Reader "WhatDoYouWantNow" comes across to us as more yapper than reader. The topic has been under discussion for months now. See a current post, "Low health-care costs in Massachusetts?" in the Local forum and another current post "Medical payment magic bites dust" in the Health forum. Where were you, dear friend, when it might actually have mattered?

Reposting from the first of these--

Although history-challenged Globe reporters seem unaware, Massachusetts has set up and sometimes abandoned one medical cost-control effort after another over the past 40 years. The early 1970s "certificate of need" requirements aimed to hold down proliferation of new hospital progams. They were soon exploited by bigger hospitals seeking to protect themselves from smaller competition. [A.E. Reider, J.R. Mason and L.H. Glantz, Certificate of need: the Massachusetts experience, American Journal of Law and Medicine 1(1):13-40, 1975]

Hospital rate-setting in the late 1970s disintegrated as emergency rooms started churning patients and hospitals laid off nursing staffs. HMO capitation in the 1980s became another failed experiment, producing massive rejection by health-care insurance subscribers. At one time or another, the state has experimented with almost every popular medical cost-control notion except the one that might work, single-payer care.

Gov. Patrick, his foolish advisers and a State House contingent bereft of insight are now embarked on a high risk, low return project to rein in costs of medical care. Unlike Congress, trying fitfully to restrain the growing cost of Medicare, they lack effective leverage. If the state tries to squeeze payments any more for Medicaid, a/k/a Commonwealth Care, the high proportion of state physicians who already refuse new Medicaid patients will skyrocket, and there will be hardly any physicians caring for low-income people.

In her latest press-release article on the mess, Liz Kowalczyk does not even mention powers that the state has available to enforce cost goals. Quite possibly that is because, despite her years of attention to this development, she really does not understand. If she did, it might be embarassing to describe a slipshod effort driven entirely by personal ambitions and public relations. [ Liz Kowalczyk, Legislative leaders reach compromise plan to control health care spending, Boston Globe, July 30, 2012, at ]