The long effort to develop an effective cost-containment law for the Massachusetts health care system has entered a worrisome phase. With just two weeks left in the Legislature’s formal session, a conference committee is reportedly making little headway on resolving critical differences and arriving at compromise legislation.
The committee pits House legislators pushing hard for a plan that would give state regulators broad powers to enforce health care cost caps against Senate negotiators arguing for using a lighter hand to nudge the market toward more cost-conscious practices. Several knowledgeable sources say things have grown so tense that one meeting last week ended abruptly, with legislators snapping at each other.
In another indication of how unsettled things remain at this late juncture, the Patrick administration is said to be trying to fashion a compromise that would enhance the attorney general’s power to intervene in the health care system as a substitute for some of the regulatory provisions in the House bill. That could end up being a good idea, but such a plan should be subject to public examination and discussion, and not emerge from left field at the 11th hour.
Lawmaking is seldom neat or orderly. Yet because of how important the health care sector is to the Massachusetts economy, this law must be wisely crafted — not the kind of legislative farrago that can result from last-minute horse-trading.
One particular peril conferees need to guard against is the tendency to over-invent and overreach in dealing with an acutely complex system. That’s all the more true because of the encouraging news in the last year on health care costs. Last week brought more such news; as the Globe reported, Blue Cross Blue Shield of Massachusetts has made promising progress toward reining in health care spending by paying physicians a set annual sum for patient care rather than a fee for every service.
Conferees are said to be in basic agreement on proposals for transparency, wellness, and medical malpractice. It shouldn’t be hard to find common ground on stronger consumer protections, administrative simplification, and electronic medical records. If, in addition to that, the final legislation encourages increased competition, nudges along the already existing trend away from fee-for-service care, and sets a reasonable cost containment target, it would make for a very good bill. Indeed, simply getting widespread agreement on the goal of keeping increases in health care costs at or near the rate of state economic growth would qualify as a first-in-the-nation accomplishment.
Arriving at a carefully crafted, coherent law will require genuine give and take. The House has wisely backed away from its previous plan for an new, quasi-independent authority to oversee the health-care sector. It now wants to vest that oversight function in a new division within Health and Human Services. The Senate should cede that point; the state doesn’t not need another authority.
Conferees need to guard against the tendency to over-invent and overreach in dealing with an acutely complex system.
In general, however, the lighter, less coercive philosophy of the Senate bill remains the preferable course, and is more likely to get the kind of buy-in necessary to make such complicated legislation work. And a law that works, rather than pride of authorship, must be the goal that motivates the conference committee in the crucial days ahead.