It might have been the deep-water harbor and railroad hub that built Portland, but anyone on Interstate 295 can see that’s not what’s driving the city now.

Portland is a service center, and bigger than the banks and the law firms are two huge and growing hospitals whose looming presence tell you all you need to know about the role health care plays in the way wealth flows through our communities.

A visit to Maine Medical Center with its sparkling tile floors and wood-paneled hallways – even before you get to its state-of-the-art medical technology – speaks of the solid financial foundation of a leading health care provider.

Tourism may be Maine’s biggest industry, but it’s health care, not dining or lodging, that is the state’s biggest employer. And it’s hospitals that pay some of the state’s biggest salaries. We’re not just talking about million-dollar-a-year neurosurgeons, but also million-dollar-a-year administrators.

These nonprofit corporations don’t pay taxes, but get hundreds of millions in state and federal taxpayer money each year, although it doesn’t always come in as fast as they would like. These businesses are so lucrative that they can pool resources and pay $244,000 a year for their assistant lobbyist, former Maine Hospital Association Vice President Mary Mayhew, who is likely to be Gov. LePage’s commissioner of the Department of Health and Human Services.

If Mayhew is confirmed, and there’s no reason to believe that she won’t be, she will be in charge of the state’s social services network. She will also be the point person in legislative attempts to reform welfare.

Building on Gov. LePage’s campaign talking points about ending a culture of dependency and treating welfare as a temporary bridge to independence, those efforts are going to be focused on needy families. Bills have been submitted to restrict eligibility, cap benefits and take other cost-cutting measures.

When her appointment was announced last week, Mayhew said it will be her goal to do a top-down review of the whole department and demonstrate where every tax dollar is spent. But if that’s what happens, people will see that very little of it really goes to “welfare as a lifestyle” compared with what is shoveled into the coffers of Mayhew’s former employers.

Temporary Assistance to Needy Families, the state/federal program that most people think of as welfare, costs about $200 million, less than 3 percent of total state spending last year. Combined state and federal spending on MaineCare, the low-income health care program, made up 34 percent of total spending – $2.4 billion, with much of it going to hospitals and nursing homes, some of which are owned by hospitals.

That spending doesn’t decrease much when the economy is bad and state revenues collapse.

When the Legislature votes on a supplemental budget early next month, it will include $69.5 million of state funds that will leverage federal money to pay back $250 million of a $400 million debt that resulted from the state’s underpayment for treatment of MaineCare patients.

The state really doesn’t have a choice. Maine should pay the money it owes, and putting off payment now would just cost Maine taxpayers more when the federal reimbursement rules change. But this debt should stick in people’s mind when we start talking about welfare reform.

It’s not welfare recipients buying cigarettes or lottery tickets that is straining our ability to pay. The hospitals get the biggest share of the money and it goes to them with no strings attached.

Health care money is not distributed to poor people, but paid on their behalf to providers to spend as they see fit.

Some argue that this is a good thing. This was the sector of our economy that continued to produce jobs during the recession, and we all benefit from the economic activity these people generate. But if we are questioning our ability to help people who can’t help themselves – like the elderly, disabled, unemployed or children – why can’t we ask if we can afford six-figure and seven-figure salaries for hospital administrators?

Talk about a culture of dependency – these businesses have no interest in getting off the public dole. For them, direct infusion of taxpayer funding is not a transition to independence, it’s a business plan.

There is a bill from Auburn Democraic Rep. Brian Bolduc that would cap a top hospital administrator’s salary at the governor’s pay rate, currently $70,000 a year.

The logic works: If someone can be found to run the entire state for that much, you should be able to run a hospital.

Instead, expect to hear about bills that would limit the length of time people can stay on state assistance, cap benefits and control what people do with the money they receive, with bans on cigarettes or beer.

Meanwhile, billions more will be funneled into some of the state’s biggest private businesses, and none of us will have anything to say about it.


Greg Kesich is an editorial writer. He can be contacted at 791-6481, or: [email protected]