In his State of the Union address, President Biden focused part of his comments on the skyrocketing costs of prescription drugs.  In his remarks he noted that the drug companies are  “unfairly charging people hundreds of dollars.”  The President was drawing a line in the sand that he would veto any measure that weakened the ability of the federal government to negotiate drug prices for Medicare recipients.

American drug prices are the result of myriad factors, one of which is the nation’s system for allowing patents for medicines.  Granting a “patent” bestows an exclusive right “for an invention, which is a product or a process that provides, in general, a new way of doing something, or offers a new technical solution to a problem.”  In the area of drugs, it allows a company the exclusive right to sell a medicine approved by the Food and Drug Administration (FDA) for 20 years from the date on which the application for the patent was filed in the United States.

During this patent-protected period, drugs are exempt from normal price competition – usually from “generic” drug companies.  Thus, the manufacturers can charge whatever prices they want in order to maximize profits and reap the rewards of their investment.

The rationale for the patent system was to encourage and incentivize innovation.  Companies that successfully bring new therapies to the market can be rewarded handsomely. 

Yet, nowadays most companies are no longer innovating new medications.  Instead, they’re monopolizing existing ones.  For example, it is estimated that as much as 80% of new patent applications are not for new medicines but are for minor changes that allow companies to argue that the drugs are “new.”

Allowing new patents for essentially old drugs extends the period in which price competition is prohibited, resulting in higher costs for patients.

These increased costs impact many Americans.  Two-thirds of U.S. adults rely on prescription drugs.  And one in four people struggle to pay for them.

When people can’t afford their medicines, they often have to decide whether to skip doses or not fill their prescriptions.  High prices impact all insured people, not just those taking medications. Because drug expenses make up 20 percent of health insurance costs, when drug prices go up, so do premiums.

But policymakers can change that by doing more to allow generic competitors to come to market.  Savings from new generic drug approvals are dramatic – $10-20 billion annually.  That’s the power of a competitive marketplace.  Unfortunately, abuse of the patent laws by pharmaceutical companies undermines price competition.

Patents are meant to spur innovation.  But the monopoly-pricing granted by a patent isn’t meant to last forever.  Too often drug makers spend significant time and money obtaining new patents to gain protections for medications already available – thus blocking access to generics and biosimilars.  And while a wrongly-granted patent can be challenged in federal courts, these challenges take years and come with a median cost of $3.5 million per case.

So, what should be done?  Clearly, the Congress must push both the U.S. Patent and Trademark Office (USPTO) and the FDA to more closely examine what gets patented and eliminate incentives for drugmakers to game the system by obtaining frivolous patents.  More vigorous regulatory oversight – and whatever needed additional resources – is a critical step that must be taken.

Also, there needs to be a public database combining both agencies’ information on new and pending patents and their related drugs.  Regulators and academics need a one-stop shop for reliable information on FDA and USPTO applications and decisions.  A more robust database could inform solutions to barriers that keep drug competitors off the market.

There is growing bipartisan support for tackling this problem.  Republican and Democratic Senators have called on the patent office to crack down on the practice of granting multiple patents for minor variations on a single invention, which they said drug companies have sometimes used to stave off generic competition for decades.  According to the Senators, “The Patent Act envisions a single patent per invention, not a large portfolio based on one creation.”

Regulators must heed their call.  Unless action is taken, too many Americans will be stuck with making the cruel choice between paying for needed medicine or food.  No one should have to be forced to make that choice.

While lawmakers, public officials, lobbyists, and reporters have a reasonably good sense of how much and where New York State government spends money, there is very little publicly available about how well Albany delivers services.  When it comes to spending money, legislation is introduced, hearings are held, financial plan updates are issued.

New York State government does not issue a publicly available, comprehensive report on whether that money is being well spent.  The concept of such a government compiled report is not hypothetical.  New York City government does it.

That report is called the “Mayor’s Management Report (MMR).”  Compiling the data and the public reporting of the MMR is mandated by the New York City Charter.  The MMR serves as a public account of the performance of City agencies, measuring whether they are delivering services efficiently, effectively and expeditiously.

The report is a way to hold government publicly accountable for its performance in using taxpayers’ dollars for services and programs.

New York State government needs just such a report for all of its services and programs, but perhaps nowhere is it more important than when it comes to measuring progress toward the state’s climate goals.

In 2019, Governor Cuomo and former Vice President Al Gore held an event to commit the state to ambitious climate goals as part of the Climate Leadership and Community Protection Act (CLCPA).  The goals set were; to reduce greenhouse gas emissions from 1990 levels by 40% by 2030 and 85% by 2050; and require 70% renewable electricity by 2030 and 100% zero-emission electricity by 2040.

Elected officials agreeing to goals that are years away is not new. 

In 2004, then-Governor Pataki had the state’s Public Service Commission adopt a goal to achieve 25% renewable energy for electricity by 2013.  That goal was increased to 30% by 2015 and then to 45% under then-Governor Paterson.  In 2015, the state met the goal to achieve 30% renewable energy, but not the revised goal of 45%, which New York has yet to achieve eight years later.  And the lion’s share of renewable energy produced in New York today is the result of hydroelectric power generated from plants built decades ago.

A report released last week by the state Comptroller showed that the state is not moving at the pace necessary to meet the CLCPA goals.  While the Hochul Administration – and its predecessor – ballyhooed its approval for new solar and wind projects, the Comptroller’s report found that due to the nation’s longest timetable for project completion, “Since 2015, only approximately .294 gigawatts, or 3.1%, of the total renewable electricity generation capacity under contract awards have become operational.”

In addition to long timetables from approval to operation, the report found about 11% of renewable energy projects between 2005-2023 have been cancelled.   Thus, announcements of projects are no guarantee that they will actually happen.

The result?  In 2021, 3% of New York’s energy was generated by wind and another 3% by solar.  Both well short of the pace needed to meet the goals of the CLCPA.

The state’s pace toward achieving its goals is not because the goals are too ambitious.  The goals were based on science.  The world’s experts have made it clear that in order to avoid the most devastating consequences of climate change, each nation must commit to achieving net zero greenhouse gas emissions by the middle of this century – which is exactly what the CLCPA did.

The problem is with government processes and lobbying by the oil industry and its allies who throw up roadblocks, advance disinformation campaigns, and supply sympathetic lawmakers with talking points to undermine the momentum to achieve the necessary climate goals.

Which brings us back to the report card mentioned earlier.  The public needs to weigh in and it can’t cut through the smog of oil industry public relations efforts if the government is unwilling to honestly, objectively report on what it’s accomplished.  In the face of stiff industry opposition, climate progress will only come about from determined public pressure — and that pressure requires a motivated public armed with accurate information.

A government that is more concerned about controlling the narrative and obscuring its slow progress is not the leadership New Yorkers deserve – and need.  While the Comptroller has done an important public service by reviewing the state’s recent work on renewable energy, it’s no substitute for an annual comprehensive Climate Report Card.

New York – like the rest of the nation – spends enormous amounts of money on health care.  Yet states’ health care spending varies greatly.  According to the most recent data provided by the federal government, per capita personal health care spending ranged from $7,522 in Utah to $14,007 in New York.  Per capita spending in New York State was 37 percent higher than the national average ($10,191).

When it comes to spending on health care provided by hospitals, New York spends the second most, behind only California.  Some of that spending is, of course, the result of more generous coverage benefits, but a second set of federal data about the quality of the care offered by New York hospitals raises some troubling questions.

The U.S. Department of Health and Human Services publishes Medicare.gov/Hospital Compare, which reports the quality of the nation’s hospitals to the public. It gives each hospital one, two, three, four, or five quality stars, with one-star hospitals being the worst and five-star hospitals the best.  The overall rating summarizes a variety of measures across 5 areas of quality into a single star rating for each hospital. (The 5 measures are mortality, safety of care, readmission rates, patient experience, and timely and effective care.)

According to the Centers for Medicare & Medicaid Services (CMS), the Hospital Care Compare is a consumer-oriented website that provides information on the quality-of-care hospitals are providing to their patients. This information can help consumers make informed decisions about health care.  Hospital Care Compare allows consumers to select multiple hospitals and directly compare performance measure information related to heart attack, emergency department care, preventive care, and other conditions.

According to the Hospital Care Compare about 15 percent of the nation’s 4,654 star-rated hospitals earned five-star status.

Here in New York, of the 194 hospitals, only 11 (5.7%) received a 5-star rating.  19 received a 4-star rating, 35 received 3 stars, 48 received 2 stars, and 25 received a 1-star rating – meaning that they provide the worst quality of care, according to the feds.  Interestingly, 56 hospitals were reported in the “not available” category, which presumably means that they provided insufficient information to be ranked.

Why does this matter?  Poor quality care is not only a waste of money, but it can also have devastating consequences for patients.  The costs of substandard care are well-documented.  In November 1999 the Institute of Medicine report, To Err is Human: Building a Safer Health System, was released.  It documented a veritable epidemic of preventable deaths in United States hospitals.  In September 2009, the director of the US Agency for Healthcare Research and Quality, wrote this about To Err Is Human: “Let me be clear: I am just as frustrated as my colleagues in the public and private sectors with our slow rate of progress in preventing and reducing medical errors.”  Then in 2013, a widely-covered study published in the Journal of Patient Safety reported that nearly 400,000 U.S. hospital patient deaths each year were preventable.  

The CMS star ranking illustrates problems in hospital care in New York.  According to experts, New York’s hospital care ranks poorly when compared to the rest of the nation. 

The national think tank, the Leapfrog Group, issued a report this year looking at hospitals’ quality of care nationwide.  Unfortunately, the Leapfrog Group found that New York State ranked 37^th nationwide in terms of quality, with only 11 percent of hospitals receiving an “A” grade according to their ranking.

Why do New York hospitals perform comparatively so much worse?  In July 2019 the director of Leapfrog Group, explained what she knew about New York’s hospital safety:

“The system as a whole didn’t seem to have emphasized safety. We’ve seen other states work together and look at what’s working well at other states and implement it. It just doesn’t seem to be happening in New York. It has to be front of mind every single day in a hospital.” 

These analyses raise serious questions for New York’s new Health Commissioner, such as why did New York State hospitals rank so poorly?  What has the New York Department of Health done to respond to the national rankings that have consistently found poor quality in state hospitals? 

Meaningful responses to those questions will help ensure that New York patients – and taxpayers – are being protected.  The toll in taxpayer dollars and human lives is too great for these not to be front-burner questions.

New York’s massive $230 billion state budget ranks second only to California.  To a considerable extent that ranking reflects New York’s population – the fourth largest number of residents among the states.

And New York being New York, the state budget process is idiosyncratic, with the state’s fiscal year starting April 1^st – three months after the start of the legislative session.  This is in contrast to the 46 states that began their fiscal years on July 1^st.  As a result, the Legislature has little more than two months after the governor presents her proposed budget in January to analyze the proposal, hold hearings, approve budgets for both the Assembly and the Senate, and then negotiate a final budget agreement by April 1^st.

That short timetable is a handy justification for a budget process that largely shuts out the public.  The public hearings held to receive input are essentially from the relevant agencies; public involvement is very limited, and the hearings are held during the day in Albany when most New Yorkers are at work.  The budget negotiations are conducted in secret and the final agreement is usually passed through a loophole in the state Constitution that allows lawmakers to approve the budget without going through the normal three-day waiting period before the vote.

But there’s more.  The deliberations are only on items that are considered “on-budget.”  There are additional categories that are considered “off-budget” and thus not subject to the same scrutiny as the approved final budget. 

Beyond that, New York State has hundreds of quasi-governmental agencies, known as public authorities and public benefit corporations that can be off-budget.  Although these entities are created by and for government to provide government services, they are described as independent and not held to the same standards of public review as the state government itself.

While there are watchdogs that monitor the spending activities of off-budget items and authorities, the sheer scale of government services provided by these entities allows many activities to fly under the radar of normal accountability.   

If the powers that be find accountability inconvenient and wish to limit the oversight provided by government watchdogs, laws are changed or necessary funding is withheld.  Which is exactly what has happened in New York.

Much of this off-budget and authorities’ spending is directed to so-called economic development projects.  While much of the state’s efforts to boost economic development are well-intentioned, there is very little in the way of rigorous analyses conducted to see if these programs deliver what is expected of them. 

A report issued last week by the think tank Citizens Budget Commission, dug deep into the state’s publicly-available information to quantify how much the state is spending on economic development.  Their report found that state and local governments combined to spend nearly $11 billion annually on “tax breaks and direct spending” to stimulate economic development and that amount is expected to rise to at least $13 billion by 2025.  The report observed that “New York State and its localities’ spending on economic development programs has long exceeded spending in nearly every other state.”  The report concluded, “State and local economic development spending continues to increase without sufficient evidence that these programs cost-effectively create jobs or are more beneficial than alternative uses of the funds.”

The lack of public accountability in such spending does not simply mean that money may be wasted.  It was that combination of unaccountability and secrecy that resulted in one of the biggest scandals in the Cuomo Administration.

A combination of shadowy spending by public authorities, limits on outside oversight, campaign contributions, and hot-wired lobbyists, resulted in the convictions of Cuomo campaign donors and staff.  Although the convictions were eventually overturned by the US Supreme Court’s decision to rein in federal prosecutors, there can be no doubt that the opaque nature of these types of programs are too often not designed to benefit the public interest.  Indeed, they invite corruption.

July is the month when state agencies and the Hochul Administration begin to develop their proposed budget to be released in January.  The governor would do well to heed the reports issued by watchdogs both inside government and outside to make New York’s spending more transparent and accountable to the public.  Doing so will not only boost trust in government, but it will also reduce the risk of future corruption scandals.

There is no avoiding the cascading bad climate news:  New records in temperature, catastrophic flooding, and ongoing wildfires, all put the world’s rapidly worsening environment in the “Code Red” danger zone.  The flooding in the Northeast was the result of record-breaking rainfall.  If the climate was a person it would be in the ICU.

Weeks of a punishing heat dome have left one third of the nation suffering from incredible heat.  Wildfire smoke from Canada obscured the Chicago skyline, just weeks after triggering a spike in asthma hospital admissions in New York and Washington, D.C.  Last Sunday, eight inches of rain fell in a few hours near West Point, N.Y. – causing significant damage to the area, including at the U.S. military academy – even as another storm buried the Oklahoma City area in floodwaters, too.  Last week, ocean temperatures off the Florida coast passed the 90-degree mark.  

All in all, the planet experienced its hottest seven-day stretch in recorded history.

The toll is increasingly obvious.  A new report found that in Europe last summer more than 61,000 people died because of record-breaking heat.  The summer of 2022 was the hottest period ever recorded on the continent – a record that may well be broken this year.

The economic hit from these storms will be staggering and added to the tens of trillions of dollars worldwide that are expected by the middle of this century.  And those costs will be borne by taxpayers and consumers as well.

The evidence is piling up and the catastrophes are increasing, yet the oil industry is escalating its drilling efforts in order to drive up its already massive profits.  BP scaled back an earlier goal of lowering its emissions by 35% by 2030, saying it will aim for a 20 to 30% cut instead. ExxonMobil cut its funding for a heavily self-promoted effort to use algae to create low-carbon fuel.  Shell announced that it would freeze its investments in renewable energy this year, despite its previous promises to reduce its carbon emissions.

While Shell argues that it remains committed to fighting climate change, its new CEO told the BBC that cutting fossil-fuel production would actually be “dangerous and irresponsible,” because doing so could cause the “cost of living” to start to “shoot up.”  Closer to home his talking points are parroted by the oil industry’s allies as New York tries to take steps to shift from an economy based on fossil fuels to one based on alternative power sources. 

As Governor Hochul crisscrossed the state moving from one climate catastrophe to another, she described the situation as the “new normal.”  But increasingly intense storms, rising sea levels, and a hotter planet are anything but normal:  They are the direct consequences of the burning of oil, gas, and coal, which has triggered a climate catastrophe.

The science is undeniable and the costs are real.  According to an estimate by the think tank Rebuild By Design, the climate costs to New York could be $55 billion by the end of this decade.  Furthermore, the U.S. Army Corps of Engineers estimated that it would cost $52 billion to protect NY Harbor.  It was recently estimated that Long Island faces $75-$100 billion in climate costs.  And while storms get worse, sea levels are rising and groundwater poses a higher risk of flooding – and we don’t even know how much yet.  The storms from last week alone are estimated to cost New York $50 million.  Clearly, New York is facing staggering – and growing – climate costs. 

The question facing the Governor and the Legislature is: Who should pay?  It will undoubtedly be the case that the ongoing devastation from the worsening climate crisis will cost New York tens of billions of dollars over the coming decades.  As it stands, under the direction of the Governor those costs are being borne – and will continue to be borne – by taxpayers.

Big Oil should pay.  They chose profit over the planet.  Their fossil fuel pollution caused the climate crisis.  They are raking in record profits.  After all, they knew decades ago that the burning of fossil fuels would rapidly heat the planet and with incredible precision predicted exactly the situation we’re in today.  Instead of alerting the world, they undermined science, bamboozled the public, and – to this day – fought tooth and nail to block environmental protections. 

This summer it has become clearer that there are dire environmental and public health implications of relying on fossil fuels to power our economy.  Every year will be worse.  Unless the state, the nation, and the world, acts, the situation will move from bad to worse.  And the costs and challenges will only multiply unless the world aggressively reduces the burning of fossil fuels.

The costs of dealing with this unfolding catastrophe will be enormous.  It’s time to make the oil companies pay and to do it in a way that they cannot pass on those payments to the public.  In passing the Climate Change Superfund Act the New York’s state Senate has shown how it can be done.  Governor Hochul should embrace that plan.  There is no time to waste.