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State lawmakers return from their Presidents’ Week “mini-break” and begin to seriously debate the next state budget.  New York’s fiscal year starts on April first, thus giving Albany 5 weeks to negotiate the proposed $178 billion state budget.

Contained in that budget are many important policies – from Medicaid spending to higher education to the environment to education financing.  Most of the budget’s “top line” items are publicly debated; sometime equally important items are not.  One under-debated issue is the rising threat from infections that are increasingly resistant to antibiotics, also known as “superbugs.”

According to the U.S. Centers for Disease Control and Prevention (CDC), antibiotic-resistant bacteria are most prevalent in environments associated with high antibiotic use: healthcare settings, the general community, and in livestock production.  Antibiotic resistance can spread from person to person, from animal to person, via the natural environment or contaminated food and from bacteria to bacteria.  Some bacteria have developed resistance to multiple antibiotics, making them especially difficult to treat, and thus very dangerous and sometimes deadly.  Common infectious diseases such as tuberculosis, pneumonia, blood poisoning, food poisoning, and gonorrhea have already become harder and sometimes impossible to treat due to multidrug-resistant bacteria.

The problem of antibiotics-resistance is not just one found in the United States, it is a worldwide problem.  And worldwide problems demand global responses.

Antibiotic resistance happens when bacteria develop the ability to defeat the drugs designed to kill them.  Each year in the United States, more than 2.8 million infections from bacteria that are resistant to antibiotics occur and more than 35,000 people die as a direct result.  Many more die from complications from antibiotic-resistant infections.

A study commissioned by the U.K. government predicts that if action is not taken now to combat antibiotic resistance,by 2050 the annual death toll will have risen to 10 million globally.  

The situation is getting worse with the emergence of new bacterial strains resistant to several antibiotics at the same time (known as multidrug-resistant bacteria). Such bacteria may eventually become resistant to all existing antibiotics. Without antibiotics, the world could return to the “pre-antibiotic era”, when organ transplants, cancer chemotherapy, intensive care and other medical procedures would no longer be possible.  Bacterial diseases would spread and could no longer be treated, causing death.

There is hope.  Data from European agencies show that interventions can work.  Medical data shows that Scandinavian countries and the Netherlands have low rates of superbugs, but that there are higher rates in Southern Europe.  Countries with lower resistance rates have generally lower use of antibiotics, while countries with higher antibiotic resistance rates use more antibiotics.

Buried in the governor’s proposed health budget is an item to begin to address the rise of antibiotics resistant superbugs.  In his budget, the governor proposed that every general hospital and nursing home must establish an antibiotic stewardship program that meets or exceeds federal conditions of participation for antimicrobial stewardship programs in health care facilities. Additionally, such program shall incorporate an ongoing process to measure the impact of the program.  While vague, the governor’s program leaves the details up to the state’s Health Commissioner.

Yet, the governor’s plan leaves out an important area of antibiotics overuse and misuse: use on farms.  Nearly two-thirds of antibiotics that are important for human medicine are currently sold for use in livestock, not people. These drugs are routinely given as poor compensation for inappropriate diets and the stressful, crowded and unsanitary conditions on industrial feedlots. This practice hastens the spread of antibiotic resistance in bacteria and increases the risk of drug-resistant infections in people.

When antibiotics are given to food-producing animals, they kill most of the bacteria in them. The resistant bacteria, however, survive and can contaminate animal products during slaughtering and processing. They can also contaminate fruits and vegetables via contaminated soil or water, especially when animal manure is used as fertilizer. Antibiotic-resistant bacteria can contaminate food prepared on germ-filled surfaces and the environment via animal feces. According to the CDC, approximately 1 in 5 antibiotic-resistant infections are caused by germs from food and animals.

Thus, the governor’s plan ignores 20 percent of the problem – and in dealing with the growing menace of superbugs, comprehensive approaches are the only ones that will work. 

It is clear from the Scandinavian experiences that policies can significantly reduce the rise of “superbugs”: policies that focus on cleanliness in health care settings, a reliance on antibiotic use in humans only when medically necessary, and a drastic reduction in use on farm animals.  The most obvious way to reduce use among farm animals is for veterinarians to stop the use of antibiotics on healthy livestock.

This is a worldwide problem, unless the rise of “superbugs” can be stopped, the next generation will be faced with a world without effective antibiotics, one in which illnesses like urinary tract infections will be untreatable, leaving people to suffer and perhaps die, from infections easily treatable today.

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Last week, Governor Cuomo made a push for environmental initiatives contained in his budget plan.  The governor advanced what he described as an “historic $33 billion, five-year commitment to fight climate change.”

The governor urged support for measures: to ban single-use styrofoam food containers and packing materials; to earmark $300 million for the state’s Environmental Protection Fund; to add $500 million to improve drinking water infrastructure; and to permanently ban hydrofracking. 

But the centerpiece of his environmental package was his plan to create a $3 billion environmental bond act that “will fund critical environmental restoration projects in every corner of the state to ensure New York is able to withstand the threat of more intense and frequent storms fueled by climate change.”  He dubbed this part of the plan, the “Restore Mother Earth” bond act. 

On the need for billions to address the costs of climate change, the governor’s right.  New York – like the rest of the planet – will have to spend billions to mitigate the enormous damage caused by climate change.  A “Restore Mother Earth” bond act offers a down payment for the costs that New York will undoubtedly have to pay.

The question is, who should pay back the costs of the bond act borrowing?

The governor’s plan proposes that the general public pay the back the costs of borrowing the bond monies; for most bond acts, the public usually pays. 

A bond act is a way for the state to borrow a large amount of money to meet pressing needs.  The borrowed money should be used for projects that are expected to last at least the lifetime of the borrowing – usually 30 years.  Thus, spending makes sense for state projects that would protect drinking and fresh water supplies. 

Usually, bond acts are paid back through general revenues – we all pay them back.  But not always.  In the Environmental Bond Act of 1986, for example, which was designed to finance the clean-up of hazardous waste sites, the bond monies raised were to be offset by the state charging polluters responsible for the messes.  That formulation was so successful that the 1986 Bond Act was overwhelmingly approved by voters. 

It’s a formulation that makes sense now. 

Governor Andrew Cuomo’s proposed bond act is – as he has stated – to finance projects to help the state “withstand the threat of more intense and frequent storms fueled by climate change.”  But who’s responsible for climate change?

The responsible parties for the climate crisis are the oil, gas and coal industries.  It is those industries that should pay the borrowing back. 

It was those industries that knew for decades the dangers of global warming from the burning of fossil fuels.  It was those industries that spent money – on lobbyists, public relations and campaign contributions – on a disinformation campaign to combat measures to curb greenhouses gas emissions that form the “blanket” contributing to the heating up of the earth.

The oil, coal and gas industries should pay for the costs resulting from their actions, not the general public.  If your neighbor dumped poison on your lawn and it had to be cleaned up, should you pay or the neighbor?  The neighbor should.

While that is a hypothetical scenario, effectively that’s what happened with climate change.  The fossil fuel industries used their political know-how to undermine the science—including their science—that warned the public about climate change and used their deep-pockets to block policy reforms designed to protect the public and the environment.

But like that fictional neighbor, it is their fault.  They made the mess, they should clean it up.  A responsibility lesson that every child learns, they’ve been able to dodge through political muscle and their fat checkbooks.

Governor Cuomo and state lawmakers should ensure that the oil, gas, and coal industries are on the financial hook, not taxpayers, for the looming climate catastrophe.  The “Restore Mother Nature” bond act is needed, but those responsible should pay.

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Last week, as the state budget hearings continued, lawmakers heard pleas from academics, faculty and students that higher educational institutions are struggling, and that New York’s public policies make things worse.

One consistent refrain was the need for the Legislature to change the governor’s proposed budget by closing the so-called “TAP gap.”  What’s a TAP gap?  First, some background.

When Governor Cuomo came into office in 2011, one of the initiatives he advanced was a plan to annually increase tuition at public colleges and universities.  The appeal of predictable increases, according to the governor, is that students and their families would know the annual cost of tuition.  Under his plan, tuition would go up annually, but be capped at a certain amount.  In the early years, that cap was set at $300 annual increase.

But what was not fully discussed was the impact it would have on the state’s biggest college financial program – the Tuition Assistance Program, or TAP.  TAP is an almost fifty year old program that awards state financial aid to college students – both at public and independent colleges – based on income.  The poorer the student, the larger the award.

Until Governor Cuomo, the maximum TAP award matched the cost of tuition at public colleges.

When the governor first advanced his plan, that relationship was severed.  Instead the maximum TAP award was frozen at $5,000 annually (it was bumped up a few years later to $5,165) while tuition costs annually went up.  Tuition at the State University of New York today hovers around $7,000.  Under the new system, the local college must make up the $2,000 difference per needy student out of their own local budget.

The difference between public college tuition and the maximum TAP award is known as the “TAP gap.”  That “gap” is increasingly putting strains on the community colleges and four-year public colleges, since they now must pony up a million dollars or so to help needy students – assistance that used to be provided by the state.

Independent (private) colleges are facing the financial pressure too, since TAP offers less and less assistance for low-income students that often needs to be made up by those institutions.

In addition, there are substantial demographic changes in New York.  The upstate population is shrinking, particularly among the college-aged.  SUNY community colleges have taken a dramatic hit, with tens of thousands of fewer students than a decade ago.

As a result of these pressures, SUNY 4-year colleges have had to raise tuition and administrative fees to cover costs.  Many SUNY community colleges are teetering on the brink as they grapple with cratering student enrollments and tight state assistance.  Community college tuition – already among the highest in the nation – has had to jump.  With fewer students, but the same costs, tuition hikes have to cover the difference.  Higher tuition results in fewer students and things keep getting worse.

Independent colleges and universities are taking a hit too and their share of the TAP awards has dropped substantially. 

What is to be done?

In the short-term, the state needs to cover the difference of the “TAP gap.”  Doing so will immediately bring relief to struggling campuses.  The help to community colleges will need to be even more robust, as some of them are in dire financial straits.  Also, the state must boost aid to independent colleges to help them make ends meet. 

A longer-term solution is to modernize the state’s TAP program.  Peg the maximum award to the cost of public college tuition – which helps all colleges – and modernize it.  Ten years ago, the state stopped awarding TAP to graduate students.  In the modern age that doesn’t make sense.  Part-timers – students typically juggling job and family responsibilities – should get aid, too.

The state’s Excelsior Scholarship – which offers some help – benefits only a very small portion of students.  Last year, of the total 452,000 full-time undergraduate public college students (287,000 at SUNY and 165,000 at CUNY), only 25,000 received an Excelsior award.

One hundred years ago, reformers pushed to make public school free.  They argued that a better educated populace benefited the nation’s economy and strengthened democracy. 

In the 21^st Century, education beyond high school is as critical now as universal education was at the turn of the 20^th Century.  Public policies today should seek to make it more affordable and accessible, not less.  One place to start is by closing the “Tap gap.”