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Brian McGrory

Health costs killing cities

By Brian McGrory
Globe Columnist / March 25, 2011

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No need to worry anymore about whether we keep Boston City Hall or move it, whether we live with the desert of brick in Government Center or try for the millionth time to change it.

It doesn’t matter, because the way things are going, we might as well sign the whole ridiculous piece of property over to Massachusetts General Hospital and let them turn it into yet another annex. The parking clerk’s office will make a great emergency room.

This is what I was thinking as I walked on Cambridge Street the other day, knowing that inside City Hall, an extremely capable official, Meredith Weenick, was doing what she often does: stressing over health care costs.

And for good reason. She’s the acting director of finance, and health care is killing Boston. It’s killing virtually every city and town across this Commonwealth. It’s killing small businesses. It’s killing families.

You don’t believe me? Let’s go to the numbers. A reputable group known as the Boston Municipal Research Bureau reported this week that the city of Boston cut 1,050 jobs in the past two years, yet payroll still increased. Why? There are a few small reasons and one big one: health care costs.

From 2008 to 2011, with markedly fewer workers, the city increased its health care spending by more than $40 million a year, and it’s projected to go up another $20 million next year. This means that Boston has fewer workers offering fewer services to residents and businesses paying rising taxes, all because health costs are out of control.

Put another way, Boston now spends more annually on health care, $301.5 million, than it does on policing ,$270.8 million. The projected rise next year of $20 million is bigger than the city’s $16 million parks budget.

I respect Partners HealthCare, which comprises Massachusetts General and Brigham and Women’s hospitals, two of the best health care providers in the world. Partners is the state’s biggest employer. It is a company where brilliant people perform life-saving miracles every day.

But even as they save, they’re killing us. It’s that easy. Teachers, firefighters, cops, restaurant workers, store clerks, engineers — you name it, their jobs are gone or in jeopardy because governments and businesses need to cut to keep pace with Partners’ insatiable appetite for cold, hard cash.

Feel free to blame municipal unions for part of the problem, and rightfully so. They have the kind of sweetheart health care deals with Boston and other towns that private-sector workers lost long ago. And blame insurance companies for absurd multimillion-dollar salaries and payouts to profoundly mediocre executives. That’s you, Cleve.

But it’s mostly about costs, and there may be no more difficult place in the world to achieve controls than here, where health care is the dominant industry, with Partners alone pulling in $8 billion — yes, a “b’’ — a year in operating revenue. It’s tough to put a black hat on someone wearing a white coat.

The good news: Governor Deval Patrick has proposed a bill that is as aggressive as it is complex. Partners chief executive Dr. Gary Gottlieb has publicly said the current situation is “impossible to sustain and contradicts who we are and what it is we need to do.’’

The bad news: The state Legislature seems poised to do exactly what it does best, which is virtually nothing. “A long involved debate process,’’ is how House Speaker Bob DeLeo described what’s ahead.

Until then, another year, another rate hike, another round of cuts. It’s the kind of death spiral only the people of Partners can prevent.

Brian McGrory is a Globe columnist. His email is mcgrory@globe.com.