How’s this for chutzpah – the trustees of this city’s hospitals are joining with one of the state’s most powerful unions to spend millions of dollars attacking Governor Pataki for trying to impose some restraints on health care spending. And the money they are spending comes, in part, from the taxpayers who are already shouldering the highest state and local tax burden in the nation to support health care spending that nearly everyone except the trustees and the union acknowledges is outrageous.

The hospitals are diverting taxpayer money for this political use in the face of a campaign in which both Democrats and Republicans running for governor have sharply attacked the legislative budget that the trustee-union combine is trying to protect from the governor’s vetoes. Even the New York Times devoted a series to the waste and fraud that make New York’s Medicaid program cost $46 billion a year, more than Florida’s and California’s combined.

The $3.5 million that the Healthcare Association of New York State, the Greater New York Hospital Association, and 1199/Service Employees International Union are spending may be a rounding error in the bloated $46 billion Medicaid spending in the state. But it is an enormous sum in the context of New York politics. As our Jacob Gershman pointed out in his dispatch yesterday on the spending effort, it is more than the combined fund-raising of all the Republican candidates for governor as reported in the candidates’ January filings.

What the hospital trustees and the health care workers’ union are diverting this money for is a scare campaign of television and radio and print advertisements and direct mail warning of hospital closures and nurses being thrown out of work. Well, maybe if some hospitals closed, New Yorkers wouldn’t be bearing the enormous tax burden of a Medicaid program that costs more than twice the national per capita average.

The latest issue of the Greater New York Hospital Association newsletter reports that the association and the union have lawyered up, hiring counsel “to pursue litigation in the event the Governor implements his cuts, despite veto overrides, or refuses to implement new spending.” Meanwhile, the Census Bureau reports that New York led the nation from 2000 to 2004 in the percentage of its residents fleeing to lower-tax jurisdictions. The Sun’s Daniela Gerson reports on these data elsewhere on page 1 today.

How’s that for an Empire State three-for – leading the country in Medicaid spending, combined state and local taxes, and population flight. It underscores the message that at some point, the far-sighted among the hospital trustees and union leaders are going to want to rein in their lobbyists and political advocacy, because it starts to be self-defeating. All those New York hospitals that avoided closure and all those New York nurses that avoided being laid off won’t have any patients left to treat. The paying customers will have moved to Nevada and Florida and California.