The world is in crisis: climate change has triggered once-in-a-millennium catastrophic weather events and we are all enduring the second year of a worldwide pandemic. 

There is, unfortunately, another public health crisis that is emerging: the growing inability of antibiotics to kill off infections.  Unless the world responds intelligently to this growing threat, these antibiotic-resistant infections, also known as “superbugs,” could kill more people worldwide than cancer by the middle of this century.

You heard that right:  Experts now predict that unless the threat posed by “superbugs” is curbed, in the not too distant future more will die from currently treatable infections than will die of cancer.

An appropriate response has a two-pronged approach: curb the overuse and misuse of current antibiotics and invest in new therapies that will kill “superbugs.”

How did the world find itself under this new threat? 

The more antibiotics are used, the faster bacteria evolve and develop resistance to them.  The U.S. Centers for Disease Control and Prevention (CDC) estimates that more than 2.8 million people develop resistant infections each year in the United States, and more than 35,000 die.

The pandemic may have made the situation worse.  The early treatment for COVID patients was to use antibiotics as a way to help fend off secondary infections – antibiotics attack bacteria, they do not kill viruses.  Yet, the regular use of antibiotics on COVID patients may have helped accelerate microbial resistance. 

All this to say that the nation – and the world – need to act before it is too late and the current antibiotics lose their effectiveness.  Some steps have been taken.  New York State now requires all hospitals and nursing homes to develop infection stewardship programs to better regulate the use of antibiotics.

There also is a growing recognition of the dangers posed by the overuse and misuse of human-important antibiotics on farm animals – but outside of the states of California and Maryland, little has been done in the U.S.  More on this in a moment.

And despite the obvious urgency, global research and development for new antibiotics is running dry.

Unlike cancer drugs or medicines that people take for years to control chronic illnesses, antibiotics must be used as conservatively as possible to preserve their effectiveness.  Using a product sparingly undermines its profitability.  Given that the antibiotics-making-business is unprofitable, drug companies spend their investment dollars on other therapies with big payoffs. 

Additionally, as mentioned earlier, hospitals and health systems have begun to implement much-needed antibiotic stewardship programs to reduce inappropriate antibiotic use and preserve the drugs’ efficacy.   While those actions are appropriate, a collateral effect is that it reduces the sales of new antibiotics.  Few drug companies find it feasible to spend big bucks to create an affordable drug that is meant to sit on the shelf for as long as possible.

These market factors have led almost every large pharmaceutical company to leave the field in recent years.  In 2014, eight big drug makers had a new antibiotic in the clinical pipeline; last year only two did.

The Biden Administration has advanced in its budget plan funding increases for key agencies, including the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health—which are deeply involved in the fight against antibiotic resistance.  Congress is considering legislation that would offer funding contracts to drug companies, providing them with a fair return on investment for the risk they incur to develop a new antibiotic based on the drug’s value to public health.  Hopefully, action will be taken.

Here in New York, the governor and state lawmakers should also consider measures to reduce overuse and misuse of antibiotics on farm animals.  Nearly one-quarter of all antibiotic-resistant infections emerge from agriculture, putting workers and communities at risk.  The superbug problem needs to be attacked at every level, including in agricultural settings.

There is no time to waste.

For over a decade the Joint Commission on Public Ethics (JCOPE) has been the state’s leading ethics watchdog agency.  Its job is to oversee compliance with ethics standards set for the executive branch, in a limited way to do the same for the legislative branch, and to regulate state and local lobbyists and their clients.  Since its inception critics have charged that the structure of the agency is not independent and it is, in fact, a political agency – one in which the leaders of the executive and legislative branches controlled the actions of the agency.

This week, the state Senate’s Ethics Committee will hold a hearing to examine the work of New York’s ethics watchdogs. 

Unfortunately, the evidence has borne out those criticisms.  While the activities of JCOPE have been shrouded in secrecy (largely the result of state laws), reporting by investigative journalists has shed light on this critically important agency.  And the picture that emerges is deeply troubling.  The hard work of digging into JCOPE has been led by the Albany’s Times Union newspaper, which has devoted considerable resources into getting under the hood of JCOPE to see how it operates.  What little the public knows of JCOPE’s inner workings has been through the media, primarily the Times Union.

One issue currently under JCOPE’s consideration is examining the use of public resources for private gain.  Both of Governor Cuomo’s book deals were approved by the JCOPE staff without, it appears, full Commission approval.  It has been reported that some commissioners now believe that such approval should have gone to the full Commission. 

In both cases, the governor’s office argued that there was precedent for staff to decide the issue without going to the full board that directs JCOPE.  In both cases, the governor’s book deals resulted in significant compensation.  How the staff made their decisions and whether they were aware of all the details of the size of the financial compensation is not at all clear. 

Moreover, when the Executive Chamber’s employees requested approval on behalf of the governor, the correspondence was written on state letterhead and may have been written by a government employee working on public time.  These facts raise questions about where JCOPE draws the line in determining when the use of public resources is appropriate and when it is not. 

JCOPE has been criticized from within as well.  Members of the JCOPE board have alleged that the governor was told of the private discussions about allegations that a former top aide to the governor misused public resources.  Under state law, those discussions are supposed to be secret.  As of today, no one is aware of how the governor and his staff were alerted to these internal discussions.

There have been public complaints made by commissioners that JCOPE’s decision-making hinges on a small number of commissioners working with senior staff.  Again, it is not clear if this is true. 

This week’s state Senate’s hearing should be the place were these – and other – questions get raised and answered by JCOPE officials.  The new Executive Director of JCOPE will testify at that hearing, but it is not clear if the Senate plans on interviewing other members of the Commission or the senior-level staff.

Since the public pays for the ethics agency, they should have a right to know if any of these allegations are true.  The public deserves to get a better understanding of how ethics enforcement works – or doesn’t work – in New York.

Of course, the structure of the agency is the root problem: Commissioners appointed directly by the governor and the Legislative leaders – the very people whose ethical behavior could be questioned.

That simply cannot work.

That’s what government watchdogs and a New York City Bar Association review concluded.  The Joint Commission on Public Ethics (and the Legislative Ethics Commission) should be replaced with an independent ethics enforcement agency that would monitor and enforce ethics for the executive and legislative branches. 

Nowhere is the public’s trust more susceptible to harm than when lawmakers act in ways that skirt not only the letter, but also the spirit, of ethics laws.  New York has seen its share of ethical lapses, yet little has been done.  Prison sentences, convictions, plea deals, scandals and other allegations of ethical misconduct have been on the front pages of the state’s newspapers far too often.  As a result, the ways in which the state regulates political ethics has been a front-burner issue. 

Unfortunately, little is clear when it comes to New York State’s ethics laws.  The laws are riddled with loopholes and poorly – if at all – enforced.  Changes are needed to comprehensively reform the state’s ethics laws.  Let’s hope that the Senate uses its powers to get important questions answered and begins to develop reforms that will both ensure independent, competent ethical oversight and bolster public confidence in state government.

In New York City’s recent primary a new system of voting was implemented: ranked choice voting (RCV).  RCV allows voters to rank candidates in order of preference, instead of limiting their decision to one candidate.  The new system was put in place after New York City voters overwhelmingly approved it (73.5%) for municipal and primary elections in 2019.  RCV is rare in the U.S., existing in several municipalities as well as in the states of Maine and Alaska.

Here’s how the NYC RCV system works:  Voters can choose to list up to five candidates in descending preference.  The New York City Board of Elections (BOE) then tabulates the votes.  A candidate who receives more than 50% of the vote wins.  If no candidate exceeds 50% in the first round of voting, counting continues.  In the second round, the candidate who received the fewest votes is dropped from consideration and that candidate’s votes are applied to the remaining candidates.  For the voters whose candidate was eliminated, their votes are redistributed based on their second choices.  If no candidate still garners 50%, then a third round is calculated, eliminating the candidate with the fewest votes, and redistributing those votes to the remaining candidates.  The process continues until one candidate’s vote count exceeds 50%.   

Proponents of the new system successfully argued that RCV gives voters more choices, that candidates are more likely to cooperate since they would not want to alienate other candidates’ voters.  Why?  Because if they are not a voter’s first preference they would want to be listed as a second or third choice since that may still help them to win the election.  Lastly, proponents argued that the RCV system would save money.  Prior to this new system, if no citywide candidate received 40% of the vote, a runoff election was held – and running elections costs money.

How did the new system perform?  There is good and bad news.  The good news is that despite fears it would be too complicated, New Yorkers overwhelmingly found it easy and straightforward to rank.  Primary turnout hit its highest levels in more than 20 years.  The mayoral race attracted a wide range of high-quality candidates, and quite a lot of media attention. The race was interesting because it was uncertain and competitive — and it was uncertain and competitive in large part because of ranked-choice voting.  Dynamic, competitive races lead to higher turnout. More voters are engaged, and more votes matter.

And according to a voter survey, New Yorkers liked the system.  In a survey jointly released by Common Cause/NY and Rank the Vote NYC, and based on exit polling conducted by Edison Research, 77% of New Yorkers want RCV in future local elections, 95% of voters found their ballot simple to complete, and 78% said they understood RCV extremely or very well.

On the negative side, the agency responsible for running the RCV election – New York City’s Board of Elections – has so far done a poor job.  The City’s BOE, which was established decades ago, has been long criticized as incompetent and too focused on the needs of the two major political parties, not the needs of voters.  The criticisms originate with the structure of the BOE. 

The NYC BOE – like all of the state’s local elections agencies – is run jointly by the two major political parties.  The commissioners are usually chosen due to their partisan loyalty, not their ability to competently run elections.  Of course, that does not mean that all elections commissioners and board staff cannot do a competent job – there are some that are quite skilled – but that the process of appointing them is far too likely to reward partisan loyalists. 

As a result of this system that rewards the party faithful – not necessarily what’s best for elections administration – polls across the state have been plagued with errors, incompetence, and too often illegalities.  New York City has not been immune.

For example, in 2016 the NYC BOE mistakenly purged 200,000 people from voting rolls, which led to some voters waiting in four-hour lines to cast their ballots.  In 2020, the BOE sent out 100,000 absentee ballots to voters, but with incorrect names and addresses.

In this year’s June Democratic primary, the BOE included 135,000 test ballots in the preliminary unofficial release of ranked-choice voting results.  After the error was identified, the BOE took down the faulty tabulations.  But the damage was done – giving RCV opponents an excuse to criticize the new system itself and cast doubt on the election results.

Of course, the BOE error in reporting the preliminary count has nothing to do with RCV.  BOE’s mistake was the result of human error.  It’s incomprehensibly incompetent, but it’s not a failure of RCV. 

New Yorkers are still waiting for the final results of the June Democratic primary election – absentee ballots still need to be counted and those RCV votes tabulated.  But until then, and despite the underwhelming performance of the NYC BOE, ranked-choice voting has passed its first test – City voters liked it, it reduced elections costs, and may even have begun to move toward a less toxic election cycle.  For other municipalities with run-off elections, it serves as a positive option. 

Last week, western North America suffered through a record-breaking heat wave.  In the month of June, nearly 90 percent of the western US was in a state of drought made worse by climate change.  Lakes have been at historically low levels and restrictions were imposed on water use across the region.  Canada is getting hit too.  As one Canadian climatologist commented, “I like to break a record, but this is like shattering and pulverizing them.  It’s warmer in parts of western Canada than in Dubai.”

Records being set in the western United States are equally impressive.  For example, Phoenix hit a record-breaking 118 degrees last week.  Tacoma Washington hit triple digits for only the third time since 1945.  CBS News described it as “Pacific Northwest bakes under once in a millennium heat dome.”

Alarmingly, according to the world’s experts, the worst is yet to come. In a leaked draft report that became public last week, the world’s experts in climate change painted a devastating picture of what is to come unless aggressive actions are immediately undertaken.  The draft report, prepared by the United Nations’ Intergovernmental Panel on Climate Change, predicted that millions of people worldwide are in for a disastrous future of hunger, drought, disease, and massive dislocation. 

According to media outlets, the report stated that “Climate change will fundamentally reshape life on Earth in the coming decades, even if humans can tame planet-warming greenhouse gas emissions.”  The report, due to be released in final form next year, predicted that “The worst is yet to come, affecting our children’s and grandchildren’s lives much more than our own.”

Even though it is well-known that global warming is fueling both the record heat and the growing droughts across the world, the IPCC draft report carried a punch.  The report makes clear that unless the world takes immediate actions, rising sea levels will threaten coastlines and major cities, many species of life on Earth will become extinct, and devastating heat waves will make parts of the world unlivable causing widespread famine and disease.

Action must be taken.

Here in New York, the state has set aggressive goals to curb greenhouse gas emissions and to shift power generation to non-fossil fuel sources.  In 2019, a state law was approved that established a road map for responding to the growing crisis by requiring:

• net-zero greenhouse gas emissions by 2050;

• 70% of electricity be generated by renewable sources by 2030;

• new efficiency targets for reducing energy use in buildings; and,

• massive increases in the reliance of solar and wind power as well as a mandate to dramatically boost energy storage capacity.

While those are the types of goals that the world must adopt to avert a climate catastrophe, such a plan must have broad public support in order to succeed.  To build that support, these goals need to be in sync with the reality of the state’s performance, so that New Yorkers know the state is doing everything it can to protect their health and their future.

Unfortunately, New York has had a poor track record when it comes to matching its impressive rhetoric with its real performance.  For example, in 2009 New York set a goal of generating 45% of its power from solar and wind by the year 2015.  Today New York only gets approximately 5% of its electricity from wind and solar.

In order to build public support and to hold officials accountable, a monitoring system must be developed.  New York – and every government – should create an open, scientifically verifiable, “report card” that allows the public to understand how well government is doing in moving toward its climate goals.  For example, in New York, for the state to have 70% of its power generated by renewable sources in eight and a half years, it must show its annual movement in that direction.  New York currently generates 27% of its power from renewable sources (if hydropower is considered renewable).  Thus, the state must expand its reliance on alternative sources by approximately 5% annually.  How will New Yorkers know?

In the two years since it set its aggressive climate goals, it is still difficult for New Yorkers to discern what progress, if any, the state has made towards those goals, and how far it still needs to go.  NYPIRG recently released a review of the state’s goals and how far it has yet to go, but getting access to the data was difficult and incomplete.

The incomplete picture it painted was that New York is not on pace to achieve its goals.  With so much at stake, New York – and the world – must set significant climate protecting goals and establish a way for their performance to be measured. 

The ongoing ideological fight over whether the United States should ensure that all Americans have health care coverage came to a head last week with the US Supreme Court’s decision to uphold the Affordable Care Act.  While that decision rested on technical grounds – the Court ruled that the states and individuals bringing the challenge did not have legal standing to force a decision on the legal merits – it was widely viewed as a victory for the ACA law itself.

The Affordable Care Act – often called “Obamacare” – has now been law for a decade and has fundamentally changed health care delivery in the nation.  At the same time, the ACA has helped expand health insurance coverage to those most in need – individuals whose incomes were too high to obtain Medicaid coverage (health coverage for the poor and needy), yet too young to obtain coverage from Medicare (the universal health insurance system for those over the age of 65).

The morally reprehensible position of trying to take away health coverage from those covered by the ACA was made clear as the COVID-19 pandemic swept the nation.  Recklessly putting partisan and ideological interests ahead of the health of Americans is simply indefensible in normal times and particularly odious during a pandemic.

Simply put, lacking health insurance can be a death sentence.

Yet, the USA stands in stark contrast to the world’s developed nations.  All other wealthy nations have universal health coverage, although they organize their systems differently.  England, for example, has a national health service (NHS) that provides health care to all its residents.  Its government owns the hospitals and providers of NHS care, including ambulance services, mental health services, district nursing, and other community services.  Germany, on the other hand, has a more decentralized system, one that allows roles for its regional governments and a highly regulated private sector.

In all cases, however, the cost of health care delivery is less expensive than in America, and the life-expectancy in all these nations exceeds that of the USA.  The United States spends 17 percent of its Gross National Product on health care (pre-pandemic) yet ranks 28^th of the 37 Organisation for Economic Co-operation and Development (OECD) member nations in life expectancy. 

In short, citizens in those countries pay less and get more than Americans when it comes to health care.

That’s not to say that other nations’ health systems uniformly perform better that the American system – COVID vaccine rollouts have taken far more time outside of the US (and China).

Nevertheless, the Supreme Court’s decision should open a national debate over how best to proceed.  Assuming universal coverage is the goal, the United States still has a long way to go.  While the ACA expanded coverage to 20+ million Americans, nearly 30 million still lack health insurance of some form.

Vermont’s Senator Sanders is leading an effort in the Senate to include health coverage in the next round of the Congress’s budget reconciliation.  The Senator is pushing for changes that include a lowering of the age of Medicare eligibility from 65 to 60 and providing expanded coverage for those on Medicare – such as dental coverage.  Whether Sanders’s efforts will succeed is unclear, but that doesn’t mean that states should sit back.

The Affordable Care Act used the state of Massachusetts’s health insurance system as its model.  That plan, advanced during the tenure of Republican Governor Mitt Romney, required residents to get insurance, expanded Medicaid coverage to those whose incomes were close to – but not below – the poverty line, and offered government-organized health coverage with state subsidies for those middle-income residents who did not qualify for other programs or whose employers did not offer coverage.

Massachusetts now has near-universal coverage.  Over the past decade, New York State set up its own program and has seen a dramatic reduction in its uninsured. 

But there are still an estimated one million New Yorkers who lack coverage, with one quarter million lacking coverage due to their immigration status.  Given the fiscal limitations of expanding coverage – the state has been looking for ways to spend less on Medicaid for example – any expansion should be coupled with ways to rein-in costs.

One proposal with widespread legislative support (known as NY Health), is for New York to reorganize its health coverage system to squeeze out insurance industry costs and use those savings to fund a robust program of coverage.

Amid the worst acute public health crisis in generations, the current insurance system failed massively.  People lost their health insurance.  Hospitals and providers, operating with just-in-time systems and investments oriented to expensive treatments rather than public health, were less well equipped to absorb the pandemic demands than they should have been.  Ensuring coverage for all is one critical way that New York – and the nation – can help people who are sick, can reduce costs, and extend lifespans.  Those are benefits worthy of serious debate at both the federal and state levels.