Archive for July 2023

The Nation’s Hospitals Get Graded by the Feds

Posted by NYPIRG on July 31, 2023 at 9:08 am

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 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 37th 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.

The Debate Begins Over Accountable New York State Government Spending

Posted by NYPIRG on July 24, 2023 at 9:56 am

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 1st – three months after the start of the legislative session.  This is in contrast to the 46 states that began their fiscal years on July 1st.  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 1st.

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.

The World Faces a Climate “Code Red”: Catastrophic Wildfires, Floods, and Heat, Hammer the Planet

Posted by NYPIRG on July 17, 2023 at 11:02 am

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.

Protecting Consumers From Medical Debts

Posted by NYPIRG on July 10, 2023 at 10:08 am

One of the last-minute deals at the end of the New York legislative session last month was approval of a bill to help protect patients from the repercussions of outstanding medical debts.  The bill, if signed into law by Governor Hochul, would prohibit credit reporting agencies, including Transunion, Experian, and Equifax, from including medical debt in consumer credit reports.

Credit reports and their accompanying credit scores have become a crucial gateway to participating in many standard economic activities. Credit scores might be checked when applying for a loan, getting a credit card, renting an apartment, or even applying for a job.

One of the biggest impediments to Americans having a healthy credit score is medical debt.  Approximately 60% of consumer debt that appears on credit reports is medical debt.  It is therefore one of the main factors that can contribute to a person’s low credit score, which can sabotage them from successfully engaging in simple wealth-building activities like applying for a job or a mortgage.

The three credit reporting agencies have already voluntarily agreed to stop reporting medical debts under $500.  However, in an effort to reduce even further the reporting of certain debt, the Consumer Financial Protection Bureau (CFPB) issued an interpretive rule inviting states to further restrict what can be reported than is required under the Fair Credit Reporting Act.  This ruling reflects the finding by federal agencies that approximately 1 in 5 Americans have some false or erroneous information on their credit report that is harming their credit score.

The New York legislation approved in June would build on the ruling issued by the CFPB to prohibit credit reporting agencies from reporting all medical debt on the credit reports of New Yorkers.  Medical debt differs from other types of consumer debt:  It is not taken on voluntarily, but accumulates due to emergencies, and therefore it is not indicative of a person’s ability to pay back their financial obligations.  Medical debt should not be taken into account when determining a person’s credit score and should not prevent a person from being able to get a job, rent an apartment, or open a bank account.

Important to note that the legislation would not absolve patients from paying their outstanding bills, just prohibit those outstanding charges from appearing on the individual’s credit report.

Of course, the whole situation is ridiculous.  Why should anyone have their finances damaged because of medical bills in the first place?

Health care is too often unaffordable for New Yorkers.  As a result, many patients suffered serious financial harm because they needed medical care.  Over 53,000 New York patients were sued by hospitals between 2015 and 2020, and thousands had liens placed on their homes or had their wages garnished.  Last year, New York recognized this problem and placed a prohibition on the placement of medical liens and wage garnishments.  These are laudable changes, but they failed to provide help to the 38 percent of New Yorkers who say they avoid necessary medical care because of costs or the 34 percent who say they have experienced serious financial harm due to medical bills (such as being unable to afford basic necessities or using up all of their savings).

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, 53 percent of people without insurance said the same.”

Health care in America is based on a system of insurance that is expensive yet fails to provide the benefits we expect.  The United States spends nearly 17 percent of its Gross National Product on health care (pre-pandemic), yet ranks 29th of the 37 Organisation for Economic Co-operation and Development (OECD) member nations in life expectancy.  It is clear that American health care is expensive and doesn’t deliver on its most basic mission: providing coverage to all those who need it. Public policy must ensure coverage for all residents. 

And while the nation continues its decades-long debates over how best to ensure universal coverage, it’s up to the states to stanch the financial bleeding.  New York has recently taken steps to protect patients from some of the worst hospitals’ aggressive bill-collecting practices, but keeping medical debt out of credit reports helps, too.  While outstanding hospital bills will still have to be paid, those charges will not further harm patients’ creditworthiness.  Illness and injury are difficult enough without having to tackle credit reports.  Governor Hochul should see it the same way.

Big Oil’s Summer of Deception

Posted by NYPIRG on July 3, 2023 at 8:32 am

Halfway through 2023 and it’s clear that climate changes are triggering catastrophes across the globe.  Incredible storms, wildfires, and floods are hammering people everywhere.  There has been a record-breaking cyclone in southeastern Africa, an unusually intense typhoon in the Pacific, wildfires in Chile and Canada, unbearable heatwaves across Asia, the southern areas of the United States, as well as parts of Europe, and flooding from extreme rainfalls in Europe and Africa

And things are expected to get worse.  In the most recent report released by the Intergovernmental Panel on Climate Change (IPCC), published in March, environmental experts predict that at the world’s current rate of collective inaction against the climate crisis, we could be facing 1.5°C temperature rise by the beginning of the 2030s.  As such, extreme weather events would increase in frequency and strength. 

Unless the world acts far more rapidly, the head of the United Nations has bluntly stated,  “Half of humanity is in the danger zone, from floods, droughts, extreme storms and wildfires.  No nation is immune.  Yet we continue to feed our fossil fuel addiction.  We have a choice.  Collective action or collective suicide.  It is in our hands.”

No nation, no location will be immune.  As Americans in the northeast and eastern coastline choke their way through a second round of smoke from out-of-control Canadian wildfires (triggered by climate change), it’s important to note that this is just another environmental “hit” resulting from a rapidly heating planet – heating that is primarily the result of human activities.

According to a recent analysis by the U.S. National Oceanic and Atmospheric Administration, the U.S. has sustained 357 weather and climate disasters since 1980 where overall damages/costs reached or exceeded $1 billion.  The total cost exceeded $2.54 trillion.  So far in 2023 (as of June 8th), there have been nine confirmed weather/climate disaster events to affect the United States, with each loss exceeding $1 billion.

The Canadian wildfires are the most incredible seen in North America.  In just one day this past June, it was reported that more forest acreage burned in Canada than burned in all of California last year

Yet here in New York, the oil lobby and their allies continue to do all they can to erode public support for action. 

Big Oil has known for decades that the burning of fossil fuels would trigger the climate changes we are experiencing today.  Yet instead of doing the responsible thing and alerting the public, they spent millions on public relations consultants, law firms, lobbyists, and campaign contributions in a successful effort to block actions that could have minimized the global warming threat.  They laughed all the way to the bank while the planet continued to heat up as their scientists had predicted.

Now, their allies are arguing that it’s too expensive to tackle the problem and that measures to act are too “radical.”

Let’s look at that assertion.  New York State approved a law in 2019 that pledged to achieve “net zero” greenhouse gas emissions by the year 2050.  That pledge is consistent with what the world’s experts have called for.  The law set some interim goals to meet that pledge and established a task force to figure out the details. 

That group met and issued its 400+ page report late last year and it is that document that offers the blueprint for legislative and regulatory actions in New York.  Due to a lack of political will, much of what the plan called for has not been acted upon by state leaders.  One might argue that Albany has been too timid, but it is hardly radical.

What is radical, however, is to undermine science in order to sell products that can push the world to the environmental brink and to advocate for policies that slow down the efforts to save civilization and the environment.  Now that’s radical.  Dangerously radical.

When you hear that Albany has embraced a “radical” agenda to address climate change, remember that it originates from the oil industry and is advanced by witting or unwitting allies in the service of efforts to maximize oil companies’ riches at the expense of billions of people. 

Know that it is they – the oil companies and their allies – that are the real radicals.  Radicals who are pushing the world to the brink.  Instead, ignore the propaganda and support efforts to eliminate fossil fuels from our economy.  That’s not radical, it is simply commonsense.  In fact, it’s survival.