As Congress debated what to do about federal spending on healthcare, one critical issue did not get adequate consideration: How to improve the quality of hospital care. Hospital care is a big component of the nation’s overall health care spending. Spending on hospital care totaled $1.5 trillion in 2023, representing nearly one third (31%) of national health expenditures in that year. 

There is considerable peer-reviewed research that quantifies the need for improvements in the quality of that care. According to a 2023 report in the prestigious New England Journal of Medicine, nearly 1 in 4 patients who are admitted to hospitals in the U.S. will experience harm and approximately one fourth of the events were preventable.

And that additional harm drives up costs. Take, for example, the issue of readmissions. If a hospital patient has to be readmitted for a complication, that adds costs, which is why regulators monitor such problems.

The quality of care in hospitals is not an issue that is evenly distributed across the nation. Every year, national rankings are released that examine Medicare data to see how well the nation’s hospitals perform. Typically, New York State lags most of the nation.

A key way to improve patient safety is making the quality of health care delivery transparent.

Perhaps the most comprehensive safety guide is the hospital ranking issued by The Leapfrog Group (http://www.leapfroggroup.org/).  Leapfrog was created over 20 years ago by large businesses that were frustrated by the lack of quality health data.  Those businesses usually negotiated coverage for their employees, yet lacked the data to comparison shop. The Group was established to help them to make health care decisions. The Group issues its ranking twice a year.

In its most recent report, Leapfrog Group found that New York State ranked 31^st nationwide in terms of quality, with only one quarter of hospitals receiving an “A” grade. 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.”

Of course, being ranked only 31^st in the nation means there are other states that are worse off. Yet, the focus on patient safety gets short shrift.

Costs are not the only reason why the issue should be at the top of lawmakers’ consideration. If hospital patients get harmed by the care that they receive, it’s a big problem for them as well.

One national study found that medical errors are the “third leading cause of death in the US. One study reported that approximately 400,000 hospitalized patients experience some preventable harm each year, while another estimated that >200,000 patient deaths annually” as the result of these preventable harms.

The financial costs are staggering, “costing the healthcare system $20 billion each year and others approximating healthcare costs of $35.7 to $45 billion annually for hospital-acquired infections alone.” These “medical errors also negatively impact the patient, their family, involved clinicians and support staff, the healthcare facility, and the community.”

These analyses raise serious questions for Congress. Why is so little being done to invest federal dollars on patient safety? What is the federal government now doing to respond to the national rankings that have consistently found poor quality in hospitals?

Failing to get answers to those questions not only costs taxpayers money, but puts too many Americans’ health at risk. Americans deserve a more thorough, thoughtful examination of quality and safety issues when it comes to healthcare spending.

Many people know the television show “The People’s Court.” In that reality-TV show, parties to real small claims court cases agree to drop their cases, present them before a TV judge, and abide by the decision. (An inducement is that the TV show producers pay the judgments.)

Since 1934, New York State has had its own, real “People’s Court.” New York’s Small Claims Court are a low-cost, informal court where people can bring claims for relatively small amounts of money – up to $10,000 in New York City; $5,000 in city courts outside NYC and the District Courts in Nassau and Suffolk Counties; and $3,000 in town and village courts located across the state.

There are many virtues of the Small Claims Courts: The filing fees are modest, they generally operate more quickly and efficiently than higher courts, and you don’t need to hire an attorney. In its tenth decade of operation, the Court remains an essential do-it-yourself tool for New Yorkers to win back their hard-earned money.

Among the actions consumers can take, the Small Claims Court is widely used by tenants to resolve financial complaints against their landlords.

Landlords often take advantage of consumers in various ways, including by converting rental security deposits after tenants have vacated a rented apartment or home – notwithstanding that the rental premises were left in good condition and rent had been fully paid.

In reaction to those cases, in 2019 the Legislature enacted new protections, establishing tight timelines for the prompt return of residential rental security deposits and requiring that landlords itemize any deductions.

When their security deposit is wrongfully withheld, New Yorkers can look to the Small Claims Courts to recover their money. Unfortunately, historically the jurisdiction of the Small Claims Court laws was interpreted to require tenants to file their claims where the landlord lived – not where the property was located. This is a huge inconvenience for consumers. As a result, more often than not, it means the claims won’t get brought.

In 2021, the Legislature amended the four civil court acts to make it easier for tenants or former tenants to use the Small Claims Courts to get security deposits and other monies owed to them by landlords.

Unfortunately, there are two problems with the 2021 law:

• First, the law treated the downstate courts (covering New York City and most of Nassau and Suffolk Counties) differently than the courts serving town, village and city courts outside of those areas. This created the anomaly where downstate courts permit a claim against a former landlord in the court serving where the rental property is located, but in the Small Claims Courts in town and village and city courts outside those downstate areas landlords may only be sued in a Small Claims Court in the county where the landlord was located or an adjoining county.

• Second, is that court personnel don’t appear to have been provided with information and training on the 2021 Small Claims Court law. A recent review of public materials and survey of some civil court personnel across the state indicates that staff may be turning away New Yorkers who would like to use the new law to hold their landlords accountable in their local Small Claims Court.

These are not academic or trivial issues: New York City-based landlords have purchased a lot of upstate rental housing properties and far too often maintain those properties in deplorable, unsafe condition and take advantage of their low-income tenants, including by wrongfully withholding security deposits when tenants leave.

The upshot is that under current law renters in the cities, towns and villages from Westchester to Western New York – and all areas in between – cannot use their local Small Claims Court to hold landlords who are located outside their immediate area accountable for unlawfully failing to return security deposits or for other claims. That leaves those tenants and former tenants in most parts of the state without a good option when landlords have cheated them out of their security deposits, for example.

This past session, the state Senate approved legislation that would correct the problem by establishing equal protections for all tenant-consumers and ensuring that Small Claims Court personnel get the information and training they need to implement the law.

Unfortunately, like hundreds of other bills, the legislation was not brought to the Assembly floor for a vote. Since that decision was made in secret, it’s unclear why the Assembly punted.

Hopefully, next year brings some relief to tenants seeking justice to hold their landlords accountable. In the meantime, landlords continue to have the upper hand.

Last week, the big policy announcement was one made by Governor Hochul. The governor directed the New York Power Authority to develop one or more nuclear power plants with enough capacity to supply electricity to roughly 1 million households.  

The rationale for this action is that New York needs more electricity-generating capacity to meet growing demands and to comply with the state’s climate laws.

But going all in on “new” nuclear raises its own concerns.

The historical reality of nuclear power has been that it is polluting, dangerous, a security risk, and enormously expensive, both as a complicated technology that requires significant safety features, as well as one plagued by construction cost overruns. Supporters of the use of nuclear power acknowledge the risks but argue that those risks are worth it due to the worsening climate catastrophe.

A review of the experiences in New York underscores the concerns about a headlong rush into the nuclear industry’s embrace.

New York, and the nation, was first sold on nuclear power as a new way to generate electricity that was said to be “too cheap to meter.”  Former New York Governor Nelson Rockefeller was a champion at that time.  But his speedy, all-in embrace ignored one key problem – where will the wastes go?  Rockefeller’s response was to push for storage in West Valley New York. That decision led to an environmental disaster – the inadequate disposal resulted in “spreading radioactivity into Cattaraugus Creek … from which the [City] of Buffalo obtains its drinking water.”

More recently New Yorkers were asked to foot the bill to keep ancient nuclear power plants running. That idea was advanced by another New York Governor, Andrew Cuomo.  The former governor proposed that ratepayers underwrite a multi-billion-dollar bail-out of nuclear power plants that were so old that they were constructed during the Vietnam War era.

At that time, the public was told by the Cuomo Administration that the costs would be around $3 billion over the course of a dozen years.  Outside reviewers estimated that by the time the bailout was complete in 2029, the costs would be around $7.6 billion.

According to state documents, the bailout has cost over $4 billion as of April of this year and there are still four years to go!  All of that money comes from ratepayers’ pockets. 

Now the pitch is from current New York Governor Kathy Hochul.  

This time New Yorkers deserve answers before the first shovel digs into the ground. It was the failure to involve the public that led to unnecessary costs and debate over the former Cuomo Administration’s bailout of the existing nuclear power plants located in upstate New York. Indeed, that approach should be viewed as the opposite of how the Hochul Administration should go about things this time.

The public should expect that Governor Hochul will deliver a full independent public vetting of her latest nuclear power plan.  That also means allowing the entire state to be part of the discussion, examining the expected costs (including the industry’s history of cost overruns), examining the waste storage requirements (on-site forever?), and examining the full cost impacts both directly and indirectly, such as what New York Power Authority projects will be scrapped in order to fund the building of a new nuclear power facility.  The fact that the governor is eyeing new, untested approaches to nuclear power underscores the need for a full, transparent process.

In the 1960s, New Yorkers were told all would be well.  It ended in an environmental disaster.  In the early 2000s, New Yorkers were all told all would be well.  It ended in multi-billion-dollar add-ons to our electric bills.

New Yorkers are now being told, all will be well.  Let’s not get fooled a third time.

In the wee hours of Wednesday morning, the state Assembly wrapped up its 2025 legislative session, a week after the state Senate finished. In many ways the legislative session was a typical one: The budget was late (the latest in 15 years), lawmakers held campaign fundraising events in the capital district (at least 176 for the 42 nights that state elected officials planned to be in Albany) or were held by leadership, and hundreds of bills were approved in a flurry of activity in both houses.

All in all, since January 856 bills passed both houses and will, eventually, be sent to the governor for her approval. That amount was an uptick over last year, just over 800 identical bills were approved by both houses in 2024.

Yet, there was a large gap in the number of bills passed by each house. The state Senate, continuing the trend of recent years, approved far more bills than the state Assembly. The Senate approved 1,743 bills, while the Assembly approved just under 1,000 (995). This gap is consistent with previous sessions of the past decade. However, the gap is surprising since the Assembly has a lot more members (there are 150 members of the Assembly compared to 63 in the Senate) and that the Assembly met longer than the Senate.

Since only 856 bills passed both houses, essentially the state Assembly blocked hundreds of bills that had been approved by the Senate, which is also surprising. Both houses are dominated by Democrats so there should be no partisan differences and it is unlikely that there are ideological ones. Why did the Assembly block so many bills? It’s hard to say, but some of them were ones that stirred little controversy.

Take for example, legislation designed to plug a loophole in the state’s lobbying disclosure law. Current law requires the reporting of lobbying to influence laws, executive actions, agency decisions, and efforts to influence local governments but not for efforts to influence the governor’s appointments to agencies or the courts. Legislation to require disclosure of that lobbying was approved in the Senate, but the Assembly version never came up for a vote.

Plugging that loophole should be a legislative “no-brainer.” The key regulator in setting utility rates is the Public Service Commission. Under New York law, spending to get a rate hike approved or denied is considered “lobbying.”

However, due to the existing loophole, advocacy to influence the governor’s choices to be on the Public Service Commission is not considered lobbying. So, trying to influence utility rates is lobbying, but trying to influence who is picked to make the rate decision is not. How does that make sense? Apparently, the Assembly didn’t see the public interest in disclosing that lobby spending and the bill was blocked.

Another example is legislation that would have established an incentive program for landscaping companies and local governments to purchase electric lawn equipment instead of gas powered ones. We’ve all had the jarring experience of having a peaceful day interrupted by an obnoxiously loud gas-powered leaf blower or other lawn equipment that’s spewing fumes from its engine.

These machines are not only staggeringly loud, but they also produce a shocking amount of air pollution. That makes them more than a Saturday morning annoyance – they’re also a health hazard.

Legislation to incentivize the use of quieter, less polluting, battery powered lawn equipment had broad support by a diverse set of constituencies and interests, including over one hundred public health, environmental and community groups, lawn equipment manufacturers, and equipment retailers like Home Depot.

With support from unusual allies like this, it was expected that the bill would sail through the Assembly. But it too died on the Assembly floor without a debate.

Of course, there were other more controversial legislative casualties resulting from Assembly inaction. One was legislation to reduce the amount of plastic packaging in New York.

According to the to the New York State Department of Environmental Conservation (DEC), “New York’s 25 municipal solid waste landfills have a combined landfill capacity of between 16 and 25 years.” If the state’s landfills are filled to capacity in a decade or so, what should New York do? The DEC has recommended that the state adopt a “producer responsibility” approach and urged action to, among other things, reduce packaging wastes.

The Packaging Reduction and Recycling Infrastructure Act legislation would have done just that. But despite having passed the Senate, broad public support, and having more than enough votes in the Assembly, the bill never came up for a vote.

The packaging legislation was opposed by companies willing to spend big bucks to defeat it – and they did just that.

It is impossible for the public to know why the Assembly has chosen to block hundreds of Senate-approved bills. As mentioned, those bills die a quiet death, with no public debate. Obviously, the Assembly majority is comfortable with this approach, whatever the reason.

Yet, the Assembly opposition blocks solutions to serious public problems. As servants of the public, the Assembly should at least explain its inaction to voters and taxpayers who deserve some answers.

Last week, New York’s State Senate wrapped up its legislative session. During the session, the Senate approved nearly 1,750 bills. In order for those proposals to become law, the state Assembly must approve identical legislation.

The state Assembly is scheduled to return for a few days this week and, so far, has approved more than 800 bills, a lot but not quite half of the Senate’s total. It is expected that hundreds of bills will be approved by the Assembly as it rushes to finish this week.

That’s a lot of bills and little time to do them.

New York’s lawmakers introduce more bills than any other state in the nation – and it’s not even close. Not surprisingly, New York also is among the leaders nationwide in approving legislation.

Many of the bills are high impact – meaning they will directly impact many New Yorkers – and some are less. For example, New Yorkers pay among the highest utility bills in the nation. Yet, consumers don’t have a full-time, well-resourced advocate for their interests at the crucial decision points that affect utility reliability and affordability. As a result, regulators typically only get to hear fully developed arguments from industry sources. The voice of the average residential consumer can get lost in the cacophony of industry lobbyists, engineers, and economists. Legislation has been approved in both houses that establishes a utility ratepayer advocate that will look out for the interests of consumers before state regulators. How the governor will respond is unclear, but given her stated desire to make New York more “affordable,” this should be an easy one to approve.

Another bill that was approved by the Senate and is under consideration in the Assembly should be a “no-brainer.” That “inside-baseball” bill plugs a loophole in the state’s lobbying disclosure law.

New York’s lobbying law currently does not require public disclosure of efforts to influence the nomination or confirmation process for positions requiring Senate approval. This loophole allows lobbying to go unreported and thus allows spending to influence the appointment of important state positions to occur out of the public’s view.

Here’s why plugging the loophole should be a legislative “no-brainer.” As mentioned earlier, legislation has been approved that would establish a utility ratepayer advocate before state regulators. The key regulator is the Public Service Commission, which sets utility rates. Under New York law, spending to get a rate hike approved or denied is considered “lobbying.”

However, due to the existing loophole, advocacy to influence the governor’s choices to be on the Public Service Commission is not considered lobbying. So, trying to influence utility rates is lobbying, but trying to influence who is picked to make the rate decision is not. How does that make sense?

Thankfully, the Senate approved the legislation to plug the loophole and the chair of the relevant Assembly Committee, John McDonald from the Albany area, is the leader pushing the legislation in that house. The bill makes sense and has not seen any lobbying in opposition and therefore should be an easy one for the Assembly.

There is one bill that could have a big impact on people and has been approved by the Senate but has not yet been acted upon by the Assembly. That legislation would require retailers to furnish prescribed warnings that gas and propane stoves used for commercial or residential food cooking emit poisonous gases that are hazardous to human health, which can cause or worsen respiratory problems. Warning labels on products, signs/posters on premises where covered products are displayed, and conspicuous notices for online sales would be required.

The evidence is in and it’s clear that a fixture in many New York homes and restaurants – the gas stove – is a potent health danger. Gas stoves using natural and propane gas for cooking release carbon monoxide, nitrogen dioxide, and fine particulates. Gases – including the powerful greenhouse gas methane – can be released even when the stoves aren’t in use.

Unfortunately, too many people are unaware of the hazards. The public has a right to know and to be educated at the point of sale.

While it’s imperative that the world rapidly transition to renewable energy sources for heating, cooking, and transportation, public education around the health dangers associated with using gas and propane can help consumers make smarter choices – for their health and the planet’s. This legislation would contribute to public education by providing relevant health information to consumers at the time they’re considering a gas stove purchase.

New Yorkers will soon know whether the Assembly sees it that way.