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.