The crisis in the cost of medicines in America is well-known.  Americans spend more on prescription drugs — average costs are about $1,100 per person per year — than spent anywhere else in the world.  And the prices can be staggeringly high.  For example, cancer drugs in the U.S. routinely cost $10,000 a month.

These costs are often not directly borne by the average American who has insurance coverage.  Generally speaking, private insurers and government programs pick up the biggest share of the bill.  However, high drug costs directly impact health care premiums and taxes – both of which are rising.

Those rising costs impact the financial stability of the nation.  Why is this the case?  Unlike other countries, the U.S. doesn’t directly regulate medicine prices.  In Europe, governments negotiate directly with drug makers to limit the cost to their state-funded health systems.  In the U.S., drug companies can more or less set whatever price the market will bear for those receiving medicine through the Medicare program.  Private payors, such as employer health plans, typically negotiate discounts for their enrollees.

As a result, patients in the U.S. directly pay about 17 percent of prescription medicine costs out of their own pockets.  In a 2013 survey, one in five adults in the U.S. said they failed to complete a prescribed course of medicine because of cost.  The figure was one in ten in Germany, Canada and Australia.

If private employers negotiate for the price of medicines and states limit drug choices to help offset costs, who looks out for those without health insurance coverage or for seniors whose costs aren’t fully covered under Medicare Part D?

Other than possible help offered by drug companies or pharmacies, New Yorkers without coverage are left to comparison shop for the lowest drug prices.  The state of New York tries to assist that effort by collecting drug prices for the most widely prescribed drugs.

Under New York law, the state Health Department has created a website to allow consumers to comparison shop for the most frequently prescribed medicines.  The website allows consumers to search as many as six medications simultaneously by zip code, county or city.  For consumers who lack adequate coverage for prescription drugs, the Department’s website could yield considerable savings.  The law also requires that at the checkout area of each pharmacy a written notice must be provided informing consumers about the availability of the website.  (The website can be found at: https://apps.health.ny.gov/pdpw/SearchDrugs/Home.action.)

The need that could be filled by this program is real.  According to recent U.S. Census information, over one million New Yorkers lack health insurance, meaning they must pay full retail price for prescriptions, and – as mentioned earlier – seniors in the Medicare “doughnut hole” also face cost pressures for medicines.

A recent review of what pharmacies are charging showed a shockingly large range in retail prices across the state.  In fact, a recent survey of prices posted on the state Health Department’s website by the New York Public Interest Research Group, in some cases consumers could be paying as much as $200 more for the exact same prescription in the exact same region.

NYPIRG reviewed fourteen regions of the state and examined the prices for six of the most frequently prescribed medications.  NYPIRG found an enormous range in prices charged, with the greatest disparity of $207 in prices for Advair Discus in Manhattan.  In the city of Albany, the drug Advair Discus had the greatest range in price – a difference of nearly $154.

Clearly, it pays for consumers to shop smart.  Yet, those comparisons only work if the public knows of the existence of the program.  Under New York State law, each pharmacy is required to post a sign alerting the public to the drug pricing website.  Yet, when NYPIRG spot checked that requirement, it found that only about 40 percent of the pharmacies had the required signage.

Given that at least one million New Yorkers need to know the costs of their medicines, the state must do better.  If costs are too high, those who can’t afford medications often go without.  Not taking needed medicines can result in devastating consequences.

Of course, expanding coverage is the best response, but in the meantime, New York must make sure that this program works.  New York should publicize the website, make sure pharmacies are conspicuously displaying the website information and come up with an easier-to-remember website address so the program can benefit all New Yorkers who could use some help shopping for prescriptions.

Last week was a big one for Democrats in New York.  The contested primaries for Governor and Attorney General hit a peak as the candidates for those offices slugged it out in televised debates two weeks before the state primaries on Thursday September 13^th.  In both debates, the issue of corruption in state government was a major topic.

In both debates there were accusations and pledges to be tough, but it was in the Attorney General’s debate that the issue of what to do about corruption received the most air time.

Even the most casual observer of New York State government knows that corruption has been a persistent problem.  The evidence is overwhelming: A former governor was forced to resign, another had to pay a fine for lying under oath, a Comptroller was sent to prison, top aides to the governor have recently been convicted, the two former leaders of the legislature are facing prison time, and scores of additional lawmakers have gotten into hot water for unethical acts.

In most cases, it was a federal prosecutor, not a state watchdog, that investigated and brought action.  Yet, on paper New York has quite a few ethics enforcers – for campaign finance, for agency misdeeds, for monitoring quasi-governmental public authorities, and for the ethics of public officials and lobbyists.

But in most cases, those watchdogs have ignored or overlooked the high profile cases brought by the feds.

In the Attorney General debate, it was the state’s leading ethics watchdog – the Joint Commission on Public Ethics – that was the candidates’ primary punching bag.  All candidates claimed support for eliminating the JCOPE and replacing it with something independent.

You see JCOPE is a creature of political compromise.  It has a board of 14 members (by the way the largest such Commission in the nation) who are direct appointees of the governor and the legislative leaders.  All of the leaders are subject to oversight by JCOPE.

During the negotiations over cobbling JCOPE together back in 2011, all of the leaders were likely afraid that one individual would come to dominate the Commission and that they could face a threat from such an entity.  As a result, the Commission is designed to give the governor or each of the leaders enough votes on the Commission to stop certain investigations.

Essentially, JCOPE was designed as a political entity, not an independent one.

At the Attorney General debate, there was considerable agreement among all the candidates that JCOPE had to go and be replaced with an entity that was independent of political influence.

But what should an independent state ethics watchdog look like and how can it be designed to be independent?

Reformers have been hard at work trying how to do just that.  After all, someone has to appoint Commission members, how can the entity be independent?

One model is the state’s Commission on Judicial Conduct, a body that oversees judges and yet is made up of a majority of non-judicial appointees – all with required standards of independence.  The Commission was established in the state Constitution, another benefit to its independence.

Using the Commission on Judicial Conduct as a model, reformers advanced a plan that would replace JCOPE (and some other state watchdogs) with a new ethics commission, in which the majority of the appointments would be made by the courts, not the governor and the Legislature.  In that way, the new ethics commission would be sufficiently independent of those that they monitor.  In addition, the members and staff of this new entity would be prohibited from communications with their appointing authorities.  Finally, the proposal protects the budget of the new ethics watchdog, which offers insulation from another way in which political pressure can be brought.

Of course, nothing will change without the public clamoring for change and a real debate.  And even the best of laws are not effective unless they are adequately overseen by independent, well-resourced, watchdogs.  The good news is that the statewide candidates in both parties are talking about reforms.  It remains to be seen if that rhetoric leads to real changes next year.

It’s that time again; colleges are opening across New York and for many of the students, the campus experience will have a profound impact on their lives; their career choices, their world view, the connections that they make.  The public benefits too: more highly trained residents have a positive impact on the economic health of the state, the nation and the world.  Studies in New York have shown that every dollar invested in higher education results in multiple dollars more in tax revenues generated by students both while attending college as well as after they graduate.

College graduates positively impact our democracy – a more highly educated person is often in a better position to appreciate the nuances of public policy.

For those reasons, society has viewed investing in higher education as a worthwhile public good the state and nation are better off with more highly educated workers and voters.  Of course, a college degree is not the only path to economic or civic success to be sure, but it helps.

Despite the obvious benefits from public investments, New York (like much of the rest of the nation) has been shifting the costs of attending college from the state to the student and his or her family. The result has been dramatic: over the past decade or so the amount of debt resulting from attending college has skyrocketed.  Today, 70 percent of college students graduate with significant loans.

Over 44 million Americans collectively hold nearly $1.5 trillion in student debt. That means that roughly one in four American adults are paying off student loans.

When they graduate, the average student loan borrower has over $37,000 in student loan debts, a $20,000 increase from 13 years ago. With that money, borrowers could put a down payment on a home, purchase a new car or bootstrap their own business.

Much handwringing has occurred over this trend, but not much action.  Here is New York, Governor Cuomo has successfully advanced a proposal to make it easier for some to pay off their debts.  The “Get on Your Feet Loan Forgiveness Program” provides up to 24 months of federal student loan debt relief to recent New York college graduates who are participating in a federal income-driven repayment plan whose payments are generally capped at 10 percent of their discretionary income.

The governor also got legislative approval for his much ballyhooed Excelsior Scholarship program which allows some middle income students to attend public colleges and universities in New York tuition-free.

While both of these programs’ goals are laudable, both are by design very limited in their impact.  Most students are ineligible.

All State University of New York students, have seen tuition hikes nearly every year during the two terms of the Cuomo Administration.  Since 2011, state law has allowed for tuition hikes at the State University of New York for up to $300 per year.  And thanks to that law, tuition has gone up, totaling a whopping 30% increase in the cost of attending public college.

The law allowing public tuition hikes has been linked to another provision, one that requires the state to “maintain” its support for SUNY (and the City University as well). The governor linked tuition hikes with a promise that the state would not cut its support for higher education and thus use the tuition hikes to merely fill in budget gaps.  Instead, higher education advocates hoped, additional tuition dollars would be used to enhance the institutions.

As is too often the case, the fine print spelled out a different scenario.  The state’s “maintenance of effort” did not include inflation and other cost increases.  As a result, state support for higher education has been stagnant while costs have increased; meaning that student dollars are being used to close budget shortfalls after all.

Governor Cuomo will have an opportunity to close those shortfalls.  Both houses of the Legislature unanimously approved legislation that requires the state to cover the inflationary costs of SUNY, thus ensuring that the tuition hike dollars are used solely for SUNY improvements.  It is expected that the legislation will land on the governor’s desk soon.

During the time that public college tuition has increased over 30 percent, the state’s overall budget increased by over 30 percent.  Clearly, the state has had the money to cover the increases in college inflationary costs, just not the political will to do so.  Now is the time for New York to reverse its policy of increasing costs to attend colleges, boosting state support is an important first step.

The President of the United States is considered the most powerful person on Earth.  That power emanates from the U.S. Constitution, the clout of being head of a political party and interest groups that helped elect him, and the nation’s economic and military might.  All combined, a President is incredibly powerful.

But like the comic book superheroes, having the power also comes with the responsibility to use it wisely and with restraint.  When it comes to President Trump, there has been too little wisdom or restraint.

President Trump has been using his power.  He has dramatically changed the nation’s policies toward immigration, withdrawn from international agreements, fundamentally re-shaped the courts, advanced legislative initiatives, and reversed public health and environmental regulations.  All of that is in keeping with his campaign promises and, as a result, the President enjoys near unanimous support among members of the Republican party.

Being a President though is not just about popularity among members of your own party – it’s supposed to be about serving the public – everyone.  And here his policies have been lacking.

Take for example the President’s approach to climate change.  Unlike other issues in which there can be arguments on both sides, the President’s approach has been to reject science itself.  There is no doubt that the planet is heating up and the vast and overwhelming majority of climate scientists believe that human activities are the primary cause.  Even the secret research of the fossil fuel industry long ago concluded that the burning of oil, coal and gas heats up the planet.

By rejecting science, the President not only is sentencing millions to incredible misery and early deaths, but his policies are accelerating climate changes that may seriously damage civilization as we know it by the end of the Century.  His approach is reckless and dangerous.

It’s the recklessness that is also reflected in the President’s abusive rhetoric in attacking his political opponents and, in particular, the media.

His tweets includes phrases that describe reporters as “very unpatriotic,” “disgusting and dishonest people,” who indulge in “fake news.”  Those attacks are not only vulgar, but dangerous.

One example of the danger: covering a Trump rally these days opens reporters, now more than ever, to jeers, middle-finger insults, and threats of violence.  Many have to be protected by their own “security guards.”  CNN’s Jim Acosta, who covers the White House, said he was “very worried” by the “hostility whipped up by Trump.”  MSNBC’s Katy Tur told her viewers that she has been threatened with “rape”—and worse.  A reader warned New York Times columnist Bret Stephens, “once we start shooting you f—ers, you aren’t going to pop off like you do now.”

The danger goes beyond those faced by reporters, it extends to our democracy.  It is clear that the President’s goal is to undermine the credibility of the mainstream media to weaken the impact of honest reporting covering his policies and to weaken the impact of reporting of the current Justice Department probe into his campaign’s alleged cooperation with the Russian government in the last Presidential election and whether the president obstructed justice in firing the head of the FBI.

The President’s approach may work if the Justice Department’s special counsel, Robert Mueller, issues formal charges against the President’s campaign or the President himself.  The President has now positioned himself – at least among his supporters – to be believed if he responds as expected by charging that the investigation is the result of a partisan attack, one which is the result of a “witch hunt” and must not to be believed.

Because the President has a strong following within his political base, it is likely that they will believe his statements that the charges are the result of an unfair conspiracy, not the truth.  Given current Republican control of the Congress, strong support may allow the President to avert the damage of a negative report from the special prosecutor.  Of course, if no such report is issued, none of this will matter.

However, if the report is negative, and if the Congress refuses to act, where then is the rule of law, the idea that no person stands above the law, a pillar of American democracy?

It is the rule of law that is the foundation of our democracy.  Freedom of the press is enshrined in our Constitution.  If the President – or his top associates – are able to avoid punishment as the result of the manipulation and intimidation of the media, the nation loses and our democracy is damaged, forever.

New York is considered a “blue” state, one in which Democrats have a significant voter enrollment advantage over Republicans.  And it’s true: New York has about 6.2 million registered Democrats and 2.8 million registered Republicans (another 3 million-plus New Yorkers are either not enrolled in a political party or registered in a minor party).  But if you look at the state outside of the City of New York, in terms of party enrollment the state is very competitive for Republicans, with 2.8 million Democrats compared to 2.3 million Republicans.

In those areas, particularly in the suburbs, elections can be very competitive.  New York’s voter registration laws can have a big impact on electoral participation.

New York law doesn’t make it easy to register to vote and this week the first of some of the state’s important voter registration deadlines kicks in.  It’s important to pay attention to these deadlines because the party primary election is only a month away on September 13^th—and yes, your calendar is correct, that is a Thursday.

If a new voter wants to join a political party and register for a state primary election, he or she will have to do so this week (by August 19^th).  If a currently-enrolled person wants to switch a political party to vote in the primary, that deadline has passed – you have to switch prior to last year’s general election registration deadline.

This week’s registration deadline is not the only one to pay attention to, however.  In order to be registered in time for the upcoming general election, November 6^th, a citizen would have to be registered by October 12^th.  By and large, New York’s voter registration deadlines require that a would-be voter has to file the relevant paperwork no sooner than 25 days prior to the election date.

There is nothing magic about that deadline, it was instituted to make it easier for election officials, not voters.

Not all states make it so hard to register to vote.  There are a number of states that allow citizens to register and vote on Election Day.  As of March 2018, 17 states plus the District of Columbia offer same-day registration (SDR), which allows any qualified resident of the state to go to register to vote and cast a ballot all in that day. Additionally, Washington has enacted same-day registration, to be implemented in 2019.  Obviously, New York does not allow this option.

Some states take other steps to make it easier to enroll.  These states automatically enroll voters if they are signing up for a government program.

Currently, voter registration in most states is an “opt in” policy, where the burden is on an eligible voter to fill out a voter registration application, which gets reviewed and processed before the name goes on the voter rolls.  Automatic voter registration is an “opt out” policy by which an eligible voter is placed on the voter rolls at the time they interact with a motor vehicle agency (or in a few states with other government agencies) unless they actively decline to be registered.  New York is not one of the states that has this “opt-out” system.

While New York’s 25-day registration deadline is not unique, it is among the most restrictive.  Voter registration deadlines vary by state, with most falling between eight and 30 days before the election.

New York has, on the other hand, done much to avert creating other obstacles to voting.  The state is considered among the nation’s best when it comes to minimizing voter identification requirements.  Many states have developed onerous identification requirements under the guise of protecting against “voter fraud” – but there is little fraud of this kind, and the burden on voters unduly restricts the right to vote and imposes unnecessary costs and administrative burdens on elections administrators.

Despite that, New York’s inability to modernize its system to meet the needs of a more mobile population with far different work requirements than earlier generations, has led to very low voter participation rates – one of the worst in the nation.  New York needs to do better, much better.

After all, voting is a constitutional right – not a privilege.  The system should be designed to maximize the ease by which voters can participate, while ensuring that the system works fairly and honestly.  Any restrictions should only be put in place based on rigorous independent analysis, not by partisans looking to “game” the system to their own advantage.

The entity that oversees New York’s elections is controlled by the two major political parties.  The theory of that arrangement is that they will monitor each other’s actions resulting in fair elections.  In reality all it has meant is that they system is gridlocked when it comes to reforms to open up New York’s voting system.

New Yorkers deserve a system based on the public’s best interests, not the political parties’.  Overhauling the current system to put it into the hands of civil servants is a path to better administration and real enforcement.