It lies in health IT, in cutting paperwork costs and learning what the most cost-effective solutions may be, in all types of cases for all types of ailments. Paying from shared pools of money (public or private) based only on best practices can cut costs.
But it also requires changing habits. And the real health reformer in this Administration is Michelle Obama (right).
The First Lady has focused her efforts on changing America's relationship with food. Right now it's dysfunctional. People treat sugar and salt like drugs, from an early age. Changing that will do more than any "reform" effort to control costs.
The problem is urgent. The Surgeon General, who herself has come under criticism for her weight, released a report in January showing one-third of our kids are now, technically, obese. That puts them in line for heart problems, stroke, and diabetes at younger ages than we can imagine, or afford.
The problem is getting worse. A study from Kaiser Permanente shows 6% of grade school children are now extremely obese. The study used electronic medical records (EMRs) on over 700,000 kids collected by Kaiser Permanente. This is the kind of mass population study health IT can perform.
One of the most important points to make about all this is that it's not controversial. Yet. When the First Lady spoke to the Grocery Manufacturers Association this week she got a standing ovation. (The picture is from the GMA Web site.) The NFL launched its Play60 campaign, advocating more physical activity for kids, on the White House lawn.
Thousands of communities, including Kirkwood where I live, are now building little community gardens. They won't make much food, but they will bring in kids and parents to see where real food comes from.
Industry is working hard to reduce the calories in what it produces and make what it sells healthier. Government and community groups are working on the problem as well.
But it's really bigger than all that. Healthy eating means, as Michael Pollan of UC-Berkeley writes, doing some hard things. "Eat food, not too much, mostly plants."
It sounds simple. But it's not. Pollan recommends you do things like avoid the center of the supermarket, avoid food that won't rot, eat at a table with family rather than in the car, and leave the table a little hungry.
French people have avoided obesity not because fois gras is healthy. Government policy for a century has pushed mothers to limit how much their kids eat, to develop a habit of calorie restriction early, and to only indulge in what's worth eating.
This, of course, is where it will get controversial. It's one thing to cajole, another thing to dictate. But continuing to pursue a lifestyle of empty calories, and a "freedom to be fat," is going to leave you prematurely dead, at a cost that will bankrupt any system of health care that might be devised.
That's a hard truth for the start of spring, but truth is what it is.