Since enacting its sweeping health care reforms a few years ago, Massachusetts has reduced the percentage of its population without health insurance to less than 3 percent. That is, by far, the lowest rate in the nation.  But you hear a lot of criticism of the Massachusetts reforms, particularly from my friends on the left. And one of the primary critcisms is that the state hasn't done anything to control costs.

But now Massachusetts is getting to work on that problem. As Kevin Sack reports in Monday's New York Times,

Both Gov. Deval Patrick, Mr. Romney’s Democratic successor, and a high-level state commission have set out to revamp the way public and private insurers reimburse physicians and hospitals.

They want a new payment method that rewards prevention and the effective control of chronic disease, instead of the current system, which pays according to the quantity of care provided. By late spring, the commission is expected to recommend such a system to the legislature.

I'm not sure how successful this effort will be. It's extremely difficult for states to grapple with costs, given how much health care spending comes directly from the federal government through Medicare. On the other hand, it's possible the state could use its regulatory power as leverage to effect real changes in the way health professionals practice medicine--and the way insurers pay for it.

Sack also makes an interesting political point, one worth pondering as the national debate on health care reform moves forward:

Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls. The very stakeholders who were coaxed into the tent--doctors, hospitals, insurers and consumer groups--would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said.

One of these days, hopefully, the Treatment will have more to say on Massachusetts. Until then, go read Sack's article

--Jonathan Cohn