As health care costs soar unsustainably, many employers, state Medicaid programs and the Bush administration want to force patients to pay more. That's a cost-control strategy that cannot work, and it is adding to the tens of millions of underinsured Americans going without needed care. Health spending in the United States is already enough to cover all Americans---if we better use the vast sums now wasted on ineffective care and paperwork. Prompt action on health costs is vital to prevent a medical meltdown when our fragile economy stumbles. Projected health spending of $1.9 trillion will consume 15.5 percent of gross domestic product this year---nearly double spending on education, and about 3.6 times defense spending. Yet those nations have universal coverage, older populations, superior health outcomes and greater patient satisfaction with care. We can convert our high spending from a burden to an opportunity---because about half of current spending goes to unnecessary services, needless bureaucracy, excessively high prices and other wasteful expenditures. We must contain costs in ways that squeeze out waste, mobilize the savings to finance high-quality care for us all and pay hospitals, doctors and other needed caregivers adequately. Many employers' current cost-control strategy consists of requiring higher patient payments---with the goal of spurring patients to use less care and think twice before seeking it. Forcing patients to pay more cannot durably contain medical costs---especially because the majority ofhighest costs are incurred by physicians' complex decisions in treating a relatively small number of seriously ill people. Using a single-payer plan also would facilitate negotiating lower prices with monopoly drug makers, replacing cost-shifts with genuine cost controls and achieving greater equity for patients and for caregivers. If most doctors concluded that certain reforms could contain cost while protecting access and quality, the general public's hesitations would likely dissipate rapidly.