Three years ago, Massachusetts politicians began what may be the gutsiest health care experiment the country has ever seen, bringing near-universal coverage to the state in record time. There’s just one problem: they put off any attempt to control costs, the New York Times reports. Massachusetts’ health care is among the nation’s priciest, and though the state program’s finances are stable for now, everyone agrees they won’t stay that way without reform.
Now, the state is hoping to change the way health insurers reimburse doctors—to reward prevention and chronic disease control rather than paying based on the quantity of care doled out. Health policy experts say that might be an even bigger coup than universal coverage, but it won’t be easy. Among the hurdles: getting federal permission to tinker with Medicaid and Medicare.