Not satisfied with taking away health insurance coverage for over 3 million Americans, last week the Trump Administration said it wanted to take away coverage from more.  While Americans have been distracted by the scandals, investigations, and policy flip flops, the Administration and its allies in the Congress have never been deterred from one deadly mission – to strip away health insurance coverage from millions of Americans.

Most recently, the Administration announced that it will not defend the Affordable Care Act against the latest legal challenge to its constitutionality.  As a result, new challenges to the law may succeed before the courts in a way they had not in past.

It’s clear that the Administration will do all it can to further strip away health insurance coverage from more millions of Americans.

Health insurance is the protection that most of us have from debilitating disease and financial ruin.  For example, cancer.  For cancer patients and their families, the cost of fighting cancer may mean choices that could lead to huge debts under the best of circumstances.  While some individuals diagnosed with cancer have meaningful and adequate health insurance to cover most of the cost of treatment, the uninsured and an increasing number of privately insured individuals face the prospect of crippling out-of-pocket costs. Financial barriers that delay treatment for cancer can mean the difference between life and death.

More generally, even those with coverage face uncertainties; roughly 20 percent of people under age 65 with health insurance nonetheless reported having problems paying their medical bills over the last year. By comparison, more than half of people without insurance said the same.

For years, a huge problem in America was the rapid increase in the numbers of people without health care coverage.  In the 1960s, the nation developed Medicare, health insurance for those over the age of 65 and Medicaid, health insurance for the poor.

In the 1990s, the President and the Congress expanded coverage to help cover all those under the age of 18.  Yet, despite the fact that near-universal coverage existed for those under the age of 18, those over the age of 65, and the poor, the number of Americans without coverage continued to swell, peaking at about 50 million ten years ago.

For the rest of the advanced nations of the world, it was inconceivable that such a situation existed.  Western Europe, Canada, Japan and others have health care coverage for all of their citizens.  As a result, despite spending far more on health care than any other nation on Earth, the United States had more uninsured, incredibly uneven health care quality, and a mediocre life expectancy compared with other developed, wealthy nations.

Former President Obama and the Congress agreed to legislation than attempted to address that problem.  The solution that they came up with had a modest impact on the spiraling cost of health care, but did cut in half the number of Americans that lacked health insurance.

You could argue their solution – one which essentially expanded the number of Medicaid-eligible Americans and offered subsidies to help others who were required purchase health insurance – was inadequate to the task, but no one could argue that they did not try.

For years, Republicans argued that they could do it better.  They argued that if they were granted control of the White House and the Congress, they would repeal the Affordable Care Act and replace it with something better.  We now know that their pledge was pure fiction.  They had no plan to replace the ACA with anything.  All they wanted to do was repeal.

It is also now clear that President Trump, who as a candidate consistently said that he would fix the health insurance system and make it better, wasn’t telling the truth.  In a stunningly callous series of decisions, the President did all he could to deny health insurance for 3 million primarily low and moderate income Americans.   And now he is trying to do that to more.

To strip away people’s health insurance coverage with no alternative is indefensible and will cost many more Americans dearly.  Without coverage, sick people delay care, which can lead to even more devastating health consequences.  And those serious illnesses can cost those individuals and their families their financial security as well.

It started three and a half years ago with a news report from the Investigative Post, a Buffalo-based media outlet.  In its review of the so-called “Buffalo Billion” economic development programs, the Investigative Post identified an incredible clause in one of the state’s bid offerings that would allow spending on construction projects.

The Investigative Post found that in the state’s request for proposals to develop facilities to build a solar manufacturing plant there was a requirement that limited the pool of respondents to those based in Buffalo who have been in business for at least 50 years.  That’s correct; the company had to be in business in Buffalo for 50 years.

More Investigative Post research revealed that only one company could meet the criteria – LP Ciminelli, whose president, Louis Ciminelli, is one of Governor Cuomo’s biggest campaign contributors, having donated nearly $100,000 to the governor’s campaigns during his two races for governor.  While a big donor, the company was considered a legitimate contender given its work in the area for many years.

Once exposed, the state argued that the proposal’s 50 year requirement was just a typo, which should have said 15 years.  The state revised the bid request, yet the company – LP Ciminelli – won the contract anyway.  But the state’s decision-making process triggered interest by federal prosecutors examining corruption in New York State government.  LP Ciminelli earned more than $20 million in fees to manage the project, which involved the state spending $750 million to build and equip the solar plant.

Two years ago, federal prosecutors – headed by then-U.S. Attorney Preet Bharara – brought charges against the company and key New York State economic development officials.  In addition to the Buffalo case, the feds also charged that corrupt activities occurred in state economic development decisions in Syracuse and the mid-Hudson Valley.

The trial addressing the Syracuse and mid-Hudson Valley cases came earlier this year and led to the convictions of a former top aide to Governor Cuomo, a close ally of the governor’s, and some business executives.  The Buffalo case starts up this week.

Prosecutors contend that the then-head of the State University of New York’s Polytechnic Institute, with the help of the governor’s close associate Todd Howe, favored the Buffalo developers in a corrupt scam to award them hundreds of millions of dollars in state contracts for the solar plant.  Howe has pleaded guilty and admitted to accepting payments from the businessmen in exchange for influence over the awarding of the contracts.

The upcoming “Buffalo Billion” trial will focus on the allegations that the state’s contracts were rigged to benefit certain companies, those which happened to donate big bucks to the governor’s elections campaigns.  Of course, those charged – except for Howe the lobbyist and an executive at LP Ciminelli, who have pled guilty – are presumed innocent and there have been no allegations that the governor was involved in the wrongdoing.

Yet, the crimes identified in the first case and the ones alleged in the upcoming case, shine a light on what can only be described as serious ethical and financial oversight weaknesses in how the state awards billions of taxpayer dollars.

These glaring weaknesses cry out for a legislative response.  Thus, in the seven remaining days of the state legislative session, the governor and the legislature must act to restore public confidence in how the state doles out the public’s money, to protect taxpayers and ensure economic development spending is based on the merits, not rewarding connected insiders.

The first step is to enhance the power of the separately-elected state Comptroller to review state contracting decisions.  In the early days of the Cuomo Administration, the governor successfully advanced initiatives that cut back on the Comptroller’s oversight role in this area.  It is clear that his powers should be restored and strengthened.

Second, the governor and lawmakers should agree on legislation to create a “database of deals” to identify the recipient of every taxpayer subsidy for economic development and describe the details of contracts and job creation goals.  Third, they should agree to ban “pay to play” by sharply limiting campaign contributions from businesses that get state contracts.  And lastly, there should be an agreement to close the “LLC loophole” that allows contributors to pour an unlimited amount of money into political campaigns.

Neither Governor Cuomo nor legislative leaders seem to hoping for anything of consequence to get done in the seven days left in the legislative session, despite a long list of unfinished business.  Acting to prevent government corruption should be something that must get done.

The science is clear:  Human activity, particularly the burning of fossil fuels – oil, coal and gas – is heating up the planet in ways that have never been seen in recorded history.  According to the third U.S. National Climate Assessment, “Global climate is changing and this is apparent across the United States in a wide range of observations.  The global warming of the past 50 years is primarily due to human activities, predominantly the burning of fossil fuels.”

As the planet heats up, more of it will become uninhabitable.  The majority of the adverse effects of climate change are, and will continue to be, experienced by poor and low-income people around the world.

A report on the global human impact of climate change published by the Global Humanitarian Forum in 2009, projected more than 300,000 deaths and about $125 billion in economic losses each year, and indicated that most climate change-induced mortality is due to worsening floods, droughts, and violence in developing countries.

These are the people who have contributed the least to global warming.

In our affluent nation, the impacts are real, but in the short run are less devastating.  Yet even in the United States, the signs are unmistakable.  Infrastructure is being damaged by sea level rise, heavy downpours, and extreme heat.  These damages are projected to increase with continued climate change.

The rising average temperatures were documented in a report released last week.  The report examined the average summer temperature trend in U.S. cities from the years 1970 through 2016. Summers are trending hotter for 92 percent of the cities analyzed, with locations in Texas and the Mountain region of the West experiencing the most warming since 1970.

The report used data released by the National Centers for Environmental Information, a division of the National Oceanic and Atmospheric Administration, a federal government agency.  The report found average temperature increases for the city of Buffalo, 1.7 degrees, for New York City 0.6 degrees and for the city of Albany a whopping 3.3 degrees.

This is a reminder that even as increasing greenhouse gases raise global temperatures, warming will not be uniform across all areas. Nonetheless, hotter summers raise the risk of heat-related illnesses, such as dehydration, heat exhaustion, and heat stroke.

Yet one year ago, President Donald Trump pledged to withdraw the United States from the world’s effort to curb global warming, the Paris climate agreement.  President Trump described the pact, signed by each and every other nation on Earth, as “an agreement that disadvantages the United States to the exclusive benefit of other countries.”

Despite the compelling scientific evidence that climate change is primarily the result of human activity, and the terrible toll it is taking on humans, other species, and the environment, what led the President Trump to withdraw from Paris?

One can start with willful ignorance; the scientific evidence is overwhelming and the President has chosen to ignore it, likely for political reasons.  Perhaps it was the funding by the fossil fuel industry targeted at influencing the President’s campaign, the transition into the presidency, and the beginning of his administration.

As a practical measure, there is no way for the U.S. — or any other country who signed it — to withdraw from Paris until four years after it went into effect.  Thus, the process of withdrawal can only begin the day after the 2020 U.S. presidential elections.

But there is no doubt that in the meantime, the U.S. federal government will not act to comply with the Paris Agreement.  Thus at best, little will be done by the U.S. during the next few years, at worst the Administration will accelerate the damage caused by the burning of fossil fuels.

Action will need to come at the local and state levels, with decisions by states, cities and institutions to go to net zero emissions.  Of course those pledges must be matched with realistic plans and durable resource-allocation decisions.

And the public must support those efforts and do all it can to make the Trump Administration and its allies pay a political price for their reckless decisions to exacerbate the damage to the world’s climate; decisions that will cost people across the globe their lives, will increase misery for millions, and may harm the fabric of life on earth.

Climate change is an existential threat to life on Earth.  But the challenges aren’t insurmountable—we know how to get to net-zero greenhouse gas emissions.  The rest of the world is moving forward.  The U.S. is indispensable to those efforts.  But for now, the leadership will have to come from the grassroots, local and state government levels.

June is a big month in Albany.  After Memorial Day, lawmakers have just 13 days in their schedule to wrap up the legislative session.  In June of last year, the state Senate and the state Assembly each approved about 2/3 of all bills passed during the entire 6-month session.  When it comes to moving on legislation, June is the biggest month.

While there is a large number of bills moving this June, the big question will be whether the legislation under consideration actually addresses the important issues facing the state.  One of those important issues is whether the governor and state lawmakers will act to curtail the incredible corruption that has plagued New York.

In just the past few months, a top aide to the governor was convicted of corruption, the former Speaker of the Assembly was convicted of corruption, a former state Senator pleaded guilty to illegal use of campaign funds, a member of the Assembly resigned after corruption charges were filed against her, and top public officials on Long Island are in court right now waiting to see if they will be convicted of federal corruption charges.

And over the past decade, dozens of public officials have had to resign or were convicted on charges related to ethical misconduct.

Yet despite this awful track record, the governor and the legislative leaders don’t appear interested in agreeing to needed anti-corruption reforms.

Also scheduled for mid-June is the beginning of the trial examining allegations of widespread corruption in the state’s so-called “Buffalo Billion” program.  That economic development project was heralded by the governor as a massive $750 million stimulus to jump start the Western New York economy.

Whether the program’s stimulus succeeded is still unclear, but what is clear is that federal prosecutors believe that a favored company had a multi-million-dollar contract awarded to it because it hired allies of the governor.  The company has also been one of the biggest campaign contributors to the governor.  The former members of the Administration who have been charged have maintained their innocence and there have been no charges involving the governor himself.

Whatever the outcome, however, the case presented by federal prosecutors will further fuel the perception that New York’s governments are too susceptible to corruption.

Governor Cuomo and state lawmakers must act to counter both the perception and the reality of a campaign financing system and an economic development approach that are all too easily gamed for the benefit of individuals and companies that are cozy with elected officials and that operate far too often at the expense of the public.

Given the sweeping scale of the corruption convictions in New York, there is no “silver bullet” response.  Instead a comprehensive package is needed to reduce the risk of corruption.  Reformers have pushed for measures they call the “Restore Public Trust”:

• Clean Contracting. Pass legislation to strengthen the state Comptroller’s independent oversight of government contracting and boost public disclosure of those subsidies. The Senate has approved bills to achieve these goals.  The Assembly should too.
• Ban “Pay to Play.” Enact strict “pay to play” restrictions on state vendors. Evidence at the recent trial showed that state vendors clearly want to influence state contract awards by giving campaign contributions to elected leaders.
• Close the “LLC Loophole.” Ban unlimited campaign contributions via Limited Liability Companies. LLCs have been at the heart of some of Albany’s largest scandals. The Assembly has acted on this bill, the Senate should too.
• Establish an Independent Ethics Watchdog. Replace the state’s current ethics watchdogs, the Joint Commission on Public Ethics and the Legislative Ethics Commission, with an independent one, an entity free from political allegiance to those it is supposed to monitor. And one with authority over both the executive and legislature, lobbying and campaign financing.
• Real Budget Transparency. Make lump-sum budget appropriations and the resulting expenditures fully transparent.
• Strict Limits on Outside Income. Set real limits on the outside income for legislators and the executive branch. Moonlighting by top legislative leaders and top members of the executive branch has triggered indictments by the federal prosecutors.

The baker’s dozen of legislative work days after Memorial Day will tell New Yorkers whether the governor and state legislators are serious about combatting corruption.

None of us wants to think about this, but getting good medical care isn’t a sure thing.  While the vast majority of providers meet minimum requirements or better, many Americans are injured or killed by the medical care they receive.

Nearly two decades agohe National Academy of Sciences’ Institute of Medicine issued a national report, “To Err Is Human”, estimating that as many as 100,000 American hospital patients died in one year due to medical mistakes.  Subsequent studies have established a range that is even higher, from a low of 250,000 to as many as 440,000 hospital patient deaths annually.

No matter what the number, they are staggering.  And experts now consider deaths due to medical mistakes as the third leading cause of death in America, behind heart disease and cancer.

The Institute of Medicine’s 1999 report called for sweeping changes to substantially reduce the number of medical errors.  Improving patient safety is where policy makers must place their focus.

Positive medical care outcomes depend on carefully-coordinated care, communication, and policies designed to protect patients from harm.  Not all hospitals are alike.  Choosing the right hospital can be even more important than picking the right doctor.

New York State offers some information in this area.  The state Health Department has a program, hospital profiles (https://profiles.health.ny.gov/hospital/), which provides some useful information on the frequency of medical procedures that are performed at each hospitals.  It also offers doctor profiles (https://www.nydoctorprofile.com/), which allows patients access to background information on physicians.

But these profiles are often incomplete and do not rank providers by the quality of care.

In light of that vacuum of medical provider quality performance data, outside private groups have developed their own measures.  US News & World Reports magazine issues an annual “Best Hospitals in the U.S.”  Healthgrades.com also issues quality information on doctors and hospitals.

Perhaps the most comprehensive is the annual hospital ranking issued by The Leapfrog Group (http://www.leapfroggroup.org/).  Leapfrog was created over 15 years ago by large businesses that were frustrated by the lack of quality health data.  The businesses usually negotiated coverage for their employees, yet lacked the data to comparison shop.

Leapfrog’s Hospital Survey is considered by many to be the “gold standard” for comparing hospitals on standards of safety, quality, and efficiency.  Leapfrog collects voluntarily-provided surveys from nearly 2,000 hospitals and cross checks it with other publicly-released data and medical experts to issue annual rankings.  The annual ranking shows that hospitals across the country show a lot of variation when it comes to patient safety.

Leapfrog then ranks the states based on the number of hospitals that have achieved an “A” ranking.  This year, the state of Maine topped the list with nearly 70 percent of its hospitals earning an “A.”  Rounding out the top five this year were Hawaii, Oregon, Wisconsin and Idaho.

New York State ranked poorly, as it usually does, this year ranking 48^th in the nation, with only 6 percent of its hospitals getting an “A” ranking.

That means that it’s critically important that patients choose a hospital with a good track record on keeping its patients safe from harm.  In addition to researching the sources mentioned earlier, here are some other ways patients can be vigilant right now:

Ask questions. Gain as much insight as you can from your health-care provider.  Ask about the benefits, side effects and disadvantages of a recommended medication or procedure.

Seek a second opinion. If the situation warrants or if uncertainties exist, get a second opinion from another doctor:  A good doctor will welcome confirmation of his/her diagnosis and resist any efforts to discourage the patient from learning more.

Bring along an advocate. Sometimes it’s hard to process all the information by yourself.  Bring a family member or a friend to your appointment — someone who can take notes and help you understand the information and ask questions.

Hopefully, you won’t need to use this information any time soon.  In the meantime, we should all be pushing for better healthcare oversight, more transparency so that consumers have data to make medical care choices and ultimately better outcomes, a healthcare delivery system where medical errors are rare.