of all fossil fuels. That followed language at last year’s COP 26 summit in Glasgow that called for a phasedown (but not a phaseout) of coal. Some discussions over the last week have cast a wider approach as a matter of international equity, since coal is the primary fossil fuel on which developing countries rely while richer nations are more dependent on oil and gas.

At first, there was concern that India’s intervention was meant to trigger objections from major oil and gas producers like Saudi Arabia and Russia, in response to which India could then try to water down the previous agreement to phase down coal. But that risk seemed to dissipate after Indian Prime Minister Narendra Modi endorsed the coal phasedown during the G20 leaders’ summit in Bali, Indonesia.

“My fear on that is a lot less” after the G20 reaffirmed its commitment to the coal phasedown and Modi agreed, said Alden Meyer, an E3G senior associate who’s attended all but one of the 27 COPs. That in itself wouldn’t stop Russia and Saudi Arabia from trying to block language on oil and gas. But “my view of that is, let’s build support for it, get it into the decision, and then let them explain why they think coal should be phased down but not oil and gas, in the view of the whole world in the closing plenary of the COP,” Meyer told a media briefing earlier this week.

In the end, India’s proposal received support from the European Union and the United Kingdom, and the United States said it would back the plan as long as it specified “unabated” oil and gas, leaving the door open for questionable carbon capture and storage technologies. But it wasn’t in the Thursday discussion document, nor did it show up in the draft cover decision. On Thursday, the Canadian government said it wouldn’t support including an oil and gas phaseout in the cover text, Environmental Defence Canada reported.

“Acknowledging only the need to phase down coal while ignoring oil and gas is hugely problematic. This predatory delay is out of line with the science and with 1.5°,” Collin Rees, campaign manager at Oil Change International, told Bloomberg. “At a COP shaped by more than 600 fossil fuel lobbyists roaming the halls, parties fighting for progress must push back against weak language that allows the fossil fuel industry to continue its deadly expansion.”

Multiple Moves on Loss and Damage

As expected, COP 27 has seen a great deal of discussion and considerable controversy over the decades-old demand that rich countries provide funding (they vehemently resist characterizing it as compensation or liability) for the irreversible impacts of climate change. The core of the argument, and the historical reality, is that the world’s wealthiest economies are those that have benefited the most from the fossil fuel era and produced the lion’s share of the emissions, while the countries with the smallest historical carbon footprint are bearing the brunt of the climate emergency.

“Developed countries such as the United States have long resisted the idea of loss and damage” for fear of being held financially liable for the carbon dioxide they’ve pumped into the atmosphere for decades,” The Associated Press explains. But more recently, “there has been a softening of positions among some rich nations that now acknowledge some form of payment will be needed, just not what.”

At this year’s conference, much of the debate has been on whether to set up a loss and damage funding mechanism, or “facility”, immediately, or build up to a decision in 2024 while taking time to decide how the new structure will operate.

German Foreign Minister Annalena Baerbock told AP there might be no agreement on loss and damage at this year’s COP. But she acknowledged that “countries that are particularly affected, who themselves bear no blame for the CO2 emissions of industrial nations such as Germany, rightly expect protection against loss and damage from climate change.”

“We’re all willing to find some substantial steps forward, but we’re not there yet,” said the EU’s Timmermans.

That isn’t sitting well with the Alliance of Small Island States (AOSIS), whose members are among the most vulnerable in the world to climate impacts like sea level rise. “We have come too far to fail on loss and damage finance. Three-quarters of humanity is relying on a favourable outcome at COP 27,” said AOSIS Chair Molwyn Joseph of Antigua and Barbuda.

“AOSIS has worked tirelessly this year to build consensus, devise a clear loss and damage response fund proposal, and ensure the commitment of the international community to come to COP 27 and negotiate on this issue in good faith,” he added. But now, “some developed countries are furiously trying to stall progress….not only are they causing the worst impacts of the climate crisis, they are playing games with us in this multilateral process.”

That position drew support from Oxfam, with climate policy lead Nafkote Dabi declaring that “more than 40 million people in the Horn of Africa are currently experiencing climate-induced hunger crisis. Pakistan is faced with $30 billion worth of loss and damage from the recent mass floods that left a third of the country under water. It is crucial that developing countries can access a formal fund to pay for the damages and losses they are already suffering today.”

“A two-year delay to assess whether or not to create a dedicated loss and damage fund would be utterly unacceptable, given the urgency of the climate crisis, and the delays that lower-income countries have already had to endure in receiving funds to combat climate impacts,” agreed Dr. Jeni Miller, executive director of the 130-member Global Climate and Health Alliance.

No ‘Stylish’ Walkout

But Pakistani climate minister Sherry Rehman said she had no plans for a “stylish” walkout, whatever the outcome of COP 27 negotiations on loss and damage, even though her country places 147th out of 182 in an index of climate vulnerability and readiness and went through the devastating floods that helped set the stage for this year’s deliberations.

“We are not asking for reparations,” Rehman said, during a panel session at the Pakistan pavilion in Sharm el-Sheikh. “It sounds really good. It’ll get you into all the headlines. I’d be a real hero.”

But while some participants at the COP are looking for harder-line demands on loss and damage, she explained that calls for reparations wouldn’t be an effective way to “keep the country in the discussions, to be responsible players at COP, which let me remind you is one vote, one country. One veto, one country. We would be laughed out of the room as irresponsible activists.”

At the same time, “we really, really need to work with completely focusing our energies on producing something in this COP 27 something that is tangible,” Rehman’s colleague Nabeel Munir, the lead negotiator for the G77+China bloc, told Bloomberg. “Something that we can take home and tell our people that we’ve been able to achieve something.”

So far, some of the shifts on loss and damage at this COP have included about $300 million in new funding pledges for a variety of loss and damage initiatives, pressure on India and China to contribute to eventual funding program, and a proposal from Barbados Prime Minister Mia Mottley that would see the world’s biggest polluters compensate smaller countries for loss and damage. One concern about the funding announced so far is that the lion’s share is devoted to the Global Shield, an insurance-based program led by Germany and the V20 bloc of vulnerable countries that would be tailored to individual countries’ needs and pay out quickly, but would not be suitable for all forms of loss and damage.

“It’s all voluntary, small bits of money,” said Rachel Cleetus, climate and energy policy director at the Union of Concerned Scientists, adding that the approach leaves out the biggest climate impacts that are ultimately uninsurable. “When you’re talking about sea level rise gobbling up land, what are you insuring at that point?”

German officials acknowledged to E&E News that Global Shield isn’t a comprehensive solution, but maintained it’s still a useful contribution.

“It is not a kind of tactic to avoid formal negotiations on loss and damage funding arrangements,” said Development Minister Svenja Schulze. “We need a broad range of solutions and respective funding for tackling loss and damage, including for loss and damage for slow onset processes and non-economic damages.”

Egypt Takes the Blame

It isn’t unusual for UN climate negotiations to continue beyond their scheduled close, and a poor or uncertain outcome at a late stage in the process doesn’t necessarily mean the conference will fail. But the problems to date at this year’s COP have been severe even by COP standards, and the pre-emptive blame for that failure has been falling on the host country.

The first week of the conference saw a constant drumbeat of concern over Egypt’s abominable human rights record and onsite logistics so poorly organized that it was difficult (and occasionally intensely unpleasant) for participants to do their work. The second week saw COP President Shoukry criticized for being absent from the process and hands-off in his approach.

“To be an effective COP president, you have to be clear on what you want to achieve,” Pulgar-Vidal said. But “That has not been clear this COP.” Instead, “we are suffering from a lack of clear vision.”

The Egyptian Presidency “got off to a slower start, and all the big negotiating issues are still on the table,” Meyer said. “So they are a little behind the curve and playing catch-up to try to get an acceptable outcome.”

Last year, an early outline of the cover decision was deemed “non-sensical” for its failure to mention energy or fossil fuels, but it at least appeared five days before the conference was due to close, in time to serve as a catalyst for intensive debate and negotiation.

But that timing was only possible because working groups had begun sorting through the “real crunch issues” weeks in advance, Meyer said. This year, four of the five working groups were only appointed earlier this week.

While the main blame for this year’s process is falling on the Egyptian Presidency, Meyer acknowledged that negotiating countries bear some of the responsibility for the slow pace. “Clearly, waiting late in the game to get going on the cover text and engaging ministers was the presidency’s decision,” he told Bloomberg. “But part of it is the games that are being played by other countries—both developed and developing countries in this process—to take negotiating hostages and hold their cards until the very last minute.”

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