Sometimes one can only marvel at America’s system of health care.  It’s almost as if a bunch of people got together and decided to make a system that defies logic – a system that costs more than that of any other nation, one that produces mediocre life spans, and is so complex that the public simply cannot fathom how to navigate it.

The inefficiencies and illogic of this system manifest themselves in bizarre ways.  For example, hospitals are supposed to treat the sick and injured, no matter whether they have insurance coverage or not.  Obviously, as medical costs increase and coverage weakens, hospitals are forced to try to figure out ways to cover their costs.  It’s difficult to pass the costs of the uninsured – or underinsured – onto the bills of those with more robust coverage, because those prices are usually negotiated between the health care institutions and insurance companies. 

As a result, hospitals look to do what they can to directly squeeze patients to pay for the charges for their hospital stays.  One tool used by hospitals is to go after patients with outstanding bills through a debt collection process.  There have been reports of hospitals getting the courts to place liens on the homes of patients, or getting wages garnished, as a way to collect outstanding medical debts.

This is the way that businesses attempt to collect outstanding debts on cars, credit cards, or homes, in cases where the owner is claimed to have not paid their bills.  But what makes the health care arena different is that patients are not choosing to buy the care – they have to go due to illness or injury.

The American system does not provide universal coverage for those hospital patients, unless they are 65 years old or older (and that system is also complex, but the coverage is there).

So, patients who must get hospital care to recover from their illness can find themselves up against a forceful debt collection machinery when they have outstanding bills.  This adds mental anguish to the physical ones that they experienced.

Who are these patients?  Typically, they are the working poor – those with just enough income to make health coverage unaffordable – or those with inadequate coverage.  Exactly the people who face other forms of financial stress. 

New York’s system of health care – much like the rest of the nation’s – allows for hundreds of thousands to go without health coverage and hundreds of thousands more with inadequate coverage.  This reliance on a hodgepodge health coverage system can put the finances of millions of Americans at risk.

The consequences of inadequate coverage impacts the nation.  According to Forbes, “Fully half of Americans now carry medical debt, up from 46% in 2020” and that “More than half (57%) of Americans with medical debt owe at least $1,000.”  Those debts can often leave needy patients facing legal actions by hospitals and other providers, with judgments often enforced through liens on property or wage garnishments.  And the not surprising result is that medical expenses are the leading cause of bankruptcy in America. 

The most obvious solution is for the nation to offer coverage to everyone, similar to what seniors have now.  But that’s not in the political cards.

Another is for states to step into the breach and place financial band-aids to eliminate the worst practices.

Buried among the 1,000 bills that passed the Legislature this past session are two that attempt to provide such protection.

One bill simply outlaws the practice of hospitals dunning patients with debts.  This legislation would prohibit a lien being placed on a person’s primary residence for medical debt judgments as well as prohibit wage garnishment for medical debt judgments.

Another bill outlaws a sneaky fee that hospitals add to patients’ bills.  This legislation requires that patients be notified that a hospital will be charging a “facility fee” and whether such fee is covered by the patient’s health insurance.

Facility fees are expenses charged by hospitals to cover their overhead.  People who receive outpatient care at hospital-owned buildings can be charged a facility fee, in addition to treatment costs.  Since hospitals do not have to disclose the costs of facility fees beforehand, patients are often shocked when they receive a bill that is much higher than they expected.  The two main ways patients face facility fees are through outpatient treatment at an emergency room and at a hospital-owned doctor’s office.

Patients needing urgent treatment, requiring greater use of the facility, results in the patient being billed a bigger facility fee. That’s the rationale hospitals use to justify facility fees; but unfortunately those fees can too often be excessive. 

A case could be made to ban such fees, but this legislation does not do so.  It merely requires providers to inform patients of such fees and whether the patient’s insurance covers such fees prior to providing the medical care.  Surely a very reasonable approach and one that will help consumers to avoid those charges. 

Of course, approval of these two bills by the Legislature does not make them law.  Those bills must be approved by Governor Hochul.  But given the financial woes facing New Yorkers, easing those pressures when a patient must go to the hospital would seem like a no-brainer.  The governor must act.

Lawmakers wrapped up the 2022 legislative session last week.  In some ways, the session was like pre-pandemic versions.  In January, the Capitol and the Legislative Office building were opened up to the public.  Hearings were held.  Lobbyists scurried about pleading their cases.  But the pandemic’s ongoing plague cut back public access: legislative committees met online, not in person and lawmakers often participated in floor debates from their offices – freed from having to vote in person.

Despite all of the COVID impacts, some new trends emerged.  The 2022 session saw a total of 1,007 bills pass both houses, more than the nearly 900 last year and the 935 bills that passed in 2019 – although the pandemic session of 2020 saw less legislative activities due to the shutdown. 

And like sessions of the pre-pandemic past, a huge number of bills that were approved by the Legislature came during the final weeks:  651 of the 1,007 bills came in the last two weeks. 

The return to some version of “typical” also meant that some big issues were tackled – often in near secrecy.  During the budget approval in early April, the governor pushed through a billion dollar subsidy for the Buffalo Bills football team, as well as measures to change the state’s public safety laws.  In the last weeks of the session, the governor and Legislature cobbled together big deals on abortion rights and gun control – largely in secret.  Both measures responding to recent events, but neither subject to public scrutiny.  And a $10 billion subsidy for chip fab manufacturers emerged and passed in the wee hours before the state Senate wrapped up its work.     

Not everything was done behind closed doors.  There were very public, months-long fights that resulted in legislative action.  In the area of the environment, the Legislature approved a bill to place a two-year moratorium on a type of energy-intensive “cryptomining.”

Cryptomining is a relatively new technology that provides the basis for private digital currency, like Bitcoin.  Cryptocurrencies are not based on physical notes or coins and do not belong to a central bank, meaning they have no government backing.  Their ability to be electronically transmitted without government oversight makes them a popular choice for cybercriminals. 

These digital currencies require “authentication” through the solving of complex mathematical equations.  The first “cryptominers” to solve an equation authenticates the transaction and wins currency for their effort.

The climate change component of this is that to solve these mathematical equations and to win the currency for their effort, these “miners” need incredible amounts of electricity to run their warehouses full of computers. 

Cheap electric results in more profit and cryptominers in New York are converting old fossil fuel energy plants to power their activities.  The problem is that firing up these old plants contributes significantly to the amount of greenhouse gas emissions – at precisely the time that the world’s climate experts are arguing that we need to cut back.  The legislation puts a hold on permitting the use of these mothballed plants until the state understands the climate (and freshwater) impacts of these operations. 

Unfortunately, other important environmental measures – like requiring that new building construction rely on electricity, not oil or gas for power – were stalled in both houses.

Legislation was also approved to allow do-it-yourselfers and independent repair shops to fix common digital devices.  Manufacturers of products like cell phones, computers, tablets, video and digital audio systems refuse to share diagnostic information, replacement parts or tools.  That means consumers have limited repair choices and spend more time and pay more money to repair fixable items and generate an enormous amount of electronic waste as items are discarded instead of being fixed cheaply and locally.  Legislation spearheaded by state Assemblymember Pat Fahy and state Senator Neil Breslin addressed that problem by requiring that manufacturers make information and parts publicly available.  This “Right to Repair” legislation, if approved by the governor, will provide a first-in-the-nation protection for consumers.

Overall, the number of bills passed in 2022 documents that one-party control has reversed an overall historical trend:  Since seizing control of the Senate, the Democratic majorities in both legislative houses have increased approval of matching bills, reversing the previous decade’s overall decline and reaching the highest amounts seen over the past two decades (other than the 2020 pandemic session).

Yet quantity is not necessarily quality.  The climate crisis caused by the burning of oil, gas, and coal is an existential one and deserves urgent legislative attention.  Lawmakers did end the session with a significant amount of approved legislation, but unless they are willing to tackle the significant steps needed to respond to climate threats, their work is not done.

Memorial Day is the traditional beginning of summer for most people.  Despite Memorial Day’s origins – a time for mourning the U.S. military personnel who have died while serving in the armed forces – the three-day weekend at the end of May is also a time when most Americans begin to turn their attention to summer activities.

If weather cooperates, the Memorial Day weekend is the first in the summer’s weekends of relaxation and fun.  Those hotter days and more travel also mean something else: increasing gas prices and more smog.

This year’s gasoline prices are already creating pain at the pump for motorists. 

Usually, the summer driving season means higher gas prices.  The reasons?  First, more people are driving which puts a strain on supply and second “summer gas” tends to be more expensive.  Refineries switch the gasoline formula twice a year typically to a summer blend in mid-April (then back again after Labor Day). 

The blend is really about the level of butane in the gasoline.  Simply put, winter gasoline contains higher levels of butane. That butane is needed to help start a car in cold temperatures.

But in warm temperatures, gasoline with a lot of butane starts to evaporate quickly, producing ground-level ozone that can contribute to smog.  Thus, summer gas has less butane and is replaced with a more expensive substitute. 

This summer is looking to be even more expensive.  Inflation, reduced fossil fuel production, supply chain issues and boycotts on Russian oil after the invasion of Ukraine, have all combined to boost the increase in gas prices.

As a result, prices at gas stations across the US have hit record after record over the past two weeks. 

The average gallon of gas in the US hit $4.59, about 51% higher than a year ago, according to drivers’ group AAA data.  Regular gas prices have never hit this level.  And in California, AAA data showed, prices can be over $6!

A JPMorgan note recently stated that the average US gas price could surpass $6 a gallon this summer as driving season gets fully underway.  Of course, higher prices could cut into driving rates, which could offset those increases, but prices will still rise. 

Here in New York, expected gas price hikes could be somewhat offset by a gas tax holiday that starts on June 1^st and goes through the end of the year.  That “holiday” will shave about 16 cents off the price of a gallon of gas.

As mentioned earlier, “summer gas” is an attempt to reduce smog during summer months.  “Smog” is created when sunlight warms gasoline vapors, vehicle exhausts and other chemicals, with the ground-level pollutant ozone being formed. 

The ozone layer found high in the upper atmosphere shields us from much of the sun’s ultraviolet radiation.  However, ozone air pollution at ground level where we can breathe it causes serious health problems.  Ozone aggressively attacks lung tissue by reacting chemically with it.  Again a lot of ozone is the result of pollution from the burning of fossil fuels.

While the world suffers from the burning of fossil fuels – through exposure to ozone as well as the existential threat posed by global warming – there is one beneficiary: Big Oil.

The first three months of this year has been staggeringly profitable for the oil and gas industries.  According to recent reports, during those three months the biggest companies racked up profits just short of $100 billion – in three months!

Why should the oil and gas industries rake in cash like that?  Why should they profit while the planet, our lungs, and consumers’ wallets burn?

They shouldn’t and last week legislation was introduced by state Senator Liz Krueger and Assemblymember Jeff Dinowitz to claw back some of Big Oil’s windfall profits.

The legislation ensures that climate polluters pay for the damages that they have caused.  The bill tags the oil companies for their relative share of the greenhouse gas emissions that are heating up the planet.  Thus, the biggest companies would be assessed more than smaller ones.  It is that fact that should make it impossible for the companies to pass any additional costs onto consumers. 

Right now consumers are facing pain at the pump as well as in their gas and electric bills.  At the same time, the oil and gas industry are raking in enormous profits.  The Krueger/Dinowitz legislation will claw back some of the oil and gas industry’s recent windfall profits and use them for adaptation costs that would otherwise be charged to state taxpayers and to do so without harming consumers’ wallets.

Approval of that legislation would be a real cause for a summer celebration.

While lawmakers were seeking to wrap up the legislative session, a big issue has been percolating in the courts – how best to draw the new political boundaries for New York’s Congressional delegation and its state Senate.

For those of you who might have missed this, recently the state’s highest court ruled that the district lines drawn by the Legislature violated state law.  The court then selected an impartial academic from Pennsylvania to draw new lines that were approved last week.

As background:  Every ten years the nation conducts a census to quantify the number of its inhabitants.  That count is then sent to the states for each to adjust political boundaries to account for recent population shifts within the state.  Local governments then do the same.  The idea is to ensure that the nation’s political boundaries allow for more or less equal representation in all levels of government based on recent counts.

Each state has its own way in which it determines how to draw these lines.  For most of the country, the political parties establish the lines to maximize the number of representatives from their party.  The most egregious examples are called “gerrymandering.”  New York has had a long history of allowing the two major political parties to run the redistricting show.

For most of the past 40 years the Republican-controlled state Senate would draw the lines for their House and the Democrat-controlled Assembly would do the same.  When they couldn’t agree on Congressional lines, the courts – like this year – stepped in and drew them.

In 2014, a new system was approved by voters, which was first used this year and has failed miserably.  A new so-called “Independent Redistricting Commission” was supposed to draw the lines.  But with equal numbers of Democrats and Republicans, their work ended in gridlock.  That gridlock triggered legislative action.  Thus, the Legislature drew its own lines.  With Democrat-supermajorities in both Legislative houses and with a Democrat as governor, the lines favored Democrats.  It were these new legislatively-drawn maps that the courts found unconstitutional.

The new maps unveiled this past week are – certainly to the naked eye – more reasonably drawn.  The academic who drew the lines did so using methods to draw the maps in a way that ignored typical political calculations.  For example, he clearly ignored the residences of incumbent members of Congress and as a result long-time incumbents will likely face each other in primaries to be held in August.  Moreover, there are more districts that are up for grabs, meaning that the districts have reasonably close percentages of Democratic and Republican leaning voters. 

Looking at the new maps from a statewide perspective, the districts seem to make more sense.  Of course, within those districts, changes of a few blocks can have dramatic impacts.  Nevertheless, in some cases big changes have been made and the maps drawn by the courts are now the law of the land.

So unless the state Constitution changes, it seems like the courts will have the ultimate say in redistricting process for New York’s future Congressional and state Legislative political boundaries. 

Of course, it doesn’t have to be that way.

There are other states that offer a model for how New York could fix its state Constitution so that a real independent redistricting commission could have the final say – instead of deals between the two major political parties or through the intervention of the courts.

The best such model is found in the state of California.  In that state, any person can apply to be on its 14-member redistricting commission.  Applications are reviewed, background checks are conducted, and then 60 qualified individuals are chosen to be part of an applicant pool: 20 Democrats, 20 Republicans, and 20 who do not belong to either of those two parties.  The law requires an independent auditor to conduct a random drawing to select the first eight commissioners (three from the Democratic pool, three from the Republican, and two from the independents) and those first eight commissioners are charged with selecting the final six members from the remaining applicants in the pool (using the same representative criteria).

While this may seem complicated, it is the randomness of the selection process that makes it harder for the political parties to rig the outcome.  Closer to home in New York, lawmakers will have one of two choices as they consider what to do next: leave the system as is and let the courts be the final arbiter or fix the system. 

It’s hard not to despair considering the news.  Violence around the world puts millions at risk.  The war in Europe threatens to escalate.  Political and racist violence feels like it could tear the nation apart.  Overheated – and usually false – political rhetoric poisons the nation’s civic life.

And while all of those threats – violence, civil discord and the rise of authoritarianism – are real, none (at least not yet) pose an existential threat to humankind in the same way as the climate changes resulting from the burning of fossil fuels.

The threat posed by global warming is a real existential threat to the future of the planet – and all that inhabit it.  The atmosphere is heating up and with it the temperatures of our air and water.  Last week, it was reported that temperatures in the Indian peninsula are hitting record highs.

In a region of 1.5 billion people, triple digit temperatures are baking India, Pakistan, Bangladesh, and Sri Lanka.  For India, this past April was the hottest in 122 years and followed the hottest March on record. For Pakistan, it was the hottest April in 61 years. Nighttime temperatures are staying in the 90s, granting little relief for the overheated.

The sweltering weather has reportedly killed at least 25 people in India and 65 people in Pakistan, though the true number of casualties is likely much higher.  Even birds are getting heat stroke.  Hundreds of birds have been sent to animal hospitals during deadly heat waves.  One Indian animal hospital said it had treated a record number of birds for conditions such as fever, dehydration and heatstroke as temperatures rose to over 114.8^oF this week.

Surging electricity demand and stress on the power grid triggered power outages for two-thirds of Indian households.  Outages in Pakistan have lasted up to 12 hours, cutting off power when people need cooling the most.  Without electricity, many households have lost access to water.  The hot weather has also increased dust and ozone levels, leading to spikes in air pollution in major cities across the region. The heat melted mountain glaciers faster than normal, triggering flash floods in Pakistan.  That heat will impact other nations too, for example the hot temperatures are threatening wheat production, which could push already rising food prices even higher around the world.

It’s just May.  Those Asia subcontinent nations have to be poised to react to the summer months, when the heat could really take off.  

So, it is easy to despair. 

The false and hateful rhetoric that poisons our civic life cannot be allowed to drive policymaking.  As the old adage goes, “denunciatory rhetoric is so much easier and cheaper than good works, and proves a popular temptation. Yet it is far better to light the candle than to curse the darkness.”

New York State has to do the good works to “light the candle.”  When it comes to strengthening its democracy, the state has to show that elections can be fairly run at the same time as it makes it easier for all those eligible to vote.

New York can take a page from the turn-of-the-20^th Century Progressives and expand its independent, professional civil service system to more governmental positions, including the enforcement of elections and ethics.

It must also show how to tackle the existential threat posed by global warming.  Here the state has taken important steps, such as setting scientifically-sound greenhouse gas emission reduction goals.  And banning the sale of fossil fuel-powered vehicles by the year 2035.

Yet the false information advanced by the oil and gas industries, echoed by its witting (and unwitting) allies, are seeking to roll back those environmental goals and to block their implementation.  We see it in the fight to keep expanding oil and gas pipelines and the continued reliance on gas to power new buildings, a reliance that runs directly in opposition to the state’s climate goals.

Yet reliance on electricity for powering buildings and transportation, electricity that will rely more and more on solar, wind, and geothermal sources, is the real solution, not the fake options advanced by the fossil fuel industries and their allies.

Will Albany strike the match and light the candle?  Or will our elected leaders do nothing and curse the darkness?  New Yorkers will know by early June.