Two recent studies show public employees health care costs are out of control. Still, Gov. Deval Patrick resists taking the steps needed to give cities and town the tools they need to manage those expenses.

Mayors, selectmen and town managers argue that they need more flexibility in designing the type of health plan that should be offered employees — an authority described as "plan design." A recent Metropolitan Area Planning Council survey has debunked Patrick's claim that Bay State cities and towns can save plenty of money in health care costs without resorting to plan design.

In this post-Wisconsin environment, some legislators, but the governor especially, seem petrified of taking any action that might aggravate the public employee unions. And those unions don't want to lose their ability to trade concessions on health care for pay increases — despite the fact many municipalities can't afford either the current level of benefits or to give employees raises.

Thus the effort to win plan-design authority has so far fallen on deaf ears in many precincts of the Statehouse. (One notable exception: House Speaker Robert DeLeo who has made clear his feeling that the status quo can't be tolerated.)

Patrick has for months tried to shift the focus off plan design by insisting there are millions to be saved if only cities and towns would shift retirees to Medicare — something that can be done without legislative approval.

One problem: According to MAPC, 90 percent of the 101 communities in the metropolitan Boston area have already taken that step. Most north of Boston communities require retirees to sign up for Medicare when they become eligible.

How significant is this problem? Very. A study this week from The Boston Foundation and the Massachusetts Taxpayers Foundation labeled municipal government health plans "gilded benefits from a bygone era" and called upon Patrick and the Legislature to allow municipal health plans to be designed outside of collective bargaining, the State House News Service reported.

The study compared municipal premiums and cost sharing for 28 municipal government plans, two state plans, one federal plan, and the average benefits in plans found in a 2010 statewide survey of employers conducted by Associated Industries of Massachusetts.

The study found that:

For family coverage, the average municipal premium is $5,600, or 37 percent higher than the average private sector premium and 21 percent more than the state's Group Insurance Commission plans.

The average co-payment for a visit to a primary care physician in a municipal plan is $11. State, federal and private workers on average pay twice as much.

No municipal plan studied included a deductible. In the other public and private plans, members are responsible for a minimum deductible of $250 for individuals and $700 for families.

Municipal workers pay less for generic drugs and many face no co-payments for medical services such as high-tech imaging, outpatient surgery or hospitalization.

For too long, municipal workers have been enjoying lavish medical benefits that far exceed those of the taxpayers who support them. This particular gravy train must end.

Like it or not, if Patrick and the Legislature are sincere about helping cities and towns cope with rising health-care costs, they're going to have to address plan design. And they have only three months to act before fiscal 2012 budgets take effect July 1.

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