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Bit by bit over the past two months or so, the conversation about health care reform has shifted. While there are still complex coverage issues to consider and resolve, public and private health leaders are increasingly focused on the law’s sustainability, which requires us to focus on the growth of health care costs in Massachusetts.

Consider the following examples from the last two weeks alone:

Paul Levy has posted to his blog a list of simple but provocative questions and answers about cost, attracting much discussion. Jon Kingsdale and Leslie Kirwin have both worried publicly about the impact of health costs on the state budget and the health care reform law. At the Quality and Cost Council’s annual meeting, Stuart Altman presented a number of interventions to slow the growth in health spending, arrayed on a spectrum from very limited impact to greatest potential impact. Writers from across the health care community have used the WBUR blog to talk about cost.

I have three small suggestions on this emerging cost conversation:

First, the discussion needs to move beyond the blogs and boardrooms to the broader public. Polls suggest that rising health costs are the public top health concern. Let’s discuss openly the tradeoffs that Stuart Altman outlined in his presentation.

Second, let’s not focus the debate on the interesting, but less productive question of how Massachusetts health costs compare with other states. Instead, let’s concentrate on how to slow the rate of increase in health spending, because that is the problem imperiling health reform.

Third, let’s keep quality in the forefront of the cost discussion. Evidence continues to accumulate that making care better actually saves money. This is the issue that will unite patients, caregivers, and purchasers of care.

The Quality and Cost Council has given the Commonwealth an exquisitely simple goal on this problem: to reduce the annual rise in health care costs to no more than the unadjusted growth in Gross Domestic Product by 2012. In other words, health spending in the state should grow no faster then the rest of the economy.

Let’s use this goal to guide a focused, sustained and public effort to understand and address rising health care costs in Massachusetts.

Andrew Dreyfus is Executive Vice President for Health Care Services at Blue Cross Blue Shield of Massachusetts and former President of the Blue Cross Blue Shield of Massachusetts Foundation.

This program aired on October 1, 2007. The audio for this program is not available.