Now that the Supreme Court has upheld the constitutionality of the individual mandate , it 's time to focus on what has always been a key goal of health reform : Controlling health care costs . No matter how you count it , health care spending is large -- and growing at a worrisome rate . In 2011 , Americans spent $ 2.7 trillion on health care , almost 18 % of our GDP . The federal government spends more on health care than on defense , Social Security or any other single expenditure category . Investments that could have gone into important areas like education or infrastructure are instead diverted into footing our health care bills . The individual mandate by itself will have little effect on costs . This is because the main effect of the mandate is to add a relatively small number of people , about 15 million , to the insurance rolls . The vast majority of Americans , more than 250 million , already get their health insurance on the job or from public programs such as Medicare and Medicaid . The mandate alone was never going to change their health spending patterns . However , this does not mean that the court 's decision will have no effect on health spending . The Affordable Care Act contains many provisions intended to drive the health care system toward providing greater value . It would not be an overstatement to say that , with the exception of eliminating the tax break for employer-sponsored health insurance , the health reform law contains almost every idea that anyone , Democrat or Republican , has had in the past 10 years , about how to increase quality and efficiency in the health care system . These ideas include accountable care organizations , patient-centered medical homes , value-based purchasing in Medicare , incentives for hospitals to provider better , safer and more efficient care , an excise tax on `` Cadillac '' health plans , and better information about treatment effectiveness to help patients and providers make informed decisions . The value-based purchasing program , for example , will change the way Medicare pays hospitals for inpatient care . Instead of paying hospitals for the amount of care they provide , Medicare payments will now also depend on the quality of care provided . The idea is that by following best practices , hospitals will forgo unnecessary care , help patients recover faster and spend less . Some of these reforms targeting the health care delivery system are novel , and experts are rightly cautious in their predictions about what they can accomplish and whether they will `` bend the curve '' of health care spending until it is sustainable . There are other ideas out there on how we can reduce the federal government 's obligations -- notably the plan advanced by Rep. Paul Ryan , R-Wisconsin , which takes the brute force approach of simply shifting costs from the government to states and individuals . The Affordable Care Act is the better choice . Instead of papering over our problems by shifting ever-increasing costs to those least able to afford care or depriving people of the services they need , the health reform law applies the most creative thinking to address the roots of our spending problems . Today , the court gave us the green light to get on with seeking solutions to the underlying problem of inefficient spending . It permitted the government to do what it should , to innovate in the face of a seemingly intractable social problem . Not everyone is happy with the decision . But no one can deny that it opens a new chapter in our history as we move forward on a bold and necessary policy experiment .
The Supreme Court has upheld the constitutionality of the individual mandate . Jill Horwitz and Helen Levy : Now it 's time to focus on key goal of reducing health care costs . Affordable Care Act contains provisions that can improve health care system , they say . And , others : Court 's decision opens a new chapter in our history as we try out new policy .