More gloom and doom on the health care economics and fiscal sustainability front. Or, choosing a more cheerful perspective, more great incentives for fixing our health care system.

The GAO in a recent report to the Senate Finance Committee added its voice to the Washington choir (in which CBO chief Peter Orszag and Fed chairman Ben Bernanke are the star soloists) warning that we are on an unsustainable fiscal path, and "over the long term, health care spending is the principal driver." That "we" is a big "we"—federal, state, and local governments, as well as the private sector. Like other top government agencies and experts, the GAO has recognized that the challenge is not merely demographics. Yes, with the Boomers retiring, we will have more older people, and older people develop health problems. But it's how they use costly (and sometimes unnecessary) health services, what the GAO calls "increased costs per beneficiary" not just sheer numbers of people that counts.

Growth in health-related spending is the primary driver of the fiscal challenges facing state and local governments as well. Unsustainable growth in health care spending also threatens to erode the ability of employers to provide coverage to their workers and undercuts their ability to compete in a global marketplace. Public and private health care spending continues to rise because of several key factors: (1) increased utilization of new and existing medical technology; (2) lack of reliable comparative information on medical outcomes, quality of care, and cost; and (3) increased prevalence of risk factors such as obesity that can lead to expensive chronic conditions. Addressing health care costs and demographics—and their interaction—will be a major societal challenge.

Rethinking patterns of utilization. Developing comparative effectiveness. Promoting wellness, controlling obesity and managing related diseases. Sounds like an agenda. And from all accounts, Senate Finance is listening.