How to change the future

By Neal Peirce and Curtis Johnson  |  December 20, 2004

(Last in a series)
GREATER Boston's assets, from its deep pools of talent and capital to the great center city and picturesque towns, are world renowned. So why rock the boat, spend time, money, or intellectual capital on risky new undertakings? We caught a whispered undertone in many interviews: "Aren't we already the `hub' of what counts?" But there's a fatal flaw in defensive strategy. Boston has seen its advantages wither before. If innovation is its critical resource, momentum should be its mantra.

We nominate three bold maneuvers:

Forge a new American healthcare system. Few places on earth compete with Greater Boston's distinguished constellation of teaching hospitals, schools of public health, and profusion of research-related clinics. A third of FDA-approved drugs originate with Boston-area corporations. In biosciences, Boston's lead over other regions is so wide that Harvard Business School professor Michael Porter confidently told us: This is "one lead we won't lose."

But there are risks. Expensive to run, teaching hospitals face growing crises in recruiting nurses and lab technicians in a high-cost local economy. Single-purpose private clinics are nipping at their heels. Massachusetts' extraordinary multi-billion dollar share of federal medical research outlays, already declining, may well become a political target.

Meanwhile, American healthcare is at a crisis point, its costs inflating wildly, unnecessary medical deaths at 100,000-plus a year, millions of Americans without health insurance. Hospitals are engaged in an arms race for advanced equipment and superior surgeons. Pharmaceutical firms are generating costs faster than cures. Inflating Medicaid costs are on a path to consume the entire Massachusetts state budget.

Are either Congress or state legislatures likely to solve the crisis? We think not. Some region of the country -- some citistate -- could lead the nation by redesigning today's dysfunctional system so that the quality of healthcare actually improves, costs stop their giddy escalation, and all citizens get basic care. Could Boston be that pioneer? We believe so.

The ingredients for a breakthrough may be at hand -- the systematic data collection efforts of the Massachusetts Health Quality Partners, models like the Longwood Medical Area's 19-institution collaborative, and the growing interest in radical system reinvention in the New England Health Care Institute.

But Boston's hospital administrators will have to squelch their historic turf wars and jealousies. The goal -- tough but not impossible -- must be a region-wide approach that stops medicalizing most conditions (got a problem, here's a surgery or a pill). Instead, the region's medical establishment has to shift course to make prevention techniques and smarter life styles a big part of its formula.

Sounds tough? Cracking the human genome did too. If any American region has the range and depth for 21st-century medical system reform, it's Boston.

Invest billions in transit. Lots of debate centers on stemming sprawl that devours the region's classic New England landscapes. But there's need for a vital, companion strategy: to "remagnetize" the region's array of cities, either grand today or potentially grand tomorrow -- Boston to Lowell, Somerville to Worcester, Lawrence to New Bedford to Providence. These are the communities where critical answers to the region's housing crisis will emerge. And they're where business increasingly needs to locate and relocate operations. More development along I-495 and beyond just feeds congestion, imperils water supplies, saps cities' strength. Let Nevada specialize in sprawl; let New England be itself, and rebuild on its grand urban tradition.

Commonwealth investment practices -- channeling money, skill, and ideas to the cities -- can do a lot to make this happen. Public transportation is critical -- improvements in a creaky and overextended MBTA on one hand, commuter rail improvements on the other. The Conservation Law Foundation is on the right track, we'd guess, in pressing the state to fund the MBTA extensions and rail service to T.F. Green Airport in Rhode Island it promised in 1990 as a condition for building the Big Dig.

But a bigger commitment is needed: to channel significant new capital into the MBTA, now operating beyond design capacity. The region needs to shake off its post-Big Dig exhaustion, the belief that one mega-project a century is sufficient. The proposed Urban Ring (emphasizing suburb-to-suburb travel) is a potential national model for adapting transit to the realities of modern commuting.

Would the Ring cost billions? Yes. Could the money be found? It's easy to say no, certainly to outright government appropriations. But how about tapping the minds and skills of the region's extraordinary set of super-economists, lawyers, and consulting firms?

For example: Several universities and major hospital complexes would be served by the ring's proposed line, touching Boston University's main campus, the Longwood Medical Area, Northeastern, BU's Medical Center, and -- depending on the precise route finally selected -- MIT, Harvard, and Tufts. Can these institutions contribute ideas or support? How about Harvard exercising leadership by offering a large bonding guarantee out of its endowment? What are creative financing possibilities that build on the value of MBTA-held lands near stations?

If the Boston region can't deploy its world-class set of legal and financial minds to solve these critical mobility problems, maybe throw in a measure of its fabled political acumen to get the strategic approvals, one fears for the region's future. Solutions aren't just optional: They're critical for the region's economy and viability.

It's worth noting that a successful Urban Ring would also be a godsend for such neighborhoods as Roxbury and Dorchester, and possibly later Chelsea and Everett, providing their low-income residents transit access to downtown, the hospitals, universities, and other job-rich locations.

Green up. Boston and all of New England are an energy Sahara, at the mercy of such places as Texas, Venezuela, and Saudi Arabia.

So it's a good thing that Mayor Thomas Menino, Governor Mitt Romney, mayors and state legislators, the Green Roundtable, the Massachusetts Technology Collaborative, and others have warned publicly of the perils posed by global warming. Their collective call for conservation and "green," renewable alternatives could hardly be more timely.

The Romney administration is the first in the United States to include the impact of greenhouse gas in evaluating highway projects. Menino has an imaginative "green economy" initiative aimed at extended building life cycles, greater worker productivity and retention, even encouraging financiers to adapt real estate investment trusts to enable higher up-front outlays for green building features. World-class "green" buildings are sprouting in Boston and Cambridge.

But is it enough? Other states -- New York, Washington, and especially California -- are racing down the energy conservation track faster than Massachusetts. There's no sign of a big Boston area mobilization to tap the area's remarkable university and private lab brain power, its capital and legal skills, to elevate a renewable, green future from idealistic hope to on-the-ground reality.

Or, for that matter, in-the-sky reality. There's opposition on Cape Cod to the proposal for 130 massive wind turbines on Horseshoe Shoal off Nantucket. But the energy yield could be substantial. Think a few years ahead and those windmills' great turbines could be a symbol of collective will for sustainability in a new age.

Another argument for green energy: It promises to spread wealth and benefits in a refreshingly democratic way. Ask who benefits most from the region's highly touted biotechnology/pharmacology sector, and the answer is affluent scientists, physicians, corporate executives, and investors. But a truly green future would serve everyone -- energy security for all classes, career openings for scientists and high-tech workers, and real-life, on-the-ground jobs for building tradesmen at the construction sites. With a little luck, green construction and building retrofit may spell a century of blue collar jobs.

Fancy, high-cost, intellectual Boston needs that balance.

Neal Peirce and Curtis Johnson, authors of the book "Citistates" and principals of the Citistates Group, were commissioned by the Boston Foundation to evaluate Greater Boston's 21st century challenges. Their report, "Boston Unbound," is available at www.tbf.org.