The rate of health cost growth in the United States has been reduced almost by half in just four years. The cost curve has been bent by the absolute burden which health costs represent for American families and businesses. The real problem is that we simply cannot afford the health system we have. The affordability problem doesn’t disappear under health reform- it just gets shifted to a government with a well-known incapacity to say “no” to anyone. The flurry of cost containment “science projects” contemplated by health reform legislation provides little reassurance that future federal outlays will be reduced, given the sorry track record of past demonstration projects. Whether federal health spending is brought under control will depend ultimately on whether Congress will permit the incomes of any actor in the health system to actually decline.