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It has tackled costs by shrinking the work force 19% since 2001.
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However, few studies tackled cost reduction and experimental optimization.
For instance, Massachusetts is trying to achieve universal coverage first before tackling costs.
"I think most of them know they have to tackle costs," he said.
After all, many economists argue that national health reforms must tackle costs hand-in-hand with coverage or else be deemed reckless.
Last month the White House proposed the creation of an Independent Medicare Advisory Council (IMAC) to tackle costs and improve quality in Medicare, the government health scheme for the aged.
Such changes sweetened by a colossal increase in spending, of 7% a year in real terms were designed to increase capacity and efficiency, not tackle costs.
One of the ways that Clinton plans to tackle costs other than tuition is by allowing students to use the total of their Pell Grants for living expenses.
Now the state seems poised to tackle costs — with an approach that is far more ambitious than anything currently being contemplated on Capitol Hill.
With Mr Obama's, the big unknown is how much it will really cost to reach near-universal coverage, while the uncertainty about Mr McCain's strategy to tackle costs is whether it will do much to expand coverage.
The hope was that by ruthlessly tackling costs and promoting efficiency, market-minded insurers would help rein in runaway health inflation where flabby government bureaucrats could not.However, private insurance seems to have pushed expenditure up not down.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com