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.

Lawmakers wrapped up the 2021 legislative session last week.  In some ways, the session was unlike others.  For the entire January to June session the Capitol and the Legislative Office buildings were closed to the public.  Lawmakers did not have to be in Albany in order to vote.

But in other ways, the session was more like ones the occurred pre-pandemic.  The 2021 session saw a total of 892 bills pass, just shy of the 935 bills that passed in 2019 – and dramatically unlike last year’s passage of only 414 bills.

And like sessions of the past, a huge number of bills that were approved by the Legislature came during the final week:  461 of the 892 bills were approved last week. 

That return to some version of “typical” does not mean that the session was any more substantive.  Important issues were approved, for example, there will be five constitutional amendments on the ballot this November for voters to consider.  Two of those amendments will make voting easier – one eliminates the current requirement that voters need an excuse to obtain a mail-in ballot.  If approved by a majority of New Yorkers casting votes on the proposal that amendment will change the state Constitution to allow any voter to obtain a mail-in ballot merely by asking for one.

Another constitutional change would allow for new voters to register and vote on Election Day instead of the current blackout period that prohibits voters from registering within 10 days of Election Day.  

In the area of the environment, the Legislature approved a bill to require that the state establish regulations for some persistent toxic contaminants in drinking water supplies but did little when it came to tackling climate change.

One notable issue that lawmakers punted on was a bill that would have placed a moratorium on energy-intensive “cryptomining” in New York State.

Cryptomining is a relatively new technology that provides the basis for cryptocurrency.  Cryptocurrencies such as Bitcoin are virtual currencies, which means they exist only online and there are no physical notes and coins.  Cryptocurrencies do not belong to a central bank, meaning they have no government backing.  They are international currencies and can be used to send money around the world without any identity checks, making them a popular choice for cybercriminals. 

These digital currencies require authentication to prevent fraudulent transactions.  One important way in which authentication occurs requires that the transaction be approved using a complex mathematical equation.  For the transaction to go through, crypto “miners” compete to solve the mathematical equation.  The first one to solve an equation authenticates the transaction and wins currency for their effort.

While it sounds like a science-fiction system, it is in use today.  The climate change component of this is that to solve these mathematical equations and to win the currency for their effort, these “miners” need incredible amounts of electricity to run their computers.  And the cheaper the source of power, the less overhead, and the larger the profit.

Crypotminers in New York are now considering turning on old fossil fuel energy plants to power their activities.  Firing up these old plants is cheaper yet contributes significantly to the amount of greenhouse gas emissions – at precisely the time that the world’s climate experts are arguing that we need to cut back.

The legislation would have put a hold on permitting the use of these mothballed plants until the state understood the climate (and freshwater) impacts.  The legislation was blocked in the Assembly.

While that is an example of an important bill that was waylaid by lobbyists, the number of bills passed in 2021 documents that one-party control has reversed an overall historical trend:  Since seizing control of the Senate, the Democratic majorities in both legislative houses have increased approval of legislation, reversing the previous decade’s overall decline and at the highest amounts over the past two decades (other than last year’s pandemic session).

Yet quantity is not necessarily quality.  The threat posed by the global warming resulting from the burning of oil, gas, and coal is an existential one.  It deserves attention.  No matter how seemingly productive lawmakers were, their collective failure to tackle climate threats outweighs by far the improvement in the number of bills passed.

New York’s campaign financing system has been called a “disgrace” and an “embarrassment.”  One of the most brazen examples of the disgraceful nature of the state’s campaign financing system is that it allows those with business before the government to shower contributions on elected officials who control government contracting decisions.

One does not have to look far to see the consequences.  Former U.S. Attorney Preet Bharara took down a “pay-to-play” scheme in which a Buffalo-based developer funneled campaign contributions to Governor Cuomo’s re-election campaign at the direction of the governor’s aides and close allies.  Bharara also uncovered a scheme in Syracuse in which a local developer there did the same thing.

In both cases, the developers’ efforts were successful – until the U.S. Attorney’s office got involved.  As a result, the developers as well as top aides to the governor were convicted of corruption.  The governor was not charged in either case.

But the system of “pay-to-play” – in its legal forms, in which a wink and a nod are used instead of direct kickbacks to government officials – is commonplace in New York and the rest of the nation.  The nation’s campaign finance system is based – with few exceptions – on candidates’ ability to raise money from private sources.  And those private sources are usually the ones with business before the government and who are seeking favors in the form of legislation and lucrative government contracts.

An independent commission looking into New York’s campaign finance system stated three decades ago, “When running for public office requires enormous expenditures of privately raised funds, challenges to incumbents are all but limited to the most wealthy and well-connected.  Moreover, huge campaign costs pressure candidates to maintain political views that do not offend big money.”

It doesn’t have to be this way.  Some states have taken steps to curb this pay-to-play culture.  Our neighbor across the Hudson, New Jersey, has had a robust program to curb contributions from those with business before the government. 

Under New Jersey’s pay-to-play law, for-profit business entities that “have or are seeking” government contracts are prohibited from making campaign contributions prior to receiving contracts.  Moreover, businesses are forbidden from making “certain contributions during the term of a contract.”  These pay-to-play restrictions apply at state, county, and municipal levels of government.   NJ law requires contributions over $300 to be reported, and the contributor’s name, address, and occupation to be identified.  A government entity is prohibited from awarding a contract worth more than $17,500 to a business entity that made a campaign contribution of more than $300 “to the official’s candidate committee or to certain party committees,” specifically to committees that are responsible for awarding the specific contracts. 

The notion that those receiving government contracts can be restricted is not a new concept.  The federal government’s Securities and Exchange Commission, for example, has enacted a pay-to-play rule.  The rule, under the Investment Advisers Act of 1940, prohibits an investment adviser from providing services, directly or indirectly, to a government entity in exchange for a compensation, for two years after the adviser or an employee or an executive makes contributions to political campaigns of a candidate or an elected official, above a certain threshold.  Moreover, the rule prohibits an investment adviser or an employee or an executive from providing or agreeing to provide payments to a third party, on behalf of the adviser, in order to seek business from a government entity, unless the third party is a registered broker dealer or a registered investment adviser, in which case the party will be subjected to the pay-to-play restrictions.   

New York’s State Senate is advancing legislation that would take steps to curb pay-to-play.  State Senator Zellnor Myrie has moved a bill to the Senate floor that restricts campaign contributions from vendors to “any officeholder of or with authority over the state governmental entity or entities responsible for issuing such procurement.” 

Governor Cuomo has said that he supports such limits but has not put his muscle behind reform legislation.  If the Senate approves the Myrie measure, the attention will turn to the Assembly.  In that chamber Assemblywoman Sandy Galef has a bill that matches Myrie’s legislation, but there has been no movement this session – at least not yet.

As Albany hurtles toward wrapping up its legislative session later this week, lawmakers should remember that their work to repair New York’s democracy is still unfinished.  Banning pay-to-play is an important step for them to take.

This year marks the 50^th anniversary of a landmark reform in American democracy.  In 1971, the nation approved the 26^th Amendment – a change that allowed 18-, 19- and 20-year-olds the right to vote.  The change went into effect after 3/4 of the states approved the measure.  The amendment was first approved by the Congress in March 1971 and New York State approved the change on June 2, 1971 – 50 years ago this week.

The change came after decades of debate.  The idea to lower the voting age started after President Franklin Roosevelt lowered the draft age to 18 as part of the World War II effort.  The slogan “Old enough to fight, old enough to vote” was first used in 1941 and the proposal was supported by then-First Lady Eleanor Roosevelt but failed to pass the Congress. 

States began to take up the measure: In 1943 and 1955 respectively, the Georgia and Kentucky legislatures passed measures to lower the voting age to 18.  President Eisenhower, in his 1954 State of the Union address, became the first president to publicly support prohibiting age-based denials of suffrage for those 18 and older.  But again, no action. 

During the 1960s both Congress and the state legislatures came under increasing pressure to lower the minimum voting age from 21 to 18.  The intensity level to support lowering the voting age grew as young adults clamored to obtain their full rights as adults.  

College students’ activism came after their involvement in the campus Free Speech movement, as Freedom Riders and advocates for Civil Rights, and in reaction to the Vietnam War.  It was the War that tipped the balance, a war in which many young men who were ineligible to vote were conscripted to fight yet lacked any means to influence the people sending them off to risk their lives.

Passage by Congress of an expansion of the Voting Rights Act in 1970, lowered the voting age to be 18 in all federal, state, and local elections.  Subsequently, Oregon and Texas challenged the law in court, and the case came before the Supreme Court in 1970.  By this time, four states had a minimum voting age below 21: Georgia, Kentucky, Alaska and Hawaii.

In its 1970 decision, the Supreme Court struck down the provisions that established 18 as the voting age in state and local elections.  However, the Court upheld the provision establishing the voting age as 18 in federal elections.

The decision resulted in states being able to maintain 21 as the voting age in state and local elections, but being required to establish separate voter rolls so that voters between 18 and 21 years old could vote in federal elections.

It was that split decision that triggered the constitutional amendment. 

In March of 1971, the Congress approved a constitutional amendment to guarantee the minimum voting age could not be higher than 18 anywhere in the nation.  Having been passed, the proposed 26^th Amendment was sent to the state legislatures for their consideration.  Ratification was completed on July 1, 1971, after the amendment had been ratified by the required thirty-eight states.  New York’s legislature approved the amendment 50 years ago this week, on June 2, 1971.  Having been ratified by three-fourths of the states, the 26^th Amendment became part of the Constitution.

Although the 26^th Amendment passed faster than any other constitutional amendment, other barriers to young adults’ voting continued.  New York’s state and federal courts overruled local elections officials’ actions that prohibited college students from voting from their campus addresses.  But barriers continue to this day.

The most notable is to place polling sites off campus to make it harder for college students to vote.  For example, in this past Presidential election, just 14 of the 238 colleges and universities had early voting polling places.  There are over 1.2 million college students in New York (although not all are registered or are New York residents).  Fourteen early voting polling sites is far too few.

Legislation currently under consideration in the state Legislature would require that all colleges and universities have at least one polling place if they have at least 300 college students registered to vote living on-campus. 

Young adults are the least likely to vote.  Part of solving that problem is education, in order to ensure that college students and other young adults better understand the system.  Another solution is to make it easier for them to vote when they are registered.  Requiring polling places on campuses is one way to make voting easier.  A fitting way to commemorate New York’s 50^th anniversary of ratifying the youth vote is to make it easier for college students to vote on their campuses.

It is well established that the oil companies knew for decades that the burning of fossil fuels would result in a hotter planet.  They knew it and yet did all they could to keep the public disinformed.  Like the tobacco industry, the fossil fuel companies spent big time on public relations efforts, political consultants, hot-wired lobbyists, campaign contributions and funded fake groups to advocate against the science that they knew to be true.

And they succeeded.  Despite the mounting evidence that the burning of oil, coal and gas was accelerating the world’s pace toward a climate catastrophe, nothing of consequence was achieved.  The industry’s political muscle, its front groups and fake experts were in 2016 joined by a compliant White House and Congress that reversed what modest steps had been taken.

But facts are facts and the scientific evidence keeps piling up.  It is now widely viewed that unless the world takes immediate and aggressive steps to slash greenhouse gas emissions, the growing climate changes that we are all experiencing may reach a point of no return – and result in mass extinctions and the end of civilization as we know it.

Last week, the International Energy Agency added its views.  In its net zero roadmap report, the IEA found that to keep the world from catastrophic overheating, a new clean energy revolution must take place.  The IEA concluded that the world’s consumption of oil must drop by one-quarter by the end of this decade.  And then be down to one quarter of the total consumed today by the year 2050.

The IEA concluded that starting now, the world cannot allow new fossil fuel projects: no more new oil fields, no new gas extraction, no new coal mines.

Public investors funding new fossil fuel projects should back out now.  Consumers will have to change too – the IEA found that half of greenhouse gas emissions will require “consumer choices,” like buying electric cars and driving slower (the IEA called for a ban on the sale of gas-powered cars by the year 2035); installing electricity-powered heat pumps and solar panels; traveling more on trains and less on planes; changing heating temperatures.  Governments and companies will have to dramatically increase funding for solar, wind, and geothermal projects; the IEA stated that the pace of the installation of solar panels and wind turbines will have to quadruple by the year 2030.  Aggressive energy efficiency measures will have to be implemented.

According to the IEA, “Global electricity networks that took over 130 years to build need to more than double in total length by 2040 and increase by another 25% by 2050.”

The IEA concluded that limiting global warming to 1.5 degrees Celsius remains technically and economically feasible, but there is little margin for error or delay. “Making net-zero emissions a reality,” the report concluded, “hinges on a singular, unwavering focus from all governments – working together with one another, and with businesses, investors and citizens.”

In a nation that cannot agree on the value of vaccines in a pandemic, meeting the IEA’s recommendations is a tall order.  Even today – despite the overwhelming scientific consensus – the oil industry and its media and political toadies are attacking the Biden Administration’s efforts to curb the use of fossil fuels.

Like it was for the tobacco industry, the oil, coal, and gas companies are using their deep pockets to fight science to the bitter end.  Unlike tobacco, however, the world needs energy to eat, travel and flourish.  Thus, the world must quickly move into a new non-fossil-fuel-powered future, and the oil, coal, and gas companies need to develop plans to “wind down” their activities as their products are too dangerous to keep using.

The IEA identified the immediate steps – ban the expansion of the plans to drill for more oil and gas, invest in renewables, and move efficiency measures up to scale.  In addition, the world needs to make plans to gradually shutter the oil, coal, and gas companies – at least as far as their reliance on the exploitation of fossil fuels as their core business.  In addition, that “wind down” measures should include requiring the industries to pay their fair share of the necessary investments and clean up needed to close down that industry.

As the IEA plainly stated, success “hinges on a singular, unwavering focus.”  All levels of government must start actions now, before it is too late.