The Payor of Last Resort · Episode 11 of 12 · 13 min
Smoke With No Owner
Wildfire smoke is associated with roughly 41,000 excess deaths a year in the contiguous United States, yet it crosses every jurisdictional line and arrives with no defendant, no invoice, and no payer. The episode weighs rival exposure methods and the evidence for and against prescribed fire as a remedy. Its finding is a negative one: no U.S. health payer finances fuel treatment.
Who's who
- Minghao Qiu+2 more episodesCo-lead of the 2025 Nature study of smoke mortality under climate change
- Marshall Burke+2 more episodesCo-author of the Nature study and of work on prescribed fire smoke
- Rachel ConnollyLead author of the California wildfire smoke death study
- Luke DenninCarnegie Mellon lead author pricing 2017 smoke damages at about $200 billion
- Iván Higuera-MendietaCo-author of the 2026 Science study on low-severity fire
- Benjamin JonesEconomist whose Georgia study found prescribed burning created infant-health costs
- Robert BerrensEconomist and co-author of the Georgia study and a 2022 review
- Amin AdibiLead author on the cost-effectiveness of high-efficiency air filters
Where it happens
- California+30 more episodesStudy found 52,500 to 55,700 smoke deaths from 2008 to 2018
- GeorgiaPrescribed burn study linked smoke to low birth weight
- Flint, Michigan+3 more episodesMedicaid covered the exposed population in 2016 but declined lead abatement
- Butte County, CaliforniaGot worse under the most aggressive treatment scenario
- WyomingMedicaid respiratory claims spiked after smoke episodes
Timeline
- March 3, 2016CMS approves Flint's Medicaid expansion but declines to fund lead abatement.
- June 18, 2024A Science Advances study attributes 52,500 to 55,700 California deaths to wildfire smoke, 2008-2018.
- March 4, 2025CMS rescinds the health-related social needs framework.
- September 18, 2025Nature reports about 41,000 excess smoke deaths a year, rising to 71,420 by 2050.
- June 11, 2026A Science paper finds low-severity fire cuts severe-fire risk about 92 percent for roughly a decade.
Still debated
Long-term exposure studies give about 41,000 deaths a year while acute-exposure work gives about 11,400, and conclusions flip on the choice. Whether prescribed fire reduces net smoke damage nationally is unresolved, and four fire economists wrote in 2022 that the public-health case is not known to be true.
