If Baltimore was a patient instead of a city, his doctor would advise him to lay off the drugs and alcohol, stay in school and away from criminal behavior. But at the end of the check-up, there would be one word written on the prescription pad: Jobs.

This city needs economic opportunity, it needs to put the unemployed to work, it needs good-paying jobs that can support families and allow distressed neighborhoods to rebuild. Whichever side one takes in the strained relationship between city residents and police, it's clear that the underlying economic maladies that predated the arrest of Freddie Gray had as much to do with the April unrest as one man's needless death.


That's why it's disappointing to learn that a plan by Johns Hopkins Hospital and Health System and other local hospitals to create 1,000 good-paying jobs with upward mobility — and greatly improve the delivery of health care to the community, by the way — recently received a thumb's down from the staff of the independent state agency that sets hospital rates. Members of the Health Services Cost Review Commission are expected to make a final decision on the proposal next month, and we would urge them to take a second look.

We understand the bean-counting purpose of the HSCRC and its goal of keeping rates as low as possible. That rate-setting approach has served this state well, saving consumers tens of millions of dollars by putting hospitals in an efficiency-embracing, cost-cutting, bottom-line pressure that other states can only envy.

But the purpose of any health care plan is not simply to find ways to deny payments to providers, it's to improve the health of its users — and that point is underscored by Maryland's new arrangement with Medicare, which has focused the system's incentives around keeping people well, not just making them better when they're sick. By this gauge, the Hopkins plan hits the mark twice: By adding community health workers and similar jobs to provide desperately-needed outreach and follow-up care to patients, it will reduce the likelihood of a readmission to the hospital. By filling those entry-level jobs with people living in targeted, high-unemployment neighborhoods, the city's overall health and welfare can be improved markedly. The program's $40 million cost (or $40,000 per job when benefits and training are included) may seem high, but it adds no more than one-quarter of 1 percent to a hospital bill, a negligible impact on insurance rates that would in no way threaten Maryland's precious waiver from typical Medicare reimbursement rules.

Would 1,000 jobs be enough to rebuild distressed neighborhoods? Of course, not. But it's a significant building block. Hopkins has already launched itself in this direction, unveiling a "build, hire and buy" initiative earlier this fall that is aimed at helping reduce those same economic disparities by buying more goods and services and hiring more minorities and minority contractors from the city's high-poverty areas.

What makes the effort particularly noteworthy is that these are not minimum-wage jobs nor do they require a college degree or highly specialized skills like nursing. They would pay in the neighborhood of $13 an hour or more, and training could be provided by the hospitals themselves. Small wonder that the effort has strong support from local ministers and community advocates who are currently experiencing the worst city crime wave in years.

Make no mistake, the bottom line should still be the bottom line. The challenge is simply for the commission to look more broadly at the problem than a minor surcharge on tomorrow's hospital bills. The economic health of these communities relates directly to the health of their residents — ultimately, poverty may be the worst chronic disease of all.

The numbers back that up. In neighborhoods like Upton and Druid Heights, the average life expectancy is 63 years — or two decades less than in Roland Park. The difference? Those two West Baltimore neighborhoods have a median household income of less than $14,000 a year, or 15 percent of the average in Roland Park a mere five miles away. Conditions like heart disease, obesity and diabetes are far more prevalent in low-income neighborhoods — and so is gunfire and the street-level violence that has taken more than 300 lives so far this year.

But if "jobs" are the prescription, who fills it? Insurance carriers may not typically support raising rates, but this may be one occasion when they should. Part of the mission statement of CareFirst BlueCross BlueShield, the region's largest insurer, is to "fairly address the needs of the customers in each of the jurisdictions in which we operate." For Baltimore, there's little doubt that reducing poverty sits at the top of that particular list, and jobs, not handouts, offer the best remedy.