New York’s system of health care — much like the rest of the nation’s — allows for hundreds of thousands to go without health coverage and many more living under the fear of financial ruin that comes from knowing your healthcare coverage is woefully inadequate. 

The threat of mounting medical costs is best understood by the growing medical debts in the nation.

A recent study showed that Americans owe at least $220 billion in medical debt. Approximately 14 million people (6% of adults) in the U.S. owe over $1,000 in medical debt and about 3 million people (1% of adults) owe medical debt of more than $10,000.

The consequences of inadequate coverage impact the nation.  As reported by Forbes, “Fully half of Americans now carry medical debt, up from 46% in 2020”

Under current New York law, hospitals that receive funding from the Indigent Care Pool (nearly every hospital in the state) are required to have a financial assistance policy and charge discounted prices to eligible patients. The state’s Indigent Care Pool distributes over $1 billion a year. Non-profit hospitals are also required by the IRS to screen patients for financial assistance before engaging in collection activities, such as selling a patients’ debt, reporting adverse information to credit agencies, or suing them.

Yet medical debts still plague too many New Yorkers.

A July 2023 study by the Urban Institute revealed that 740,000 New Yorkers faced medical debt and that it is disproportionately shouldered by people of color, low-income people and people who live in rural parts of New York State.

The Long Island newspaper, Newsday, recently reported that the Stony Brook University Hospital has been suing patients over medical debt. The report concluded that more than 950 cases have been filed against people believed to owe Stony Brook hospital money in the first half of 2024. Stony Brook University Hospital is the area’s only regional system suing for unpaid medical bills. Last year, the Stony Brook system accounted for 52% of all medical debt cases brought by the state’s more than 200 hospitals combined.

According to Newsday, other regional hospital systems — which are all nonprofits or government-run — have moved away from suing over unpaid bills and none currently file lawsuits against patients.

Legislation has been introduced in New York to stop the practice. The bill would protect New Yorkers who receive care from State-operated hospitals from medical debt lawsuits. There are five New York State-operated hospitals — SUNY Upstate (Syracuse), SUNY Downstate (Brooklyn), SUNY Stony Brook (Long Island), Roswell Park (Buffalo) and Helen Hayes (Rockland County). Together, they sue their patients at grossly disproportionate rates compared to other New York hospitals: they are responsible for three-quarters of all medical debt lawsuits filed in 2022. 

There is no economic rationale to support medical debt litigation. Again from Newsday:  In six months, the hospital’s lawsuits sought a total of $13.7 million, or about 0.8% of the $1.8 billion net patient revenue Stony Brook reported in 2021. Stony Brook received four judgments in 2022.

In addition, the total amount generated by Syracuse-based SUNY Upstate from suing patients for in one year was just $16 million. SUNY Upstate’s annual operating budget was $1.5 billion, indicating its life-ruining practice of suing its patients will do little to improve its bottom line.

Suing patients is expensive and will do little to offset the state-run hospitals’ stressed margins.  It does, however, torture those patients and their families who have both the trauma of recovering from a hospital procedure while contending with significant bills. 

The American health care system fails to deliver when it comes to the basic necessary coverage people need. Allowing hospitals to sue over payment disputes just adds another level of uncertainty to an already difficult system. Patients and families without adequate insurance have enough to deal with without facing financial ruin from hospital bill lawsuits. Hopefully, next year’s session will end this practice.

More frequent heat waves, bigger wildfires, rising sea levels, hotter temperatures are the unmistakable signs of climate change.  Last year was the hottest ever and earlier last month we had some of the hottest days in recorded history.

There are other collateral impacts from a changing climate that cause harm.  These include “harmful algal blooms,” which threaten drinking water supplies and the public’s health.

The blooms are a blue-green slimy substance that floats in water.  Harmful algal blooms aren’t your typical green surface ooze that you may see on the top of lake waters.  While ugly to look at when at the surface, a bloom can also be extremely dangerous, so much so that the state has a blanket policy warning to stay out of the water should there be evidence of one.

The heating planet drives the production of algal blooms.  Warmer temperatures prevent water from mixing, allowing algae to grow thicker and faster.  Algal blooms absorb sunlight, making water even warmer and promoting more blooms. 

While every algal bloom isn’t toxic – some algal species can produce both toxic and nontoxic blooms – toxic blooms can cause problems for swimmers and other recreational users in the form of rashes or allergic reactions.  People who swim in a bloom may experience health effects, including nausea, vomiting, headaches, respiratory problems, skin rash and other reactions.  There have also been reports nationwide of dogs and livestock dying shortly after swimming or wading in a bloom.

Heat alone doesn’t stimulate algal blooms.  As we know, climate changes have also caused stronger, more powerful storms, storms that release much more rainwater than in storms of the past.  Those incredible downpours swiftly flush whatever is sitting on the land directly into lakes, so instead of letting a natural filtration process take place, nutrients that would benefit the soil are washed into surface waters and wreak havoc in the water in the form of algal blooms.

The nutrients these blooms primarily rely on are phosphorus and nitrogen.  The algal blooms have increased due to a rise in nutrient runoff from sources such as soil erosion from fertilized agricultural areas and lawns, erosion from riverbanks, riverbeds, land clearing (deforestation), and sewage effluent.  All of these are the major sources of phosphorus and nitrogen entering waterways.  These nutrients coupled with warm, calm water is the recipe for an algal bloom.

Obviously, algal blooms pose a threat to recreational water bodies.  But they pose a greater danger to drinking water supplies.  Once these blooms are found in drinking water supplies, they are hard to treat.  The toxins released from algal blooms make it difficult for treatment facilities to remove them safely and efficiently. 

The City of Auburn, New York draws its drinking water from Owasco Lake.  Since 2016, more algal blooms have been identified and as a result, the water quality has only worsened.  Some 45,000 people on Owasco Lake rely on it as their source of drinking water and the rising threats from algal blooms endanger that supply.

Algal blooms are an increasing menace.  New York State has experienced a tenfold increase in the number of waterbodies experiencing a bloom over the past 10 years and $6 billion in mitigation expenses and lost economic value.  Last year, nearly 1,200 algal blooms were reported to the New York State Department of Environmental Conservation.

While we all must do everything possible to reduce the world’s reliance on fossil fuels and aggressively embrace energy efficiency programs and alternative energy sources, due to the amount of CO₂ in the atmosphere, the planet will continue to heat up.  There is not much that New York can do to reduce the damage that has already been done or immediately undo the sources of the current rising heat of the planet.  Of course, sticking to the science-based climate law and eliminating the state’s emission of greenhouse gases must be a top priority.

When it comes to minimizing the threat of algal blooms, New York policymakers can take action.  And, in fact, there is no shortage of such plans already developed. 

But when it comes to protecting surface waters and drinking water supplies, the state has to do a lot more to reduce the runoff from agriculture, landscaping and wastewater sources.  New York must be proactive about protecting drinking water supplies and recreational waters.  The costs for prevention are cheaper than the cost of remediation and illness.  That’s a lesson we’ve had to re-learn too many times – particularly when it comes to public health and environmental threats.

For individuals concerned about algal blooms, you can check out the New York lakes where algal blooms have been reported to the DEC on its website.  Those interested can review the entire listing of current algal bloom sitings at the DEC’s website.   

New York has a strong climate law based on the world’s best scientific recommendations.  The large size of New York’s economy makes it a global financial player.  Not being a nation, it is not a political player on the world stage.  As a result, New York’s ability to influence climate accords is limited (although it still has the ability to lead by example).  However, when it comes to attacking the algal bloom threat, the state controls how aggressively it protects drinking water supplies and New Yorkers’ health. 

As we all suffer through another summer of heat, torrential rains and increasing algal blooms, let’s make sure that candidates for state office are advancing their ideas on how the state can protect surface water supplies and how they can make a difference quickly.  There is little time to waste.

The effort to hold the oil industry financially responsible for the climate damage it caused was extended to the Congress when a package of bills designed to “Make Polluters Pay” was unveiled at a news conference last week.

According to the representatives, the proposals addressed critical issues facing Americans today, including measures to combat price gouging by oil companies, eliminate fossil fuel subsidies, and implement strategies to mitigate increasingly frequent extreme weather events linked to climate change, all while holding the largest oil companies accountable for climate damages and decades of deception.

The lawmakers highlighted the industry’s history of deceiving the public about what oil companies’ scientists had discovered about the impact of burning fossil fuels, like coal, oil, and gas. 

It is clear that for the better half of the late 20^th Century, oil companies knew that burning fossil fuels was heating the planet.  According to documents obtained by the Los Angeles Times, for example, a leading Exxon researcher told an audience of engineers at a conference in 1991 that greenhouse gases are rising “due to the burning of fossil fuels.  Nobody disputes this fact.”  The senior Exxon researcher went on to add that there was no doubt those levels would double by the middle of the 21st century.  Unfortunately, he was correct.

Nevertheless, the industry championed a climate change denial campaign, opposing regulations to curtail global warming, funding groups opposing climate change treaties, and undermining the public opinion about the science behind global warming.  Their success has pushed the planet to the brink.

As a result, we’re racing the clock.  Worldwide treaties have been advanced, national legislation has been debated, state laws have been passed — all to begin to move the world from its reliance on fossil fuels for power and instead to rely on alternative renewable forms.

Yet the staggering climate damage costs facing the nation have not been seriously tackled. 

A quick review of the financial costs facing New York State alone points out how big a hit to taxpayers those expenses will be.

Previously once-in-a-generation weather events are becoming more frequent and deadly.  In 2022, Winter Storm Elliot in Buffalo killed 47 people.  The year before, Hurricane Ida killed 16 New Yorkers — many drowned in their own homes.  In New York City, 350 residents die every year from heat-related deaths.  In the last month, four tornados hit upstate central New York destroying homes and killing one person.  In addition to the human costs, there are staggering financial costs as well.

It’s going to cost hundreds of billions of dollars to shore up New York against the impacts of climate change — some estimates put the price tags at $52 billion to protect New York City Harbor, $75-$100 billion to protect Long Island, and $55 billion for climate costs across the rest of the state.  The state Comptroller has predicted that more than half of local governments’ costs will soon be attributable to the climate crisis.  Currently, these costs are falling on taxpayers, even though the biggest oil companies, largely responsible for the policy gridlock that kept the nation and the world from tackling the growing climate menace, are booming and still making enormous profits.

New York, which accounts for the fourth largest population and the third largest state economy in the nation, faces big climate costs.  And when you add 49 other states — including mega states like California, Florida, and Texas — it’s fair to say that the staggering climate costs facing New York alone are miniscule to those the nation faces.  According to the National Oceanic and Atmospheric Administration, America has already spent nearly $3 trillion since 1980 to cover climate disasters and those costs will continue to rise as the planet continues to heat up.

The Congressional “Make Polluters Pay” event acknowledges the rising climate costs and places some of the financial burden on those most responsible for the situation — the largest oil companies.  Given the legislative gridlock in Washington, no one expects that package to be taken up soon.  Once again, it’s up to the states to lead the way.

Fortunately, the New York Assembly and Senate recently passed the Climate Change Superfund Act.  This legislation will put the largest oil companies on the hook for cleaning up the mess that their actions created.  It requires the companies most responsible for historical greenhouse gas emissions to pay a share of $3 billion assessed annually for each of the next 25 years to address the environmental damages they helped cause.  It does so in a way that should not impact consumers’ costs.

Vermont approved similar legislation, which became law without opposition by Republican Governor Phil Scott.  Here in New York, Governor Hochul will face her decision once the Climate Change Superfund Act makes its way to her desk for approval.

New York should show the nation how best to finance projects that both protect the public from future storms as well as pay for the damage done.  New Yorkers will soon see whether Governor Hochul chooses to shift some of the climate damage costs from taxpayers to Big Oil or whether she leaves New Yorkers shouldering the entire costs.

We have been inundated with news of a world that changes at a head snapping pace.  Unprecedented number of tornados in New York, the direct result of our worsening climate; an unending opioid epidemic; wars across the globe; an ongoing covid pandemic in which cases are rising; an assassination attempt on a candidate for president; and last weekend the first withdrawal of a sitting President running for re-election so close to a convention.  Of course, there’s more, but it’s hard to stay on top of what’s going on when so much is.

Yet, public attention on issues helps generate public demands for a resolution of those issues.  Capturing the public’s interest is an integral component for policy action.

What then happens when the opposite occurs?  What happens to an issue that has been well documented, has and will have a devastating impact, but has seen little sustained public attention?

That’s what’s happening when it comes to the growing resistance of certain infections to treatment by antibiotics. 

Due to the overuse and misuse of antibiotics in humans and animals, many strains of bacteria have evolved resistance to medically important antibiotics, meaning they are not killed by the drugs.  Instead, they survive, multiply, and spread.  In fact, the more antibiotics are used, the faster antibiotic-resistant bacteria (a/k/a “superbugs”) develop, putting more people around the world at increased risk of contracting an antibiotic-resistant infection.  

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

In recognition of the serious threat to public health posed by antibiotic-resistant infections, members of the U.N. General Assembly back in 2016 committed to taking collaborative action.  The World Health Organization (WHO) considers it to be one of the biggest threats to global health, food security, and international development today.  The U.S. Centers for Disease Control and Prevention (CDC) has stated that fighting this threat is a public health priority and estimates that each year, at least 2.8 million people get an antibiotic-resistant infection, and more than 35,000 people die in the United States today. 

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

Yet despite the research, the scientific consensus for action, the significant death toll, and the occasional media story, the public has not been galvanized.  As a result, according to new research from the WHO, the global antibiotic pipeline remains woefully inadequate in the face of increasing antibiotic resistance. 

For example, the report found that just four of the drugs in development have the potential to treat at least one drug-resistant bacteria deemed by WHO as a critical threat, the organization’s most serious level. 

According to a chilling analysis by the Pew Charitable Trusts, “What is resoundingly clear from WHO’s pipeline data is that the new medications the world needs do not exist.  That’s because, in part, the antibiotic market is fundamentally broken.”

Contrast that with the high speed turnaround in getting vaccines developed and distributed to help combat the Covid-19 epidemic.  As a result, “Covid-19 vaccinations were rapidly developed during the first year of the SARS-CoV-2 pandemic and have saved millions of lives worldwide, at least 3 million in the United States.”

Obviously, the comparison only goes so far:  The Covid virus, while rapidly evolving, is based on a single pathogen; antibiotic resistance is a different “animal” altogether.  But the failure to develop medicines in response to the growing superbug menace is at least partially the result of the lack of a sustained public outcry and action by policymakers.

Congressional action is needed and there is legislation to help take on the superbugs.  Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act, now awaiting action in Congress, is designed to address the flaws of the antibiotic market and help kick start the medicine pipeline to combat the threat of the superbugs.

There are many threats, scandals, diseases, violence, and other dangers that constantly rear their ugly heads.  We can’t hope that these problems will solve themselves.  We need civic action to make things change for the better.  This is an election year; it would be good for the public to ask the candidates where they are in advancing solutions to the superbug threat.  We are rapidly running out of time to pose this critical question.

The planet is getting hotter and will continue to do so from now on.  This week the Northeast will be enduring another heat wave, the second one of the summer.  The impacts of rising temperature are well-documented and increasingly obvious: health consequences, more intense storms, worsening air quality, flooding, and rising sea levels.

The intense heat defines these “waves” – three days in a row hitting 90 degrees or more – based on the overall temperature of a region.  It can be hotter or cooler depending on the area where you live.  For example, asphalt absorbs a lot of heat from the sun.  As a result, urban areas tend to be even hotter than rural ones.  Recently NASA released new thermal imaging showing just how hot it was in Phoenix, Arizona in mid-June.  According to NASA, while the daily high in the city was a super-hot 106 degrees, the asphalt in the city registered between a staggering 120 and 160 degrees!  Surfaces that hot can cause serious harm.  The opposite was also true.  Areas with large green spaces were the coolest parts of Phoenix, while those with less greenery were the hottest.

The trend line for average temperatures is up, meaning the summers will get even hotter.  That’s why climate scientists have been calling for action to curtail the primary driver of global heating – the burning of fossil fuels.

Since the problem of the worsening climate is a worldwide one, the solution lies with all of us.  The world’s biggest economies can and must do the most since they not only have the resources to do so, but they’re the ones who have benefited the most from the reliance on fossil fuels. 

New York State is the fourteenth biggest economy in the world.  It has a gross domestic product of $1.78 trillion, trailing only California and Texas within the U.S.  As a result, New York is obliged to take on climate change aggressively.

That’s why five years ago New York approved legislation that set climate targets that were among the most ambitious of any in the nation.  The 2019 Climate Leadership and Community Protection Act (the “Climate Law”) requires New York to be powered by zero-emissions electricity by 2040, as part of a plan to phase out its greenhouse gas emissions by the year 2050.  As an interim measure, the Climate Law requires that the state generate 70% of its electricity from renewables like solar and wind by 2030.

The Climate Law sets laudable goals, based on science.  The rhetoric was there, but five years later the current reality is falling short.

In a state report released earlier this month, it looks like New York will miss its interim goal.  The lack of effort should be obvious.  Right now, the combination of hydroelectric power, solar, wind, and other renewables is just under 30 percent.  Even that number is sort of “padded.”  The overwhelming majority – nearly 80 percent – of that “clean power” is from hydroelectricity.  And the state’s hydro power comes from plants that were built a long time ago.  Thus, the vast bulk of renewable energy comes from power plants that were built well before the consensus on climate change emerged. 

Some have argued that it’s not that the state has failed, but that New York’s goals were simply too ambitious.  If so, then other states would be in the same situation.  But that is not the case.

New York ranks 16^th in the nation in its reliance on renewable energy.  New York ranks 13^th in the nation in its production of solar power, behind northeast neighbor Massachusetts (ranked 5^th).  Of course, differences in geography and climate can drive these rankings, but New York only generates around 5 percent of its electricity from solar, while often overcast Germany generates 10 percent.

The more likely explanation is that the state is simply being too passive and not matching the Climate Law’s mandate with a vigorous regulatory commitment.  A recent report by the state Comptroller echoed that view when it identified serious weaknesses in New York’s programs to build new renewable energy sources.

Despite New York’s economic power, it falls behind in using that clout to help save the planet.

The failure is a political one, not one based on science-based goals.  If New York is serious in its rhetoric about leading the charge in taking on the climate-change menace, then it needs to do the necessary work. 

So far, it has not.  While the goals were not set during the tenure of Governor Hochul, they are the law of the land in New York.  They are goals based on science and are part of a worldwide response to the looming climate catastrophe.  New York’s success or failure will be based on the work the governor does.

The climate clock is running out.  We’re hurtling towards a climate point of no return.  New York, the nation, the world, needs deeds, not words.