The Boston Globe reported in September that medical debt remains virtually unchanged since 2006. About 17.5 percent of Massachusetts residents said they had difficulty paying medical bills in 2010.
"Health care cost containment is much more complex than wrestling with the access issue," said David Seltz, executive director of the Health Policy Commission, a state body established by the new law to track cost-containment issues from a consumer perspective. The commission is governed by an 11-person board that has "one of the strongest conflict of interest protections in state government," he said.
Among other concerns, the commission's primary functions include examining changes in health care management; conducting a cost and marketing review of health care prices from a consumer's perspective; and taking steps to ensure that consumers know how much a specific medical procedure will cost.
The Affordable Care Act focuses primarily on efforts to ensure access for all U.S. citizens to health care, rather than ways to achieve cost controls. However, it also established a 15-member Independent Payment Advisory Board, which has the task of recommending savings in Medicare that do not affect coverage or quality.
Massachusetts' new cost-containment law doesn't set a specific budget for health care. But the state's health industry leaders have agreed to establish a goal that medical spending not exceed the overall growth rate of the state budget in 2014, or about 3.6 percent.
The commission plans in 2015 to begin identifying those Massachusetts health systems and hospitals whose cost growth doesn't meet the state's goals.
Still, the law does not appear to have enough regulatory teeth to take significant action against any offenders.
Seltz emphasized that the commission is not an enforcement agency; it's a monitoring agency.
"Let's try to do this together -- with government, payers and insurers," he said. "There's a sense that we're in this together."
Blue Cross' Dreyfus agreed that health systems, hospitals and insurers must work together to "improve quality and lower cost. ... We still have quality, safety and reliability issues."
Still, hospital administrators and patient advocates in Massachusetts and elsewhere worry that attempts to drive down health costs will result in more costly and intrusive regulations.
"What we get with this is a lot of regulation," said Dr. Tim Ferris, vice president for population health at Partners Healthcare system in Massachusetts. "So there's no question this is having a profound effect on every provider.
"It's different this time. It's not just insurers and providers, it's government," he said. "Is the state entering the private doctor-patient relationship?"
Some doctors fear an erosion of their autonomy in medical decision-making. Consumer advocates worry that patients may be left with fewer choices.
Innovation that will help achieve cost savings, Ferris said, is most likely to happen through "physicians who persuade other physicians. ... Cutting leaves the status quo in place with all of its flaws -- or you can change the payment system."
Private industry has taken the lead in Massachusetts in designing health reform models.
In 2009, Blue Cross -- the state's largest insurer -- set up an experimental project called "Alternative Quality Contract," which is designed to reduce the growth of health spending and to improve quality of care and health outcomes.
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