Patrick’s bold stroke

It also makes Patrick the anti-Charlie Baker of health care costs. That’s no accident in an election year.

The cyclical economics and politics of health care costs have swung between regulation and free markets for four decades in Massachusetts. Patrick and Baker, one of the governor’s two Republican challengers, now stand at polar opposites on that important issue.

Health care regulation took root in Massachusetts in the 1970s in response to a familiar complaint. Costs were spiraling and people wanted them under control. By 1992, Governor William Weld dismantled that system in the belief that an unregulated market would do better. His man at the wheel: Baker, then the state’s undersecretary of health.

Now Patrick wants to install a new version of the old regulatory system. He says costs are running out of control, especially for small businesses negotiating insurance rates for employees, and the increases threaten a revival of the state’s economy.

The Patrick version of health care regulation packs a punch. His plan gives state regulators the power to cap increases of premiums for small businesses at 150 percent of the national health care inflation rate.

More striking, the rates health care providers charge insurers could be “presumptively disapproved’’ by other state regulators if those prices rose faster than the medical inflation rate, adjusting for volume and severity of medical problems they treat. That includes contracts for hospitals, physician practice groups, and imaging service providers.

That’s an enormous amount of financial power over an incredibly complicated industry that drives about one sixth of the state’s economy.

One of the important lessons from old approaches to health care costs is about unintended consequences. They would surely emerge again from the Patrick plan.

The original Massachusetts efforts to regulate health costs achieved some early results. But a complex system run by government gets bogged down by a long list of special-interest considerations over time. Health care regulation eventually lost its attraction.

The Weld approach seemed to have a lot of common-sense appeal. This from a Globe story at the time: “The Weld administration hopes the legislation will cut costs as hospitals vie to attract patients by offering discounts to insurers, including Blue Cross/Blue Shield and Medicaid.’’

To the contrary, health care providers with the most market power leaned hard on insurers. A 2008 Globe Spotlight Team series showed how providers such as Massachusetts General Hospital and Brigham and Women’s Hospital were paid 15 percent to 60 percent more than competitors for similar services.

Attorney General Martha Coakley issued a preliminary report two weeks ago highlighting the market clout of the highest paid providers as the biggest force behind spiraling health care costs.

Now the governor is headed back in the other direction. He says people talk the subject to death and do nothing about health care costs by worrying over all those unintended consequences.

That’s a fair point, but consequences are very real.

To his credit, Patrick describes his plan as the beginning of a conversation. Who knows where it will go? For now, the governor has placed himself in the opposite corner from his most dangerous political challenger in the health care debate.

Steven Syre is a Globe columnist. He can be reached at syre@globe.com.