The Supreme Court’s decision upholding most of the Affordable Care Act has generated so much argument it’s easy to forget that the court was only looking at a small part of the law.

Most of the debate has been over whether the federal government can mandate that individuals buy health insurance, and while near universal coverage is an important aspect of the law, it does not on its own make health care affordable. It was the rapid inflation of health costs and insurance premiums that created the current crisis, with tens of millions of Americans with no health insurance, and cost control is the cure.

Fortunately, not everyone has forgotten that we really face an affordability crisis in health care, not just a coverage deficit, and now that the battle on the individual mandate is over, we should be looking for the most efficient and humane way to deliver health care services to as many people as possible.

The law does not spell out the method, but it does give states and health care providers and insurance companies leeway to experiment and come up with better ways to use current resources. One of the more promising experiments is going on in Maine where MaineHealth, the parent company of Maine Medical Center, is experimenting with the way it manages Medicare coverage, structuring compensation around high quality care and results rather than the number of services provided.

If it works, this kind of payment structure could reduce costs as well produce better outcomes, Nothing is more expensive in medicine than mistakes or treatment of diseases that were allowed to progress undiagnosed. Better care can be a cost saving strategy.

The MaineHealth experiment is one of many around the country that will try different approaches to control costs, and the most successful can be exported and duplicated elsewhere. Programs like this are where the heat of the health care debate really belongs.


An editorial on page D2 Sunday about Time Warner Cable’s dispute with WMTW’s owner Hearst Television should have said that the companies are arguing over a fee charged to cable companies by the stations that provide programming.