R unaway health care costs are breaking the back of workers, hurting U.S. companies’ global competitiveness, and squeezing out government spending for other public needs. As the nation’s largest health care program, Medicare both reflects and contributes to the problem of rising health care costs. In the face of a fiscal tsunami from the retirement of Baby Boomers, Medicare can no longer afford to sit passively on the sidelines, paying medical bills without question.