I feel like I'm watching one of those basketball games that dragson forever before all the important action takes place in the lastfew seconds.
The governor and legislators have been working for more than 17months on bills to control health care costs in Massachusetts. Now alegislative conference committee is running out of time to reconcilecompeting versions passed by the House and the Senate.
The idea of legislators attempting to fix any kind of marketshould come with caution flags. A government plan to influence oneof the biggest segments of the state's economy -- a last-minutecompromise hatched behind closed doors -- makes me very nervous.
There are certainly elements of a plan everyone can agree upon.Greater transparency in the incredibly opaque world of medical costshas to be a good idea. The list of agreeable details goes on, butnot for too long.
Both House and Senate would cap increases in medical spending tothe rate of growth of the state's overall economy. That wouldprobably mean an allowable growth rate between 3 percent and 4percent, based on current conditions. A Massachusetts cap would bethe first of its kind in the country.
But the House proposal comes with real regulatory muscle toconstrain costs and enforce change. The Senate version is anexercise in government finesse. This is the heart of the legislativeconflict.
Meanwhile, the political force behind the entire debate --sharply rising health insurance premiums -- has lost steam recently.The pace of rising health costs slowed substantially since GovernorDeval Patrick first pitched a cost-control proposal early last year.
Why? The bad economy surely accounts for a big part of thatshift. People don't use as many medical services in tough times, andthat utilization rate may bounce back as the economy continues torecover.
Government pressure also had an impact. When Patrick leaned oninsurers to rein in rate increases, hospitals took notice.Children's Hospital and Partners Healthcare, which operatesMassachusetts General and Brigham and Womens hospitals among others,both renegotiated insurance contracts lower -- though I'd bet thehouse that had more to do with short-term political cover than anyeconomic epiphany.
But insurers and health care providers have made structuralchanges and created new products that may have a real impact onmedical costs going forward. Those change the way providers are paid-- based more on quality of health than quantity of services -- andtry to nudge patients to less expensive facilities for routine care.
Blue Cross Blue Shield of Massachusetts has gotten results so farfrom a relatively new kind of contract that pays providers a fixedannual budgets for patient care -- plus incentives for lower overallcost and high quality care.
All health insurers are offering tiered coverage plans thatrequire patients to pay more if they choose expensive hospitals forroutine care. Even more restrictive plans offer big premium savingsfor patients.
Those market-oriented strategies all make sense on paper. But Ihave no idea whether they will really work over time. Some smartpeople who have spent their careers working on this stuff don't buyit. Even my own doctor thinks I'm nuts to apply market solutions tothe economics of medicine.
But the burden of proof should be on government if it wants toaggressively regulate a market. Can it show that prices are out ofcontrol and the medical industry is unwilling or unable to fix it?That may turn out to be true, but it's a harder case to make today.
This is why I've always preferred the Senate's less aggressiveapproach to health care costs. It establishes ways to measuremedical expenses and determine if they are climbing too fast. That'sa step in the right direction.
So what happens if costs really do start ramping up again? Itwould be a relatively easy step to go from passive financialtracking to regulation with teeth. More aggressive cost controlscould become a two-step process, if they become necessary.
No health cost law is going to be perfect. The issues are big andcomplicated -- almost certainly beyond the grasp of any single pieceof legislation. But we have been passing a new health care reformlaw every two years, and more will surely follow. Cautious stepswork best.
Steven Syre is a Globe columnist. He can be reached atsyre@globe.com.
