The belief that cost should be no object in health care has limited efforts to control medical spending; elected officials generally insist that cutting services that yield no value will be sufficient. But eliminating such waste would merely postpone the reckoning.

Primary care physicians, long in the doldrums over their incomes and challenging work–life balance, may be heartened by recent steps taken by policymakers and payers signaling the increased recognition of the foundational role they could play in a ...

Since the spending targets in Medicare's new accountable care organization (ACO) programs are being set on the basis of national, rather than local, rates of spending growth, ACOs could gain or lose financially without altering their delivery of care.

Having expanded insurance coverage to 98% of its population, Massachusetts seeks to control health care costs. A new bill includes global payment arrangements, accountable care organizations, malpractice reform, and authority to strike down insurance-premium increases.

In October, U.S. acute care hospitals will begin to be “paid for performance” under the Medicare Hospital Value-Based Purchasing program. But accumulating evidence raises doubts about whether the program will in fact improve value. What can be done to redirect the policy?

Under the Affordable Care Act, hospitals with “worse than expected” 30-day readmission rates will be penalized by Medicare. But though a focus on readmissions may have good face validity, the policy attention to 30-day readmissions may be misguided.

The Affordable Care Act's financial penalty for “excessive” readmissions may be too weak to overcome the substantial counterincentives currently at work. But a “warranty” payment would provide a stronger business case for hospitals to get with the program.

Policymakers may be overlooking the lessons of Medicare Advantage. Though current policy guarantees greater government spending on private Medicare Advantage plans than on traditional Medicare, the plans are developing low-cost ways of delivering attractive benefits.

One proposed solution to the problem of high and rising Medicare costs is to expand the use of private plans and market competition. What lessons for current Medicare policy can be gleaned from the history of Medicare Advantage plans?

There are indications that the unsustainably rapid growth in Medicare spending has recently slowed — and that this slowdown is not a fluke, but rather the result of tighter Medicare payment policies whose effects will only be bolstered by the Affordable Care Act.

A key question about aggregating payments to health care providers is determining whether to bundle services for individual, if extended, episodes of care or for whole patients. What are the tradeoffs of the two approaches, and how much money could be saved?

As the United States struggles to emerge from an economic crisis, policymakers and the public have homed in on skyrocketing health care expenditures. What lessons can be drawn from the evolution, since 1950, in sources of payment and objects of expenditures in health care?

The idea of a premium-support system for Medicare dates from 1995, but current proposals do not contain appropriate safeguards, and the circumstances of the U.S. health care system have changed in ways that would make the approach unwise today.

Under the Wyden–Ryan proposal, instead of guaranteeing to pay for services as they are rendered, Medicare would give beneficiaries a subsidy to purchase coverage from one of multiple health plans, which would compete by providing necessary services cost-effectively.

New ethics guidelines from the American College of Physicians calling for physicians to practice “parsimonious care” have reignited a debate about the role and responsibility of physicians in addressing problems with health care costs.

Government austerity is likely to hit public health programs hard, as these programs compete for funds against the health care delivery juggernaut. But such an approach seems likely to hamper efforts to improve population health and reduce medical spending.

Global payment could change the perverse incentives inherent in the fee-for-service system. But accountable care organizations that track their member physicians' earnings according to standard fees for service will undermine the purpose of the approach.