It's not much of a puzzle. Massachusetts has relatively low utilization. But our overall costs are among the highest in the nation. What we have is very high cost per unit of care delivered in Massachusetts.
The Boston Globe published the third part of its series on Partners Health Care yesterday, and fixes the blame on a "gentleman's agreement" between Partners, the parent company of Massachusetts General Hospital and Brigham and Women's Hospital, and Blue Cross Blue Shield of Massachusetts, which has a large share of the Massachusetts insurance market. The Globe reports that in 2000 the CEOs (since retired) of each organization agreed to a large pay increase, contingent upon Partners obtaining similar arrangements from BCBSMA's competitors.
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The Partners response to the Globe article is here
There is not a response posted on the BCBSMA website as of now.