Abstract: Health care spending and more importantly, health care spending
growth rates, are unsustainable. Past strategies of price controls, reliance on
administered pricing for Medicare and the dominance of a la carte fee for
service reimbursement have been part of the problem and do not represent
promising strategies for the future. Too much time has been spent debating
whether Medicare has done better or worse than the private sector since neither
represents an acceptable path going forward. Understanding the effects of
innovative payment strategies – including those that affect the patient –
will be an important part in learning how to "bend the curve". Making sure
that there are strategies to implement the results of successful pilots and
demonstrations will also be important.