Usually fairly, we spend a certain amount of time in Pittsburgh breaking our arms patting ourselves on the back on what a great city this is to live in. Yeah, well, there is still plenty that we can do to make it a lot better.
First on the list is in the area of “eds and meds,” especially our vaunted medical care — the industry that seems to have succeeded what it was that we used to do well in the past, the steel mills that aren’t coming back and so forth. The problem now blighting us in that sector is the conflict between the area’s two largest elements in health care provision, UPMC and Highmark Blue Cross Blue Shield.
Both profess to be nonprofits, enjoying tax-free status. That status is granted by governments on the basis of their taking a public-service approach to their actions. Instead, greed-ball leadership prevails and the fight between them continues, to the increasing detriment of the population of southwestern Pennsylvania and to themselves. Try, for example, with a primary care physician in the UPMC system to schedule surgery with a provider that accepts Highmark insurance. It is also a fact that doctors and facilities in the two systems, in addition to being buried in the bureaucracy and paperwork of the two organizations, are finding themselves underutilized as a result of the rivalry.
UPMC, in addition, is reaching far out of the area to try to make more money, in no small part to be able to pay the $1 million-plus salaries of 26 of its employees; it has increased its holdings to Jamestown, N.Y., and even to Colombia in South America. One has to wonder what the appeal of Colombia is for UPMC.
What needs to be done, for the well-being of our population’s medical care, that it not be allowed to decline further due to the ambitions of the industry’s leadership here, is that, by the end of 2016 if they have not settled their differences, giving all insurance-holder patients clean access to all of the area’s doctors and medical facilities, a determined assault be launched to remove their tax-free status. Engaged in the effort to treat them like businesses, because they act like businesses, would be Pennsylvania’s governor, its two senators and all its congressmen. Enough is way more than enough on this one.
Another serious problem of Pittsburgh, on the shelf, is the issue of consolidation. The current configuration of Allegheny County, divided still in governmental terms into 130 boroughs, townships and other forms of municipality, is inefficient and an expensive, unjustifiable luxury, not taking advantage of economies of scale, and fundamentally not operating on the basis of Pittsburgh the City — as opposed to the old-fashioned, I suppose, quaint concept of no longer extant neighborhoods. In terms of cost — specifically taxation — the current setup constitutes a misallocation of resources. We spend money on providing jobs to people who should be employed otherwise than providing us services inefficiently, instead of spending that money on schools and roads.
The last time the subject was addressed, in a commission headed by then-University of Pittsburgh Chancellor Mark Nordenberg in the 2006-08 period, nothing came of it. The various politicians involved — people who act on the basis of their stake in the current, antiquated status quo — showed no interest in the changes proposed and let consolidation drop again with a thud.
If Pittsburgh is to proceed as a modern city, addressing the problems of the whole metropolitan area that it includes, consolidation needs to be attacked again as serious proposals, to be acted upon. The way it is now, there are occasional mini-consolidations of a few services, usually driven by the collapse of one of some unit’s elements — no way to run a railroad.
One more, in closing. If one really wanted to bring this whole area to life in terms of transportation, instead of trying to keep Pittsburgh airport alive in the face of the whims of America’s fickle airline industry, thought should be given to building a new airport, midway between Cleveland and Pittsburgh, accessed by very-high-speed rail from both cities, with future options to link the new facility with Akron, Canton, Erie, Toledo and Youngstown, also by high-speed rail. Does anyone actually believe that the old Rust Belt cities benefit from parochialism? Where is the long-term regional planning? It certainly isn’t in Harrisburg or Columbus.
Can’t Cleveland and Pittsburgh leaders take the bull by the horns, looking ahead, not wallowing in the mud flats of the past?
Dan Simpson, a former U.S. ambassador, is a Post-Gazette associate editor (dsimpson@post-gazette. com, 412-263-1976).
First Published: August 24, 2016, 4:00 a.m.
