How can one argue that hospital downsizing is not overdue?
BRIAN ACKLEY Political Columnist
Our latest bubbling brouhaha - sure to reach full boil in the next few weeks - is

actually an almost perfect microcosm of all that ails New York state in general, and our region in particular.

And like the reflection of a surgery lamp off stainless steel forceps, it is a shining example of leadership, both elected and otherwise, which is unwilling to learn from decades of botches and bollixes that have left us on our knees begging for some fact-based decision making.

Predictably, this week's recommendations from New York's Commission on Health Care Facilities in the 21st century have drawn reactions squarely from the 20th century, when for decades we collectively refused our necessary economic and political medicine because it seemed too distasteful.

It would be different if somehow, somewhere, even one person could make a compelling argument why such a drastic downsizing is not necessary. No such person exists. There is an undeniable and unavoidable reality of a health care crisis in New York, from empty hospital beds that drive up costs to a Medicaid system which accounts for an astonishing 14.3 percent of all the national Medicaid spending combined. Collectively, New York's hospitals lost almost $100 million last year, the eighth straight year they have been in the red.

As the New York Times accurately points out, "New York State spends more per person than any other state on health care, treating it as a source of jobs and economic development as much as medical attention.

"Over the last decade, New York State's more than 200 hospitals have been more fragile financially than those in any other state. About two dozen have closed, and most of those that remain have lost money and gone deeply into debt."

Since our elected leaders continually refuse to make hard and politically unpopular decisions, we once again have left it in the hands of an appointed, unelected group - such as the two local control boards who have seized control in Buffalo and Erie County and the scores of state authorities that act as shields for those who should truly be held accountable - to do the dirty work.

Even more predictable than politicians refusing to do their jobs is the reaction from unions and corporations with their front-and-center threats of lawsuits and advertising campaigns that will equate the recommended changes to aiming an AK-47 at a baby seal.

Locally, Catholic Health Systems has already launched a "not in my back yard" campaign which flies in the face of virtually every economic sensibility facing its industry. The other major player locally, Kaleida Health, has cautiously supported the process, but with the repeated caveat that if every detail isn't to its liking, they too will work feverishly to blow up the desperately needed plan.

At the state capitol, it will be a fascinating test of wills, since state lawmakers have no options other than to accept and implement the recommendations in full or throw them all out. There are no negotiations, no horse-trading, no campaign- contributions- for- your- vote compromises allowed.

Health Care unions have traditionally been as close to Albany's elite as salt crystals on a soda cracker.

That might be about to change, at least a little. For example, the distance is greater between 1199 SEIU chief Dennis Rivera and incoming Gov. Eliot Spitzer than his predecessor. While words between the two have been civil and even mutually supportive of Spitzer's major health care reform goals, and Rivera was named to Spitzer's transition team, the governor-elect went to great lengths during the election season to not appear beholden to the health-care union's money or potential voters. George Pataki could barely lift his snout out of their money trough long enough to open wide and say "ahhhh."

Pataki has a Dec. 5 deadline to accept or reject the full plan, and the Assembly and Senate have until Dec. 31 to do the same. Should the blueprint be tossed aside, New York will lose out on some $1.5 billion federal dollars earmarked to help the "right" sizing.

We are faced with the choice of taking our icky but necessary tonic or yet again, blindly clinging to the almost fully frayed life-support cord of false hope and reality denial. Pass the medicine, please.