National healthcare reform may or may not be on the ropes, depending on which prognosticator is weighing in, but when it comes to healthcare reform in Massachusetts, one thing is for certain just like Rocky Balboa, the state just keeps on swinging.

Massachusetts first made history in 2006, when it passed near-universal healthcare reform designed to dramatically improve healthcare access. Now, the state stands on the cusp of passing major healthcare cost-control legislation, something lawmakers have been targeting since before the ink dried in 2006 from then-Gov. Mitt Romney's signature. State lawmakers always said they tackled the easy part first, and the ensuing years featured a mixture of spiraling costs, trying financial times and infighting among competing interests. However, despite differences that often spilled over into the public eye such as when insurers went toe-to-toe with current Democratic Gov. Deval Patrick over premium increases Massachusetts groups have a way of working through issues when it comes to healthcare and ending up close to the same page if not exactly on it. Kind of like a healthcare version of The Avengers.

In the past week, both the Massachusetts House and Senate unveiled sweeping legislation designed to curb healthcare costs, which have been rising around 6.7 percent to 8 percent annually in the state. However, while they do take some similar paths to get there such as bundled payments and global contracting rather than fee-for-service there are differences. For instance, the House bill in general has more aggressive oversight of the healthcare industry, while the Senate's version puts more of a focus on market-based solutions. Also, the House bill ties healthcare costs to the general growth of the state's gross state product, minus a half-percent. The Senate bill seeks only to require healthcare costs grow at the same rate of the economy, around 3.7 percent annually. And those pricey academic medical centers in the state. They'd be hit with a luxury tax in the House bill, if it is determined high prices aren't paired with above-average quality. The Senate would only require such providers file comprehensive performance improvement plans.

So obviously, there is a long way to go before Gov. Patrick can hold his own signing ceremony, akin to the one Romney held six years ago. The two legislative bodies must hammer out their differences, and look for the final bill to more closely mirror the Senate version, though compromises will be made. Still, it will be a significant achievement and one that also paints a picture of the true challenges of significant healthcare reform. Opening up access is not enough, if it doesn't come with some form of payment reform and cost-control. Massachusetts officials knew this back in 2006, of course, but just like Rocky they were prepared to go the distance.

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