In this paper we review data on health care spending growth and the reasons for the persistent high rates of growth. We discuss the cost containment provisions that are incorporated into the Affordable Care Act.A number of options that are not included in the ACA are then analyzed.We use a consistent analytic framework for making estimates relying on an extensive body of research evidence.We make estimates of the savings from eliminating tax exclusion, malpractice reform, chronic care management, prevention and various approaches to setting rates for providers.We conclude that no one option could provide substantial savings by themselves and that a combination of several policies is necessary to reduce the rate of growth.