Universal health care got an important endorsement last week from the people who see it up close. In a survey of more than 2,100 Massachusetts physicians, 70 percent said they support the state's 3-year-old health care reform law.

Universal health care got an important endorsement last week from the people who see it up close. In a survey of more than 2,100 Massachusetts physicians, 70 percent said they support the state's 3-year-old health care reform law.


They like it for a simple reason that gets lost in the numbers and rhetoric flooding our national health reform debate: It's easier to get sick people the treatment they need when they have insurance.


"They were just quite impressed, both in their own practice and statewide, that the uninsured problem has essentially disappeared from their lives," researcher Robert Blendon of the Harvard School of Public Health told WBUR.


There may be some financial benefit for health care providers from having 97.4 percent of residents insured, but many of the doctors surveyed, 37 percent of whom are primary care physicians, 60 percent specialists, know from firsthand experience what happens when lack of insurance adds to the misery of seriously ill patients and their families.


Eliminating that inconvenience and heartache is one measure of the success of the state health program that is at the center of the debate in Washington. Given the polarization in Congress - and the tendency on the Right to slam anything associated with Massachusetts - the reforms here are being branded a failure by other measures.


There are real similarities between the new Mass. law and the bills moving through Congress. It has established an insurance exchange - the Commonwealth Connector - for those who have no coverage through their employers or a government program. Through the exchange, six insurance companies, including Blue Cross/Blue Shield, Fallon and Harvard-Pilgrim, offer policies that meet state standards, but there is no "public option." The law requires everyone to have insurance, with subsidies available for families earning less than $66,128 a year, and it imposes a fine of $295 per worker on companies with more than 10 employees that don't provide insurance.


There are other measures of success. Employers haven't dropped their insurance plans, as many feared. And there are complaints as well. The individual mandate saddles low-income families with policies or tax penalties they can't afford. Small businesses complain about the costs. Like all programs, there are bureaucratic headaches.


But the failure most often attributed to the Mass. program is something it never promised to do. Massachusetts has some of the highest health costs in the nation. Premiums are high, especially if you don't qualify for a subsidy. Health costs go up every year, straining the budgets of businesses, families, local and state governments.


All that's true, but none of it is because of health reform. Massachusetts had the highest per capita health spending of all the states two years before health reform became law. It's still a high-cost state, in part because it has some of the finest, and most expensive, hospitals in the world.


Health costs are going up in Massachusetts, to be sure. They are also going up in every state, at a pace of 9 or 10 percent a year, about the same as here. Nationally, average health insurance premiums have doubled since 2000. Those increases have hit the state budget hard, especially coupled with a recession-driven revenue shortfall of historic proportions.


But the health reform program isn't behind those increases, either in health care costs or in state spending. After an extensive study, the nonpartisan Massachusetts Tax Foundation concluded last May that "the cost to taxpayers of achieving near universal coverage has been relatively modest and well within initial projections of how much the state would have to spend to implement reform."


As for cost containment, it simply wasn't on the table when Gov. Mitt Romney, legislative leaders and the lobbyists for business and the health care industry sat down to talk reform.


"Everybody felt that just achieving access would be tough enough," MTF President Michael Widmer, who was at many of those meetings, told me recently. "The whole question of costs never came up."


That question is coming up now, in light of continuing health cost inflation and the debate in Washington. Some in Boston are talking about adding a public option to the Massachusetts exchange, especially if it doesn't make it into the national reform legislation.


The Legislature last week heard testimony on a bill that would go even further, creating a single-payer insurance system for the state. It already has the support of a quarter of the Legislature's members. Inspector General Gregory Sullivan is now calling for a new law putting the state in charge of setting the rates doctors and hospitals can charge.


Another proposal comes from a special commission charged by the Legislature with tackling health costs. It would go after the fee-for-service payment system that rewards providers for prescribing more tests and treatment, regardless of whether they are needed or successful. Replacing fee-for-service with a "global payment system" would be "enormously complicated," Widmer said, and in a recent editorial board meeting in Framingham, House Speaker Robert DeLeo said we shouldn't be expecting action on the recommendation any time soon.


"I've asked my chair to meet with everyone affected before we put out anything," DeLeo said.


Those meetings, while necessary, are part of the problem. Health reform happened in Massachusetts because those with the most clout on this issue - the big insurance companies, the big hospital chains, the physicians' organizations - had much to gain from getting more people insured. They have little to gain by reducing costs, since what is a cost to us is revenue to them.


One example of the dilemmas posed by cost containment: It can cost two or three times as much to have a routine procedure done at a Boston teaching hospital as it costs at a community hospital. Reducing costs may require telling people their insurance will cover their maternity costs at MetroWest Medical Center, say, but not at Mass. General. Will people accept that? Will Partners Health Co., which owns Mass. General, put up with that loss of revenue?


Massachusetts' health reform is a model for Washington in more ways than one. From the beginning, President Obama has made "bending the cost curve" as big a priority as covering the uninsured. But at every step of the process, measures that would help bring costs down have fallen by the wayside, with the encouragement of lobbyists for industries with money to lose.


Malpractice reform was taken off the table early. The pharmaceutical lobby promised to cut costs by $80 billion over 10 years, in exchange for prohibiting Medicare from negotiating discounts on prescription drugs. Reforms of "fee-for-service" have been negotiated down to a few pilot programs. The public option is just about the only cost-containment measure left standing - and it is dangling by a thread.


Will federal health reform bend the curve of health costs? Don't count on it. An independent analysis by actuaries for the Department of Health and Human Services reported last week that, under current law, the amount of GDP spent on health care will rise from 17 percent to 20.8 percent over the next 10 years. The actuaries determined that under the leading House bill, which includes a public option, spending would rise to 21.3 percent of GDP.


The Massachusetts physicians are right: For sick people, their families and the professionals charged with helping them heal, universal insurance coverage is a good thing. We've got it in Massachusetts and may yet get it nationwide. But we pay more for the health care we receive than residents of any other country on earth, almost twice as much per capita as our nearest competitor. Fixing that part of the problem is proving far more difficult.


Rick Holmes, opinion editor of the MetroWest Daily News, blogs at Holmes & Co. (http://blogs.townonline.com/holmesandco). He can be reached at rholmes@cnc.com.