- Associated Press - Wednesday, February 20, 2019

Recent editorials of statewide and national interest from New York’s newspapers:

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The New York Times on universal health care

Feb. 16

It’s been nearly 10 years since the passage of the Affordable Care Act - one of the most sweeping health care overhauls in the nation’s history. The law has brought the number of uninsured people in America to an all-time low, secured protections for people with pre-existing conditions and advanced the notion that health care is a human right.



But the system was never perfect, and its fractures and stress points have become too great to ignore. The number of people who are uninsured or underinsured is rising again, after two years of sabotage to the current law by the Trump administration. A Republican-led lawsuit that once seemed like a lark is threatening Obamacare’s protections for pre-existing conditions. And high out-of-pocket costs, absurd hospital billing practices and ever-rising prescription drug prices have forced too many people to skip crucial treatments, avoid emergency rooms and ration life-sustaining medications.

America may be a country rich in medical innovation - a place where robots perform surgery - but it’s also one where tens of thousands of people die every year because they can’t afford basic care.

Both parties seem certain to make health care a significant election issue over the next two years. There are no fewer than six Democratic bills floating through Congress that would address these problems. And “Medicare for all” - a concept that describes only some of those proposals - has become both a rallying cry and a test of progressive credentials.

Voters, however, appear more ambivalent. Though health care has long topped the electorate’s list of concerns, including in the 2018 midterms, surveys suggest that most Democrats want their party to focus on fixing the Affordable Care Act rather than on starting a long-shot bid for a single-payer health care system. In a recent Kaiser Family Foundation poll, some 56 percent of Americans, including nearly a quarter of Republicans, supported the idea of a new federal program; but when trade-offs like higher taxes or the loss of private insurance options were factored in, that support evaporated.

As the 2020 race heats up, here’s a primer to help citizens sort out where they stand.

The plans currently in play differ in their particulars: Senator Bernie Sanders’s Medicare for All Act would scrap private insurance and create a new federal system to cover everyone; a plan from the Center for American Progress, a think tank, would create an optional public program that anyone could buy into; and a plan from Senator Debbie Stabenow would give all Americans the option to buy into Medicare when they turn 50. But these plans would extend coverage to more people and would increase the federal government’s role in providing and policing health insurance.

The proposals fall into two broad categories: universal and incremental. On the universal side, Medicare for all would largely eliminate the need for private insurance and for other public programs like Medicaid and the Children’s Health Insurance Program. Its coverage would also be more expansive than current Medicare: It would include eye and dental care as well as prescription drugs, and it would eliminate premiums, deductibles, copays and surprise medical bills.

A single federal payer - as such proposals envision - may well eliminate the waste, inefficiency and corruption that make the current system so expensive and inaccessible; the experience of countries like Canada and Britain that rely heavily on one government payer suggests as much. But such a system would require dramatic changes from the status quo and would be a tough political sell. What’s more, single-payer is not the only way to achieve universal coverage.

On the incremental side, several different proposals would allow certain people to buy into existing public plans. Some would enable older Americans who are not yet eligible for Medicare to buy into that program - at age 50 or 55 or 60. One would let people who don’t have other insurance coverage buy into Medicaid (as long as their state opted into the program).

Because these programs don’t rely on a single payer, they would not do as much to clean up the existing system. But they have a better chance of being adopted by Congress, and some could bring the country very close to achieving universal coverage.

A recent Kaiser poll found that the potential loss of private insurance was what turned most people off the concept of Medicare for all. That’s not surprising. About half of all Americans - some 156 million people - get their health insurance through employer-based plans, and another 30 million rely on other forms of private coverage, including the A.C.A. marketplace and Medicare Advantage plans. The vast majority of those people say that they like their coverage. And so far, the majority of Americans seem loath to give up what they have, no matter how good the alternative is made to sound.

That’s too bad. The idea of forcing more than half the country off existing programs might sound scary, but the majority of those people are at constant risk of losing their health coverage - for instance, if they lose or leave their jobs, if their employers change plans or if their insurers change their terms in ways that increase out-of-pocket costs.

Still, the choice between universal health care and private insurance will very likely prove to be a false one. Most of the six plans leave ample room for private options to play a role, and the ones that don’t - the true Medicare for all proposals - will almost certainly change as they are negotiated. As Vox points out, no other country has managed to achieve universal health care without including some form of private insurance.

Proponents of Medicare for all say that total health care spending would remain roughly the same, but that more of that spending would be shouldered by the federal government and less of it would be wasted.

A single-payer system would mean fewer administrative costs. Eliminating other government programs would free up billions of dollars for the new plan. And eliminating private insurers would bring billions more dollars worth of profits and employer taxes back into the health care system. (Businesses currently enjoy a tax break on the money they spend covering their employees.)

But there would also be new taxes. Proponents say that, to the extent those taxes fell on consumers, they would be offset by the elimination of premiums, deductibles and copays. But that may not be enough to assuage voters. In Vermont and Colorado, legislators dropped bids for a state-run single-payer system when it became clear that people would not support the tax increases needed to sustain such a program.

Taxes are not the only trade-off. Increased efficiency and less profiteering should mean that more people would be covered and could afford the care they needed. But a single-payer system could also mean the elimination of many thousands of health care jobs and lower pay for providers, both of which could impede access to, and the quality of, care. Those impediments could be small - slightly longer wait times, for example. Or they could be substantial - much longer wait times and far fewer doctors.

There are two basic ways for insurance programs to curb costs. One is to cover fewer things; the other is to negotiate on prices.

Medicare for all would forgo the first option, meaning that it would cover everything. But it would use the massive bargaining power of so many users - the entire United States population - to negotiate far better deals on prescription drugs, hospital stays and more. The different incremental programs would use both levers: Most would not cover vision or dental, for example. But all of them would also direct the secretary of health and human services to negotiate costs with providers.

Most other countries use negotiating power to control health care costs; that’s why prescription drugs cost so much less elsewhere than they do in the United States. But those countries accept a trade-off, inherent in this approach, that the United States has so far resisted: They forgo access to certain innovations, like pricey new drugs and medical devices whose benefits are found to be minimal.

A plan that results in higher taxes but skimps on cutting-edge medicine may seem unfair - and may well be unpopular. But many Americans are already being denied essential services every day. It may make sense to forgo innovations that a growing number of people can’t benefit from anyway in exchange for a program that sets fair prices at the outset and doesn’t leave people rationing low-tech essentials or begging for donations to cover basic costs.

The fight to once again remake American health care will almost certainly be brutal. Before voters can decide if they want to have that fight, candidates will need to clarify what they are selling. Only then can the nation have an honest dialogue about the risks, benefits and trade-offs ahead.

Online: https://nyti.ms/2NcBWIC

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The Daily Star on bail reform

Feb. 19

There is a huge income inequity in jails in New York.

Those who are poor and arrested on a minor crime often end up sitting in jail until trial because they can’t scrape together the money for bail. But those who have the funds can be out as soon as the money is paid.

A person who needs to work to make ends meet ends up sitting in a jail cell rather than working, often putting his or her job at risk.

Meanwhile, a person charged with the same crime who can afford bail can be back to work the next day, living life as if the minor offense did not happen.

Gov. Andrew Cuomo is looking to change this. He introduced his “2019 Pre-trial Justice Reform Act,” as part of an agenda of reform legislation.

The legislation would eliminate monetary bail for people facing misdemeanor and non-violent felony charges. People will be released either on their own recognizance or with non-monetary conditions imposed by the court, such as reporting to a pretrial services agency.

In some cases, such as domestic violence or other serious violent offenses, or when a defendant commits a new crime while out on pretrial release, a judge could order a defendant to be held in jail pretrial without bail if the judge finds the defendant “poses a significant flight risk or if there is a current threat to a reasonably identifiable person’s physical safety,” according to Cuomo’s proposal.

While the New York Sheriffs’ Association has not issued its final response to the plan, the group’s associate counsel, Alex Wilson, told CNHI it has already identified several major areas of concern.

One is the lack of a police officer’s discretion in issuing a ticket or placing the person under arrest. Another, he said, is that those who get tickets but fail to appear in court could strain the ability of police agencies to locate them.

Michelle Esquenazi, who heads the state Bail Bond Association and runs a bail firm in Brooklyn, said her group would support some reforms if they ensured “accountability” in the criminal justice system, with the benefits being aimed at first-time offenders whose alleged offenses did not harm other individuals.

“I would never be OK with legislating out the judiciary,” she said, contending that a system that affords judges discretion to jail a defendant due to public safety concerns best protects communities.

Cuomo’s proposal was promoted at a Jan. 29 state budget hearing by Michael Green, commissioner of the governor’s Division of Criminal Justice Services.

“The majority of people in New York’s jails are held because they cannot afford to post bail,” Green advised lawmakers. “This current system is unfair to those who lack financial resources.”

Some question that statement.

While agreeing that problems with the bail system are “worth examining,” Albany County District Attorney David Soares, who heads the state’s District Attorneys’ Association, said “only a small fraction of those charged with minor crimes or some major ones are being held in jails because of a failure to make bail.”

If it is a “majority” or a “small fraction,” it doesn’t really matter to us. Being held in jail just because you can’t make bail isn’t right. The crime, the defendant’s history and the threat to society should be factors. The ability to pay should not.

There is no doubt New York’s bail system is broken.

Is Cuomo’s plan perfect? No.

But it is a start.

Online: https://bit.ly/2T4FCBl

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The Press-Republican on blackface

Feb. 19

The overwhelming majority of Americans are ashamed of the recent re-emergence of blackface as something we have to look at and talk about.

It is a reminder of some of the worst that white people have done at the expense of the esteem and self-respect of others.

It is a reference back to slavery and how some of the best whites in history inhumanely mistreated those of other races. Our nation’s most fundamental documents referred to the rights of white men - not women or people of color.

Fortunately, our nation learned from its mistakes incrementally. We found out that all men and women are created equal after all.

Disrespecting entire races of people by portraying them with burnt cork rubbed on white skin is an enormous affront to millions of people with whom we all share citizenship and responsibility for a kind and fair nation.

Virginia Gov. Ralph Northam has undergone scrutiny and rebuke for a photograph in his medical-school yearbook for which he is accused of posing in blackface with someone dressed as a supposed member of the repugnant Ku Klux Klan, each holding a beer and laughing.

His feet have been aggressively held to the fire for this loathsome alleged misjudgment in 1984. (One also has to question how any university could abide such a characterization in one of its yearbooks, incidentally.)

While we should all be seriously taken aback by this infringement of so many individuals’ dignity, maybe we can view it in another light.

It is at least comforting that we are almost unanimously repulsed by it 35 years later. We are not only disgusted that it happened, we are ashamed of ourselves for ever allowing a culture to thrive a mere three decades ago that would celebrate or even tolerate it.

As recently as 1936, one of America’s most revered and beloved entertainment icons, Fred Astaire, appeared in blackface in the celebrated movie, “Swing Time,” with his equally beloved partner, Ginger Rogers.

This simply would not be allowed to happen today, and for that we should all breathe a sigh of relief.

As disheartening as our history proves to be in this regard, we can see a brighter today and tomorrow because we have learned from our tragic mistakes of yesterday.

This is not to say that, racially speaking, we have eradicated our shortcomings. We all know we have not.

Racial encounters - some even lethal - still occur, to the humiliation and sadness of the right-thinking among us.

But we can see progress in the fact that discussions about race are taking place across the nation.

The fact that a current governor degraded the black race in America merely 35 years ago is most discouraging. The fact that today we are outraged by it is hopeful.

Online: https://bit.ly/2T2BTo6

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The Times Union on the state Association of Black and Puerto Rican Legislators charity

Feb. 18

Where is the accountability to donors, students and the public?

If a charity claimed to provide scholarships and held a huge gala dinner every year to raise money but didn’t give away a dime, it’s a pretty good bet New York authorities would have some questions - all the more so if the group was doing its fundraising in the shadow of the state Capitol.

But when such a group is run by New York state legislators, the state seems to be curiously incurious.

This past weekend marked the annual conference of the New York State Association of Black and Puerto Rican Legislators, the nonprofit arm of the Black, Puerto Rican, Hispanic and Asian Legislative Caucus. Package tickets for the conference were priced at $445. A sponsorship cost $10,000.

The Sunday night gala, the centerpiece of the weekend, cost $225 a person. Here’s how the association’s website describes it:

“The Dinner Gala is the NYSABPRL major fundraising source, because NYSABPRL founders believed - and its current leadership is committed to the belief - that the common good and general welfare of any community are best promoted by providing access to higher education for aspiring students in need of economic assistance to achieve their dream of earning a college degree and becoming successful leaders and role models in our community. Toward that end, NYSABPRL scholarships provides financial assistance to students selected by its members, from across the state, from the net proceeds of tickets sold for its Annual Scholarship Dinner Gala.”

Sounds good, except the association didn’t give out a single scholarship last year, as far as its treasurer, Assemblyman Gary Pretlow, could recall when the Times Union asked him about it in December. It’s unclear if it gave students any aid the year before, either. Or whether it will this year. Officials of the group refuse to talk about it.

The group typically takes in more than $500,000 a year, largely from the dinner. But a Times Union look at the association’s finances in 2017 found that it had shared less than 10 percent of its revenue. In 2015, the last time it was known to have given out money, it was less than 6 percent. That’s far from the minimum 30 to 35 percent that charitable groups are expected to devote to their stated purpose. The group in 2015 said it would double the amount of scholarships, but that doesn’t appear to have happened.

One would expect this sort of track record to raise red flags with state attorney general’s charities bureau - which doesn’t appear to have even received an annual report from the association since 2015. But there is no indication the state has taken an interest in the group’s finances.

To not question whether a half-million dollars a year or more in charitable contributions are being spent properly is a disservice to every donor, to all the young people for whom the scholarships are intended, and to every nonprofit out there that does have to play by the rules or be held accountable by state watchdogs. Attorney General Letitia James should make it clear that no nonprofit is above the law - even one run by lawmakers.

Online: https://bit.ly/2SNTIYz

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The Adirondack Daily Enterprise on Amazon headquarters

Feb. 16

Count us among those who are happy Amazon bailed on its plan to build a new headquarters in New York City. But that is only the beginning of the people’s fight to rein in this juggernaut.

While Amazon’s $3 billion tax break in New York got a lot of attention, most people do not know that the company will pay zero federal income taxes for 2018, the second year in a row that has happened. That’s right - zero. That comes in a year when Amazon doubled its profits, $5.6 billion in 2017 to $11.2 billion in 2018, according to the Institute on Taxation and Economic Policy, a nonprofit think tank that tries to hold tax evaders accountable.

Since Amazon’s home state of Washington has no income tax, the company paid nothing there, either. Also, it has thus far not collected New York sales taxes from its customers in this state, although that’s set to change this year.

The only reason a corporation should pay no taxes is if it is nonprofit or religious, supposedly paying its share in public service instead. Amazon certainly does not quality as nonprofit. Therefore it must pay its fair share of our common costs of running national, state and local government - and its share is much bigger than most.

With success comes responsibility.

Don’t get us wrong: We are all for thousands of new jobs, but we are not for giving away billions of the people’s dollars to one of the world’s wealthiest corporations - the last one on earth to need government subsidies. And we are even more opposed to our top politicians negotiating corporate tax breaks in secret, without involving the public. If Amazon wants the people of New York to cut it at $3 billion break, it needs to take that up with the people in a public conversation, and the people need to vote on it in a referendum.

This deal made it clear that our state’s governor and New York City’s mayor, who claim to be ultra-progressive champions of the working class, are too comfortable dealing in private with top corporate executives. Just because more voters chose them over the other options does not mean the people signed away the right to know what is going on with such an enormous transaction.

State Republican leaders released a snide statement about “Amazon egg on Cuomo’s face,” but this is not a time for snickering or sarcasm. It’s a time to recognize that a bunch of voters are sick of being ripped off.

It isn’t just about taxes, either.

Amazon owes a gigantic debt to America for leading the vanguard that has smashed brick-and-mortar retail stores - past, present and future - in pretty much every city, village and town.

Retail used to be the heart and soul of American downtowns - and then shopping centers, then malls, then big-box store complexes. Amazon has done more than anyone else in the world to shut all that down.

This has also stifled entrepreneurism. Giants like Amazon have Hoovered up so much of people’s business that there isn’t much market left for the person with the idea, the hustle and the $100,000 loan.

Go around upstate New York, and from Buffalo to Bloomingdale, you will see empty storefronts. Many blame that on Gov. Andrew Cuomo for keeping taxes high and not doing enough for the upstate economy - but no matter how much economic development grant money he spreads around, or how many public services the legislature cuts to lower taxes, it can never affect local economies as much as the private sector does.

Yes, sure, we shop online, too. We’re not against it. But when a store comes to a town, it has to pay taxes and fees to cover its local obligations. Amazon has found a way to game the system by dodging obligations. The American people need to put a hard stop to that.

Sure, many people admire the ingenuity it took for Amazon and its fellow tech titans to win the business game - and to keep on winning. But it’s pretty bad sportsmanship for a dynasty to stick the rest of us with the bill.

Hopefully, Amazon’s retreat from New York is the start of a new reckoning between today’s titans of industry and a re-energized American people.

Meanwhile, maybe the $3 billion New York would have given Amazon can be used to upgrade our state’s transportation infrastructure: roads, bridges, subways and trains. We figure the vast majority of New Yorkers could agree on that.

Online: https://bit.ly/2TXIyNu

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