When we say that comprehensive health reform must slow the rate of health care cost growth, we mean it. We strongly believe we can save a lot—without stinting on care or harming quality—by reforming the delivery system and changing the payment incentives to reward quality care and wring out useless but costly care. But we—like the New York Times editorial page—believe we need a fail-safe mechanism in place to make absolutely sure we achieve savings.

To guarantee savings over time, Health CEOs for Health Reform propose that providers meet cost and quality standards at a specified date—or face lower paychecks. 

This concept was echoed by the former Senate majority leaders Baker, Daschle and Dole, Wal-Mart in conjunction with SEIU and the Center for American Progress, and now by the New York Times editorial page. As the Times put it:.

"Meanwhile, it will be important to get some guaranteed fast savings from the health care industries by cutting and reallocating hundreds of billions of dollars from projected spending on Medicare and Medicaid...Just to be sure, Congress ought to establish a fail-safe mechanism that could impose additional cuts after a few years if savings are less than projected."

In the near-term, this type of accountability will ensure that health reform legislation is fiscally responsible and fully financed. In the long-term, it will make certain that our health system, especially Medicare, is sustainable for generations to come.

Guaranteeing that health reform will slow the rate of health care cost growth should encourage bipartisan support by assuaging fears that somehow lawmakers are going to write a "blank check" and add to the deficit, while also appealing to deficit hawks who recognize that health care cost growth is the biggest threat to our nation's long-term fiscal balance. 

Many analysts and leaders, including Health CEOs for Health Reform, believe that this type of "fail-safe" will not be necessary if we revamp our health system's incentives to reward value over volume. Nevertheless, we cannot commit to covering all Americans (as we must) without also assuring that the cost of health care will be affordable, for families and our nation as a whole. President Obama has made clear, as a candidate and as president, that affordability is crucial.

Finally, the real virtue of using Medicare payment reform to help finance health reform is its ability to put us on the pathway to making Medicare—our number one long-term fiscal problem—sustainable (again, as we must). In the end, some hard choices are really not choices at all. We just have to be adult enough to recognize it. Sooner rather than later.