This commentary identifies methods to slow the increase in health care costs in the United States. The current proposed expansion of health insurance will cost the country an estimated trillion dollars over 10 years. To make this expansion possible, increases in the cost of health care must be curbed.

The author suggests several methods to slow health care cost growth, primarily by addressing the underlying determinants of health care costs. These methods include:

• investing in disease prevention initiatives that reduce the future burden of disease by increasing physical activity, improving nutrition and lowering tobacco use;
• creating reimbursement systems based on performance;
• developing accountable care organizations that will serve as medical homes for patients and that will implement improvements in cost and quality;
• reducing Medicare fraud and waste; and
• providing patients and employers with incentives to select the most cost-effective, highest-performing physicians and health plans.

Without reform, the heath care system will continue on a path of uncontrollable escalating costs, making it impossible to expand and sustain health insurance coverage in the long run.