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Continuing to slow health cost growth is essential; but Medicare and Medicaid are not in crisis. Recent per beneficiary cost growth has slowed so significantly that CBO has dramatically reduced its spending projections for the coming decade. In Medicare, refinement of existing payment mechanisms alongside payment reform can produce additional savings. But as the elderly population doubles over the coming decades, a balanced deficit-reduction package must include new revenues The alternative, changing entitlement structures through vouchers or block grants (or adopting an overly ambitious savings target that could produce the same results), would undermine essential protections and shift or even increase health care costs.