Philip K. Howard: Of obsolete laws and the filibuster

Anything positive that comes out of Congress is big news, as with the recent bipartisan support for a $1 trillion infrastructure package. But that’s only half the job: Congress must also fix the delivery system that delays permitting and guarantees wasteful procurement. For example, building a resilient, interconnected power grid — probably the top environmental priority—is basically impossible in a legal labyrinth that gives any naysayer multiple ways to delay, and then to delay some more.

Congress has responsibility not only for enacting new laws, but for making sure old laws work sensibly. But Congress rarely fixes old laws. Congressional oversight consists of posturing at public hearings, not corrective legislation. Congress has effectively abdicated the oversight job to the executive branch and federal courts, which have inadequate authority to make needed legal repairs. The ship of state, weighed down by a century of statutory barnacles, plows slowly in the same direction year after year.

No statutory program works as it should. Infrastructure permitting can take a decade. Health care is a tangle of red tape, consuming upwards of 30 percent of total cost; that’s $1 million per doctor. In about half the states, teachers are outnumbered by noninstructional personnel, many focused on legal compliance. Accountability of public employees is nonexistent; 99 percent of federal employees receive a “fully successful” rating. Obsolete laws notoriously distort resources; the 1920 Jones Act, for example, makes it more expensive to build offshore wind turbines because of its requirement to use U.S.-built ships.

Washington is overdue for a spring cleaning. Only Congress has the authority to do this. But neither party has a vision about how, or even whether, to fix broken government. Congressional leaders are so dug in arguing about the goals of government that they have no line of sight to how laws actually work.

The partisan myopia is revealed by the current debate over whether to retain the Senate filibuster rule. Making it hard to enact new laws, supporters of a supermajority vote argue, encourages more deliberative new programs. Eliminating the rule, on the other hand, will allow narrow Democratic majorities to enact sweeping new progressive programs. These arguments pro and con presume that lawmaking is an additive process — that Congress’s main responsibility is to enact new programs.

Fixing old programs, however, also requires lawmaking. Should Senate rules discourage repairing existing programs? Conservative scholar F.H. Buckley argues for abolishing the supermajority entirely, even though that would mean more liberal programs in the Biden administration, because making it easier to repeal or fix broken laws would be far more impactful.

Debate over the filibuster provides an opportunity to rethink how Congress does its job. The constitutional separation of powers is designed to make it hard to enact new programs. But the Framers also knew that it was important to purge old laws. James Madison believed that “the infirmities most besetting Popular Governments…are found to be defective laws which do mischief before they can be mended, and laws passed under transient impulses, of which time & reflection call for a change.”

But the Framers did not focus on the fact that, once enacted, a program will be defended by an army of interest groups. That’s why It is more difficult to repeal or amend a law than to enact a new one. The determined defense of an obsolete program by a special interest, as economist Mancur Olson explained, will always trump the general interest of the common good. That’s why farm subsidies continue 80 years after the Great Depression ended.

All laws have unintended consequences. Circumstances change. Priorities need to be reset to meet current challenges. Agencies deviate from their congressional mandate. Clear lines of authority must be clarified to give infrastructure permits on a timely basis.

Congress must come up with a practical way to fix broken and obsolete programs. One procedural change might be for the Senate to eliminate the supermajority vote for amending or repealing laws. But the backlog of broken programs is too piled up to expect much impact from one procedural change. Congress needs to go further. Here are three changes specifically aimed at fixing broken laws:

1. Create nonpartisan “spring cleaning commissions” to recommend updated frameworks in each area. Then, as with base-closing commissions, the proposals would be submitted for an up-or-down vote by each chamber.

2. Require a sunset on all laws with budgetary impact. Over the course of a decade, Congress could then methodically update the statute books.

3. Revive “regular order” in Congress to provide more presumptive authority to congressional committees to fix old laws. Congress could further empower committees by automatically approving amendments that are supported by both the majority and committee ranking members.

The failure of Congress to take responsibility for the actual workings of its laws is beyond serious dispute. By delegating lawmaking to agencies, and abandoning effective oversight, Congress has severed the critical link to democratic accountability. Government keeps going in the same direction, no matter how unresponsive and ineffective. Its inability to adapt to public needs in turn spawns extremist candidates. In order to restore trust in Washington, Congress must change the rules so it can take responsibility for how laws actually work.

Philip K. Howard is a lawyer, author, New York civic and cultural leader and chairman of Common Good, a legal and regulatory reform organization that emphasizes the importance of taking institutional, political and personal responsibility. His Latest Book is Try Common Sense. This essay first ran in The Hill.

‘Small-creature’s temperature’

The Old State House, a museum on the Freedom Trail near the site of the Boston Massacre

— Photo by Mobilus In Mobili 

"Boston is not a small New York, as they say a child is not a small adult but is, rather, a specially organized small creature with its small-creature's temperature, balance, and distribution of fat. In Boston there is an utter absence of that wild electric beauty of New York, of the marvelous, excited rush of people in taxicabs at twilight, of the great Avenues and Streets, the restaurants, theatres, bars, hotels, delicatessens, shops. In Boston the night comes down with an incredibly heavy, small-town finality. The cows come home; the chickens go to roost; the meadow is dark. Nearly every Bostonian is in his house or in someone else's house, dining at the home board, enjoying domestic and social privacy.''

— Elizabeth Hardwick, in the December 1959 Harper’s Magazine.

Actually, in the two decades before COVID-19 struck, Boston became a lot more like New York. But the pandemic has made it more like Hardwick’s description.

The Old Corner Bookstore building in downtown Boston, built in 1718 as a residence and apothecary shop. It first became a bookstore in 1828.

Urban uplift

Downtown Providence in 1844

Adapted from Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com

Providence officials, aided by professional planners, are trying to envisage how to improve the city’s downtown by stitching it together more tightly after car-dependent, suburban impulses have tended to fragment it.

Manuel Cordero, co-founder of the nonprofit DownCity Design, said “The idea is to create spaces that are welcoming and vibrant, and to address some of the longstanding issues, such as lighting and accessibility, to create a better set of interconnected spaces for our downtown.’’

Of course, every city needs to try to implement the best design ideas to adjust to changing demographics, technology, architecture, engineering and economics. But that might be even trickier than usual now because of the uncertainties of COVID-19. How might the pandemic permanently change how we live in, work in and visit cities?

To read ecoRI News’s report on this, please hit this link

The new Amtrak train hall in the Pennsylvania Station complex.

— Photo by Jim.henderson

One very good piece of urban news, especially for those of us in the Northeast Corridor:  A new, natural-light-filled train hall opened Friday in New York’s Penn Station complex. It has 92-foot-high ceilings and glass skylights and recalls the  glorious masterpiece that was the Beaux-Arts Pennsylvania Station, opened in 1910 and torn down in ‘60’s. It was replaced by the hideous cavelike, dank,  dark  and overcrowded Penn Station that we all hate – the busiest train station in America.

The new hall is in the James A. Farley Post Office building, across Eighth Avenue from the main Penn Station, which is under Madison Square Garden.

The facility will only serve Amtrak and Long Island Railroad passengers, at least initially. Subway and other riders/victims must continue to use the old station. But more changes are planned in the passenger-rail complex – by far America’s busiest – in coming years.

What a nice way for New York City, which  suffered much from the COVID catastrophe in 2020, to start the new year. And maybe it will inspire the political will to fix a lot more of America’s decayed transportation infrastructure. Big things can still be done, even in mostly gridlocked America, with strong and brave leadership.

The Yale architectural historian Vincent Scully (1920-2017) famously bemoaned the destruction of the 1910 Pennsylvania Station: “Through Pennsylvania Station one entered the city like a god. Perhaps it was really too much. One scuttles in now like a rat.”

Perhaps not a bad thing

Laffoley in his studio

“Boston is not an avant-garde place. It stays literally 15 to 20 years behind New York at all times.’’

— Paul Laffoley (1935- 2015), Boston architect and visionary artist

Parks as places for ‘relief from ordinary cares’

Walnut Hill Park is a large public park west of the downtown of the old manufacturing city of New Britain, Conn. Developed beginning in the 1860s, it is an early work of Frederick Law Olmsted, with winding lanes, a band shell and the city's monument to its World War I soldiers.

“It is a scientific fact that the occasional contemplation of natural scenes of an impressive character, particularly if this contemplation occurs in connection with relief from ordinary cares, change of air and change of habits, is favorable to the health and vigor of men and especially to the health and vigor of their intellect beyond any other conditions which can be offered them, that it not only gives pleasure for the time being but increases the subsequent capacity for happiness and the means of securing happiness.”

— Frederick Law Olmsted (1822-1903), the father of American landscape architecture and most famous as the designer of New York’s Central Park. He was born in Hartford and died in Belmont, Mass.

In the “Emerald Necklace’’ parkland of Boston and Brookline, designed by Olmsted and established starting in 1878.

“Frederick Law Olmsted” (oil), by John Singer Sargent, 1895, at the Biltmore Estate, Asheville, N.C.

It got better -- before the pandemic

The old John Hancock Tower and Boston skyline as it appeared in 1956, before the proliferation of skyscrapers in “The Hub’’.

“Boston is not a small New York … but is, rather, a specially organized small creature with its small-creature’s temperature, balance, and distribution of fat. In Boston there is an utter absence of that wild, electric beauty of New York, of the marvelous, excited rush of people in taxicabs at twilight, of the great avenues and streets, the restaurants, theaters, bars, hotels, delicatessans, shops. In Boston the night comes down an incredibly heavy, small-town finality. . . . There is a curious flimsiness and indifference in the commercial life of Boston. The restaurants are, charitably to be called mediocre; the famous sea food is only palatable when raw. . . . Downtown Boston at night is a dreary jungle of honky-tonks for sailors, dreary department-store windows, Loew’s movie houses, hillbilly bands, strippers, parking lots, undistinguished new buildings. . . . The merchandise in the Newbury Street shops is designed in a high fashion, elaborate, furred and sequined, but it is never seen anywhere. Perhaps it is for out-of-town use, like a traveling man’s mistress.’’

— Elizabeth Hardwick (1916-2007; critic, short story writer and novelist), in the December 1959 Harper’s Magazine

Prepare for cheaper cities

In eerily underpopulated downtown Boston on Oct. 8 at about 11 a.m.

There’s hope that downtown Providence, especially its newer office buildings, can grab business refugees from big cities, especially Boston and New York, to help fill some of its COVID-emptied space. The  pitch would include, among other things, the area’s shorter commuting times and, of course, the compact city’s walkability and visual charms.

Well, maybe a little. But it will be hard to fight a  technology-fueled work-at-home movement that was underway well before COVID-19 arrived and that affects all cities. Yes, having so many employees working from home erodes teamwork, loyalty and esprit de corps. But the savings to employers in office expenses may seem to many enterprises to more than offset those drawbacks.

The savings may soon come to include lower pay (never including senior executives, of course) for many, which employers would justify by pointing to the partial (if workers only come to the office, say,  two or three days a week) or full (if they work entirely at home) disappearance of  employees’ commuting costs, which for most workers total thousands of dollars a year.

We’ll see. But what does seem clear is that there will be fewer, perhaps far fewer, restaurants and hotels in most city centers in the next few years. Maybe more happily, at the same time rents will tend to fall downtown as more apartments go vacant, drawing in more people of modest means to live there even as suburbia becomes more expensive. And many of the remaining restaurants will be less expensive than before COVID. I hope that this means a revival of the old-fashioned diners. “Breakfast all day!”

Philip K. Howard: Create panel to streamline government in wake of virus, including fixing extreme pensions, work rules

Worker disinfects a New York City subway car in the current pandemic. New York State’s Metropolitan Transportation Authority operations are rife with astronomically expensive and outdated work rules and extravagant pensions. Ditto at the Massachusetts Bay Transportation Authority.

NEW YORK 

Howls of outrage greeted Senate Majority Leader Mitch McConnell’s (R.-Ky.) suggestion that Congress should resist further funding of insolvent state and local governments because the money would be used “to bail out state pensions” that were never affordable except “by borrowing money from future generations.” Instead, Senator McConnell suggested, perhaps Congress should pass a law allowing states to declare bankruptcy. 

New York Gov. Andrew Cuomo immediately countered that the bankruptcy of a large state would lead to fiscal chaos, and called McConnell’s suggestion “one of the saddest, really dumb comments of all time.” 

Indeed, the lesson of the 2008 Lehman Brothers bankruptcy was that a bail-out would have been far preferable, less costly as well as less disruptive to markets. 

But McConnell is correct that many states are fiscally underwater because of irresponsible giveaways to public unions. About 25 percent of the Illinois state budget goes to pensions, including more than $100,000 annually to 19,000 pensioners, who retired, on average, at age 59. These pensions were often inflated by gimmicks such as spiking overtime in the last years of employment, or by working one day to get credit for an extra year.

In New York, arcane Metropolitan Transportation Authority work rules result in constant extra pay — including an extra day’s pay if a commuter rail engineer drives both a diesel and an electric train; two months of paid vacation, holiday and sick days; and overtime for workdays longer than eight hours even if part of a 40-hour week. In 2019, the MTA paid more than $1 billion in overtime.   

Cuomo has thrown out rulebooks to deal with COVID-19, and recently mused about the need to clean house: “How do we use this situation and …reimagine and improve and build back better? And you can ask this question on any level. How do we have a better transportation system, a …better public health system… You have telemedicine that we have been very slow on. Why was everybody going to a doctor's office all that time? Why didn't you do it using technology? … Why haven't we incorporated so many of these lessons? Because change is hard, and people are slow. Now is the time to do it.”

Cut red tape, reform entitlements 

Perhaps McConnell and Cuomo are not that far apart after all. While bankruptcy makes no sense now, since states can hardly be blamed for COVID-19, federal funding could come with an obligation by states to adopt sustainable benefits and work practices for public employees.

Why should taxpayers pay for indefensible entitlements? How can Cuomo run “a better transportation system” when rigid work rules prohibit him from making sensible operational choices? 

Taxpayers are reeling from these indefensible burdens. The excess baggage in public institutions is hardly limited to public employees. The ship of state founders under the heavy weight of red tape and entitlements that have, at best, only marginal utility to current needs.

Bureaucratic paralysis is the norm, whether to start a new business (the U.S. ranks 55th in World Bank ratings) or to act immediately when a virulent virus appears (public health officials in Seattle were forced to wait for weeks for federal approvals). 

Well-intended programs from past decades have evolved into inexcusable entitlements today — such as “carried interest” tax breaks to investment firms and obsessive perfection mandated by special-education laws (consuming upward of a third of school budgets). 

Partisanship blocks reform

Government needs to become disciplined again, just as in wartime. It must be adaptable, and encourage private initiative without unnecessary frictions. Dense codes should be replaced with simpler goal-oriented frameworks, as Cuomo has done. Red tape should be replaced with accountability.  Excess baggage should be tossed overboard. We’re in a storm, and can’t get out while wallowing under the heavy weight of legacy practices and special privileges.   

McConnell and Cuomo each have identified the madness of tolerating public-waste-as-usual. But toxic partisanship drives them apart. Nor would ad hoc negotiations work to restore discipline to government; too many interest groups feast at the public trough.

The only practical approach is for Congress to authorize an independent recovery commission with a broad mandate to relieve red tape and recommend ways to clean out unnecessary costs and entitlements. This is the model of “base-closing commissions” that make politically difficult choices of which states lose military bases.      

Recovering from this crisis will be difficult enough without lugging along the accumulated baggage from the past. A streamlined, disciplined government would be a godsend not only to marshal resources for social needs, but to liberate human initiative at every level of society.  That requires changing the rules. But change is hard, as Cuomo noted. Broad trust will be needed.  That’s why the new framework should be devised by an independent recovery commission. =

Philip K. Howard, a New York-based lawyer, writer, civic leader and photographer, is founder of Common Good. His latest book is Try Common Sense. Follow him on Twitter: @PhilipKHoward. This piece first ran in USA Today.

Don Pesci: Those gubernatorial Caligulas

Decisive executive: A marble bust of Caligula restored to its original colors, identified from particles trapped in the marble

VERNON, Conn.

Gore Vidal – deceased, but not from Coronavirus complications – was once asked whether he thought the Kennedy brood had exercised extraordinary sway over Massachusetts. He did. And what did he think of the seemingly unending reign of “Lion of the Senate” Edward Kennedy, who had spent almost 43 years in office?

Vidal said he didn’t mind, because every state should have in it at least one Caligula.

The half-mad Roman emperor Caligula, who reigned in 37-41 A.D., considered himself a god, and the senators of Rome generally deferred, on pain of displeasure, to His Royal Deity. Caligula certainly acted like a god. The tribunes of the people deferred to his borderless power, which he wielded like a whip. They deferred, and deferred, and deferred… .Over time, their republic slipped through their fingers like water. Scholars think Caligula may have been murdered by a palace guard he had insulted.

Here in the United States, we do not dispose of our godlike saviors in a like manner. At worse, we may promote them to a judgeship, or they may be recruited after public service by deep-pocket lobbyists or legal firms, or they may remain in office until, as in Edward Kennedy’s case, they have shucked off their mortal coil and trouble us no longer

.Coronavirus has produced a slew of Vidal Caligulas, all of them governors. In emergencies, when chief executives are festooned with extraordinary powers, the legislature is expected to defer to the executive, and the judiciary remains quiescent.

This deference to an all-powerful executive department is not uncommon in war, but even in war, the legislative and judiciary departments remain active and viral concerning their oversight constitutional responsibilities.The war on Coronavirus, however, is a war like no other. Here in Connecticut, the General Assembly remains in a state of suspended animation. Every so often, an annoying constitutional Cassandra will pop up to remind us that we are a constitutional republic, but constitutional antibodies in Connecticut are lacking. Our constitutions, federal and state, are still the law of the land, and even our homegrown Caligulas are not “above the law,” because we are “a nation of laws, not of men.”

These expressions are more than antiquated apothegms; they are flags of liberty that, most recently, have been waved under President Trump’s nose. However, in our present Coronavirus circumstances, no one pays much attention to constitutional Cassandras because --- do you want to die? Really, DO YOU WANT TO DIE?Every soldier who has ever entered the service of his country in a war has asked himself the very same question. And we are in a Coronavirus War, are we not? Pray it may not last as long as “The War on Drugs.” Drug dealers won that one, and Connecticut has long since entered into the  gambling racket; the marijuana racket looms in our future.

Then too, in the long run, we are all dead. Even “lions of the Senate” die. The whole point of life is to live honorably. And this rather high-falutin notion of honor means what your mama said it meant: don’t cheat; don’t lie; treat others as you expect them to treat you. Bathe every day and night in modesty, and remember – as astonishing as it may seem -- sometimes your moral enemy may be right. Put on your best manners in company. “The problem with bad manners,” William F. Buckley Jr. once said, “is that they sometimes lead to murder.” Caligula forgot that admonition.

Once Coronavirus has passed, we will be able honestly and forthrightly to examine closely the following propositions, many of which seem to be supported by what little, obscure data we now have at our disposal: that death projections have been wildly exaggerated; that reports of overwhelmed hospitals were exaggerated; that death counts were likely inflated; that the real death rate is magnitudes lower than it appears; that there have been under-serviced at-risk groups affected by Coronavirus; that it  is not entirely clear how well isolation works; that ventilators in some cases could be causing deaths.  These are open questions because insufficient data at our disposal at the moment does not permit a “scientific” answer to the questions that torment all of us.

At some point, a vaccine will be produced that will help to quiet our sometimes irrational fears, but vaccine production lies months ahead. The question before us now is: what is more dangerous, the wolf or the lion? New York Gov. Andrew Cuomo, and allied governors in his Northeast compact, cannot pinpoint a date to end their destructive business shutdown because of insufficient data. According to some reports, Cuomo has hired China-connected McKinsey & Company to produce “models on testing, infections and other key data points that will underpin decisions on how and when to reopen the region’s economy.”

If the economy in Connecticut collapses because Gov. Ned Lamont accedes to the demands of those in his newly formed consortium of Northeast governors that business destroying restrictions should remain in place for months until a vaccine is widely distributed, the effects of the resulting economic implosion will certainly be more severe than a waning Coronavirus infestation. After Connecticut has reached the apex of the Coronavirus bell curve, it is altogether possible that a continuation of the cure – a severe business shutdown occasioned by policies rooted in insufficient data – will be far worse than the disease it purports to cure.

Don Pesci is a Vernon-based columnist.

Elisabeth Rosenthal/ Emmarie Huetteman: He got tested for COVID-19; then came a flood of medical bills

From Kaiser Health News

By March 5, Andrew Cencini, a computer-science professor at Vermont’s Bennington College, had been having bouts of fever, malaise and a bit of difficulty breathing for a couple of weeks. Just before falling ill, he had traveled to New York City, helped with computers at a local prison and gone out on multiple calls as a volunteer firefighter.

So with COVID-19 cases rising across the country, he called his doctor for direction. He was advised to come to the doctor’s group practice, where staff took swabs for flu and other viruses as he sat in his truck. The results came back negative.

In an isolation room, the doctors put Andrew Cencini on an IV drip, did a chest X-ray and took the swabs.

— Photo courtesy of Andrew Cencini

By March 9, he reported to his doctor that he was feeling better but still had some cough and a low-grade fever. Within minutes, he got a call from the heads of a hospital emergency room and infectious-disease department where he lives in upstate New York: He should come right away to the ER for newly available coronavirus testing. Though they offered to send an ambulance, he felt fine and drove the hourlong trip.

In an isolation room, the doctors put him on an IV drip, did a chest X-ray and took the swabs.

Now back at work remotely, he faces a mounting array of bills. His patient responsibility, according to his insurer, is close to $2,000, and he fears there may be more bills to come.

“I was under the assumption that all that would be covered,” said Cencini, who makes $54,000 a year. “I could have chosen not to do all this, and put countless others at risk. But I was trying to do the right thing.”

The new $2 trillion coronavirus aid package allocates well over $100 billion to what Senate Minority Leader Chuck Schumer of New York called “a Marshall Plan” for hospitals and medical needs.

But no one is doing much to similarly rescue patients from the related financial stress. And they desperately need protection from the kind of bills patients like Cencini are likely to incur in a system that freely charges for every bit of care it dispenses.

On March 18, President Trump signed a law intended to ensure that Americans could be tested for the coronavirus free, whether they have insurance or not. (He had also announced that health insurers have agreed to waive patient copayments for treatment of COVID-19, the disease caused by the virus.) But their published policies vary widely and leave countless ways for patients to get stuck.

Although insurers had indeed agreed to cover the full cost of diagnostic coronavirus tests, that may well prove illusory: Cencini’s test was free, but his visit to the ER to get it was not.

As might be expected in a country where the price of a knee X-ray can vary by a factor of well over 10, labs so far are charging between about $51 (the Medicare reimbursement rate) and more than $100 for the test. How much will insurers cover?

Those testing laboratories want to be paid — and now. Last week, the American Clinical Laboratory Association, an industry group, complained that they were being overlooked in the coronavirus package.

“Collectively, these labs have completed over 234,000 tests to date, and nearly quadrupled our daily test capacity over the past week,” Julie Khani, president of the ACLA, said in a statement. “They are still waiting for reimbursement for tests performed. In many cases, labs are receiving specimens with incomplete or no insurance information, and are burdened with absorbing the cost.”

There are few provisions in the relief packages to ensure that patients will be protected from large medical bills related to testing, evaluation or treatment — especially since so much of it is taking place in a financial high-risk setting for patients: the emergency room.

In a study last year, about 1 in 6 visits to an emergency room or stays in a hospital had at least one out-of-network charge, increasing the risk of patients’ receiving surprise medical bills, many demanding payment from patients.

That is in large part because many in-network emergency rooms are staffed by doctors who work for private companies, which are not in the same networks. In a Texas study, more than 30 percent of ER physician services were out-of-network — and most of those services were delivered at in-network hospitals.

The doctor who saw Cencini works with Emergency Care Services of New York, which provides physicians on contract to hospitals and works with some but not all insurers. It is affiliated with TeamHealth, a medical staffing business owned by the private equity firm Blackstone that has come under fire for generating surprise bills.

Some senators had wanted to put a provision in legislation passed in response to the coronavirus to protect patients from surprise out-of-network billing — either a broad clause or one specifically related to coronavirus care. Lobbyists for hospitals, physician staffing firms and air ambulances apparently helped ensure it stayed out of the final version. They played what a person familiar with the negotiations, who spoke on the condition of anonymity, called “the COVID card”: “How could you possibly ask us to deal with surprise billing when we’re trying to battle this pandemic?”

Even without an ER visit, there are perilous billing risks. Not all hospitals and labs are capable of performing the test. And what if my in-network doctor sends my coronavirus test to an out-of-network lab? Before the pandemic, the Kaiser Health News-NPR “Bill of the Month” project produced a feature about Alexa Kasdan, a New Yorker with a head cold, whose throat swab was sent to an out-of-network lab that billed more than $28,000 for testing.

Even patients who do not contract the coronavirus are at a higher risk of incurring a surprise medical bill during the current crisis, when an unrelated health emergency could land you in an unfamiliar, out-of-network hospital because your hospital is too full of COVID-19 patients.

The coronavirus bills passed so far — and those on the table — offer inadequate protection from a system primed to bill patients for all kinds of costs. The Families First Coronavirus Response Act, passed last month, says the test and its related charges will be covered with no patient charge only to the extent that they are related to administering the test or evaluating whether a patient needs it.

That leaves hospital billers and coders wide berth. Cencini went to the ER to get a test, as he was instructed to do. When he called to protest his $1,622.52 bill for hospital charges (his insurer’s discounted rate from over $2,500 in the hospital’s billed charges), a patient representative confirmed that the ER visit and other services performed would be “eligible for cost-sharing” (in his case, all of it, since he had not met his deductible).

Last weekend he was notified that the physician charge from Emergency Care Services of New York was $1,166. Though “covered” by his insurance, he owes another $321 for that, bringing his out-of-pocket costs to nearly $2,000.

By the way, his test came back negative.

When he got off the phone with his insurer, his blood was “at the boiling point,” he told us. “My retirement account is tanking and I’m expected to pay for this?”

The coronavirus aid package provides a stimulus payment of $1,200 per person for most adults. Thanks to the billing proclivities of the American health care system, that will not fully offset Cencini’s medical bills.

Elisabeth Rosenthal: erosenthal@kff.org, @rosenthalhealth

Emmarie Huetteman: ehuetteman@kff.org, @emmarieDC

On the Bennington College campus on a dreary day

Tim Faulkner: Two-way electricity trading between N.Y., New England and Quebec

A 2008 map of Hydro Quebec facilities

From ecoRI News (ecori.org)

An MIT study claims that hydropower from Quebec can provide stored energy and solve the intermittency issues afflicting wind and solar power. Researchers at the MIT Center for Energy and Environmental Policy Research illustrate how “two-way” electricity trading between New England, New York and Quebec can reduce energy-system costs, decrease natural-gas use, and limit the need for emerging technologies such as carbon capture and sequestration.

To get there, 4 gigawatts of new transmission lines must built between New England and Quebec so that existing hydropower reservoirs can send power on demand.

Meanwhile, attorneys general from Rhode Island and Massachusetts signed on to a letter in support of a 2018 rule by the Federal Energy Regulatory Commission that requires utilities to include energy storage in wholesale electricity markets. The rule is being appealed by utilities through groups such as the American Public Power Association over anticipated cost increases. The states say the rule would create billions in economic and environmental benefits.

Mayflower Wind record price

The 804-megawatt Mayflower Wind project being developed by Royal Dutch Shell and EDP Renováveis in the wind-energy zone south of Martha’s Vineyard and Nantucket was recently awarded a power-purchase contract of 5.8 cents per kilowatt-hour from the Massachusetts utilities that will be buying the electricity. The price agreement offered by Eversource, National Grid, and Unitil needs to be approved by the Massachusetts Department of Pubic Utilities.

The record low price is less than the previous low of 6.5 cents for the 800-megawatt Vineyard Wind project.

More than $70 billion of potential investments in offshore wind facilities are proposed between North Carolina and Maine, but all await the outcome of an overdue federal environmental review on the Vineyard Wind project by the federal Bureau of Ocean Energy Management.

Public comment for offshore wind

The public has until March 16 to comment on a Coast Guard proposal for the layout and navigable shipping routes for the seven leased wind areas in federal waters. The Massachusetts and Rhode Island Port Access Route Study recommends spacing of 1 nautical mile between the turbines. Developers generally favor the layout, while the commercial fishing industry prefers 4-mile transit corridors and a design that limits radar interference.

Tim Faulkner is an ecoRI News journalist.

Llewellyn King: New York and London mayors' vacuous 'virtue signaling' on fossil fuel

Indian Point Energy Center, a three-unit nuclear power plant station, in Buchanan, N.Y. New York City Mayor Bill de Blasio should fight to keep it open.

The mayors of the two greatest cities in the world, New York and London, combined on Jan. 6 to endorse folly. New York’s Bill de Blasio and London’s Sadiq Khan issued a combined call for all cities to follow their example and divest pension funds in fossil-fuel companies.

The plan is to force an end the burning of fossil fuels by pulling their pension funds out of fossil-fuel company investments. In another context, this was known as a starve-the-beast strategy.

In reality it was cheap politics: an example of what the British like to refer to as “signaling virtue.”

Putting pressure on the oil and gas companies that are the targets of their worships somehow is meant to force them to do what? To pack up, shutdown and “say ‘uncle’!”, leaving us without gasoline for cars, diesel for trucks or natural gas for electric generation, to say nothing of heating our homes and making meals?

The big woolly idea behind this and much of the Green New Deal, on which the mayors based their pronouncements, is that by punishing the oil and gas companies, they speed the arrival of carbon-free electricity and transportation. Their worships should work on congestion, affordable housing, homelessness and the other innumerable ills that plague cities, not the least New York and London.

As for de Blasio, he could do something efficacious for cleaning the air. He could fight to save the Indian Point Energy Center nuclear plant up the Hudson River, which has provided more than 20 percent of New York City’s electric power for decades with nary a smidgen of carbon being produced. Now it is to close and not a squeak from the clean-air mayor. Also, he could have spoken for other regional nuclear plants that have been closed in an untimely fashion.

Like many supporters of the Green New Deal, the two mayors are correctly worried about global warming. Their low-lying cities with tidal rivers are likely to suffer irreversible flooding within the decade. But they are closed-minded about the measures that can be taken to reverse global warming. They want clean electricity, but only if it is made in ways that are approved by the left of their parties -- the Democrats for de Blasio and Labor for Khan. They want only politically correct, clean air.

The mayors want electricity that is produced from the wind or the sun. In their dreams, to misquote Annie Oakley in the musical Annie Get Your Gun — they have the sun in the morning and the wind at night. If only. The wind blows irregularly and the sun, well we know when that shines.

Politicians are out of their depths and dangerous when they prescribe a solution not a destination. If a government, say that of the City of New York, declares that it wants more and more of the electricity generated in the city to be carbon-free, it should stick to that goal. It should not tell the market – and the industry -- which kinds of carbon-free electricity meet the goal.

The goal should be the aim, not the plays that will get the ball there.

Nuclear plants in the United States are failing because after deregulation of the electric utility industry in the 1990s, a market was established in which the lowest-priced electricity was always to be favored – neither social value nor consideration for the fact that this would favor a carbon fuel, natural gas, over highly regulated nuclear plants was considered.

The mayors did not mention -- as those who decide that the fossil companies are to blame are wont to do -- that there are technologies on the horizon to capture carbon before it gets into the air. This is known as carbon capture use and storage (CCUS).

Oddly a rah-rah, American Petroleum Institute event, which API does every January in Washington, staged after the mayors’ announcement, under the rubric of “America’s Energy Future,” didn’t play up carbon capture use and storage, although oil companies are leaders in the field. Instead, API dwelled on the virtues of oil and gas in everything thing from job growth to entrepreneurship to quality of life.

Science brought us the fracking boom, cheap solar cells, efficient windmills and it should be given a chance to solve the carbon problem, both with clean nuclear and with much cleaner fossil. The rest is posturing, even as we have just finished the hottest decade on history.

The worshipful mayors of New York and London should be panicked about saving their cities, not signaling their liberal credentials.

On Twitter: @llewellynking2

Llewellyn King is executive producer and host of White House Chronicle, on PBS. He’s based in Rhode Island and Washington, D.C.

A new Pawtucket?

Rendering of the Fortuitous Partners proposal for Pawtucket

From Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com

t’s far too early to know the fate of a Fortuitous Partners proposal to create a $400 million project in downtown Pawtucket that would include a minor league soccer stadium, an “indoor sports event center,’’ apartments, a hotel, offices, shops and restaurants. What will the financing environment look like over the next few years? What if the nation goes into a recession soon? But from what we know now it does look like a better -- and of course much bigger -- project for the city and region than the Pawtucket Red Sox plan to build a new stadium – as sad as the team’s exit is.

The project would leverage people’s love of being along the water – in this case the Seekonk River (which I always think is the Blackstone in that part of Pawtucket) – and presumably heavily promote the project to people from very expensive Greater Boston who might want to live in Pawtucket, further encouraged to do so by the Pawtucket-Central Falls MBTA commuter rail station, scheduled to open in 2022. A big question is how successful the soccer stadium would be, however popular the greatest international sport has become around here, considering that the major league New England Revolution is based just up the road at Gillette Stadium, in Foxboro.

The public part of the financing totals $70 million to $90 million, most of it from a commonly used tax technique called “tax increment financing.’’ This lets developers use part of the tax revenue created by developments to help pay to build them. Also involved in what the developers call “Tidewater Landing’’ are often controversial federal “Opportunity Zone’’ tax breaks that are supposed to encourage economic development in low-income areas but, many note, greatly benefit rich developers. But then, most tax breaks favor the rich. (See below.)

In any case, I hope that this is not one of those projects whose fate is tied in knots in layer upon layer of regulatory red tape. America used to be known for doing big projects; now, big – and needed— projects often seem impossible because of the veto power of too many interest groups, public and private. And there is no such thing as a perfect project. For an overview of our big-project paralysis, using New York’s Penn Station as Exhibit A, please hit this link.

Sam Pizzigati: Bloomberg could buy 2020 election and still make money

Via OtherWords.org

BOSTON

Gracie Mansion, the official residence of New York’s mayors since 1942, hosted billionaire Michael Bloomberg for three terms.

The first of these terms began after Bloomberg, then the Republican candidate for mayor, spent an incredible $74 million to get himself elected in 2001. He spent, in effect, $99 for every vote he received.

Four years later, Bloomberg — who made his fortune selling high-tech information systems to Wall Street — had to spend even more to get himself re-elected. His 2005 campaign bill came to $85 million, about $112 per vote.

In 2009, he had the toughest sledding yet. Bloomberg first had to maneuver his way around term limits, then persuade a distinctly unenthusiastic electorate to give him a majority. Against a lackluster Democratic Party candidate, Bloomberg won that majority — but just barely, with 51 percent of the vote.

That majority cost Bloomberg $102 million, or $174 a vote.

Now Bloomberg has announced he’s running for president as a Democrat, arguing he has the best chance of unseating President Trump, whom he describes as an “existential threat.” Could he replicate his lavish New York City campaign spending at the national level? Could he possibly afford to shell $174 a vote nationwide — or even just $99 a vote?

Let’s do the math. Donald Trump won the White House with just under 63 million votes. We can safely assume that Bloomberg would need at least that 63 million. At $100 a vote, a victory in November 2020 would run Bloomberg $6.3 billion.

Bloomberg is currently sitting on a personal fortune worth $52 billion. He could easily afford to invest $6.3 billion in a presidential campaign — or even less on a primary.

Indeed, $6.3 billion might even rate as a fairly sensible business investment. Several of the other presidential candidates are calling for various forms of wealth taxes. If the most rigorous of these were enacted, Bloomberg’s grand fortune would shrink substantially — by more than $3 billion next year, according to one estimate.

In other words, by undercutting wealth-tax advocates, Bloomberg would save over $6 billion in taxes in just two years — enough to cover the cost of a $6.3 billion presidential campaign, give or take a couple hundred million.

Bloomberg, remember, wouldn’t have to win the White House to stop a wealth tax. He would just need to run a campaign that successfully paints such a tax as a clear and present danger to prosperity, a claim he has already started making.

Bloomberg wouldn’t even need to spend $6.3 billion to get that deed done. Earlier this year, one of Bloomberg’s top advisers opined that $500 million could take his candidate through the first few months of the primary season.

How would that $500 million compare to the campaign war chests of the two primary candidacies Bloomberg fears most? Bernie Sanders raised $25.3 million in 2019’s third quarter for his campaign, Elizabeth Warren $24.6 million. Both candidates are collecting donations — from small donors — at a $100 million annual pace.

Bloomberg could spend 10 times that amount on a presidential campaign and still, given his normal annual income, end the year worth several billion more than when the year started.

Most Americans don’t yet believe that billionaires shouldn’t exist. But most Americans do believe that America’s super rich shouldn’t be able to buy elections or horribly distort their outcomes.

But unfortunately, they can — or at least, you can be sure they’ll try.

Sam Pizzigati, based in Boston, co-edits Inequality.org for the Institute for Policy Studies. His recent books include The Case for a Maximum Wage and The Rich Don’t Always Win.

'Planning with people'

Edward Logue, far right, presents some Boston redevelopment plans to Mayor John Collins and Cardinal Richard Cushing.

From Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com

Hearing of the publication of Lisabeth Cohen’s new book, Saving America’s Cities: Ed Logue and the Struggle to Renew Urban America in the Suburban Age, reminded me of cities I lived in or near over the decades, though it didn’t particularly remind me of Providence.

When I lived in Connecticut, in the early and mid ‘60s, Edward Logue (1921-2000) was already something of a national figure for his sometimes too confident efforts to push urban renewal in New Haven, where he was the city planner. He was determined to create a “slumless city’’ through assorted public-housing projects and a huge downtown mall. He did help save and/or improve some neighborhoods but overall he failed to turn around the city, home of very rich Yale University, of which he was an alumnus. Indeed, the city, run by the also “visionary” Mayor Richard Lee, continued to decline during their tenures, in part because of the destabilization caused by their tearing down of some lower-middle-class neighborhoods. Well aware of New Haven’s rising crime rate, I learned to walk fast through the city, whose train station I often used in the ‘60s.

In Boston, Ed Logue performed duties somewhat similar to what he handled in New Haven. He was an integral part of a huge effort to create what was called “The New Boston’’ in 1961-68. I worked in Boston as a reporter in 1970-71, when I saw much of his recent handiwork. The city, for so long down-at-the heels, was starting to look better – in general – though some of the new buildings were/are cold and sterile-looking.

While Mr. Logue undertook some actions that led to evisceration of some neighborhoods – some probably worthy of evisceration, such as honky-tonk Scollay Square -- he learned from the social damage he inadvertently helped create in New Haven not to willy-nilly tear down some beautiful old buildings that could be repurposed, and he consulted neighborhood leaders more than he had in New Haven. But he also was one of those pushing to create Government Center as a Scollay Square replacement whose unfortunate centerpiece is the hideous City Hall Plaza, which planners have been trying to “fix’’ ever since.

When I moved to New York, Mr. Logue was there, working on big redevelopment projects.

Mr. Logue had some big successes in reversing urban decline in some neighborhoods, along with some abject failures. He found that cities are more complicated than even the smartest and most well-meaning city planner can imagine, and that while there’s a role for top-down planning, even involving what may be unpopular decisions (if only in the short term), old cities have physical and social fabrics that are easier to tear apart than to repair. So his belated motto became “planning with people.’

What brought back some big cities, notably New York and Boston, more than planning and urban renewal, included the growing fatigue with car-based and “boring” suburbia, as well as demographic change, which brought lower crime rates and a growing percentage of single people. Then there were the multiplier effects of increasingly thriving industries in certain cities, such as technology in Greater Boston and finance in New York. Some cities became “hot’’ again.

As for Ed Logue, he spent the last part of his life happily living in rural, or maybe call it exurban, Martha’s Vineyard, amongst other refugees from urban angst.

Pataki a fine candidate, but for....

  Former New York Gov. George Pataki, who was very successful in his three terms running the Empire State, is running for  the 2016 Republican presidential nomination -- finally.

This amiable and very smart politician and administrator might be a fine president, but his nomination seems impossible in the current version of the Republican Party.

Too bad.