Massachusetts, pioneer of universal health care, now may try new approach to costs

The Washington Post reports on the struggles of central planning:

Five years ago this week, Massachusetts became the first state to move toward universal health insurance, foreshadowing the 2010 federal health-care overhaul. Now, the commonwealth is debating whether to become a role model again — by replacing the fee-for-service system that has long defined U.S. medicine.

Massachusetts Gov. Deval L. Patrick (D) is trying to “shove,” as he put it, the health-care system here into a new era of cost control. He is proposing a new way of paying for care that would try to propel changes in the way it is delivered. It would give lump payments to teams of doctors responsible for almost all the care of a group of patients, with bonuses for saving money and dispensing high-caliber services that keep people healthy.

The governor’s plan — stirring an impassioned debate inside the gold-domed State House on Beacon Hill and among players in the state’s vaunted health-care industry — would make Massachusetts the only state to promote wholesale new arrangements of “integrated care.”

Massachusetts in 2006 created a health insurance exchange, a requirement that most residents carry coverage and subsidies to help them pay for it — central elements now in the federal law. As a result, 98 percent of the residents here are now insured, the highest rate in the nation. But the state’s first round of health-care changes devoted far less attention to medical costs.

Imagine that.