Bending the Cost Curve, Not Just Talking About It

By Nicolas Terry

When the 2012 history of health care is written, which date will have the largest entry, November 5 or 6? Of course, many (but not that many) provisions of the Affordable Care Act will live or die depending on how the election affects control of the White House and Senate. But, November 5 may end up having more significance because that is the date Massachusetts’s new health care spending legislation, here, takes effect.

Signed into law by Governor Patrick on August 6, 2012, the new law now has its own website, here, the promise of a a ton of data, here, and in Brandeis University economist Stuart Altman, here, a chair for its Health Policy Commission (HPC).

Thomas Lee, here, notes “the 349-page law that was just passed in Massachusetts created 25 new boards, task forces, and commissions, and 266 new appointees are going to be enlisted to monitor and enforce compliance with spending caps, oversee provider performance improvement plans, and certify Accountable Care Organizations (ACOs).”

Nancy Turnbull, here, offers more detail on the legislation including its key cost control measures, such as ending health care’s economic exceptionalism by restricting its spending growth to the overall state economy and establishing Dr. Altman’s HPC to set and enforce spending targets.

Finally, October’s Health Affairs contains a must read article, here, on this “New Era of Payment Reform,” co-authored by Dr. Altman. It describes the new law as “unprecedented in its scope and ambition,” while carefully describing those aspects of reform that seem peculiarly local and those with broader, federal applicability.

Whether the winner of the November 6 election is the man who signed into law the original Massachusetts health care reform or the man who signed its federal version, the ramifications of November 5 may prove hard to ignore.

Nicolas P. Terry

Nicolas Terry is the Hall Render Professor of Law at Indiana University McKinney School of Law where he serves as the Executive Director of the Hall Center for Law and Health and teaches various healthcare and health policy courses. His recent scholarship has dealt with health privacy, mobile health, the Internet of Things, Big Data, AI, and the opioid overdose epidemic. He serves on IU’s Grand Challenges Scientific Leadership Team, working on the addictions crisis and is the PI on addictions law and policy Grand Challenge grants. His podcast is at, and he is @nicolasterry on Twitter.

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