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As Congress wrestles with how to make substantial cuts to Medicare over the next decade while improving its quality of care, this should be sobering. It's an article from Kaiser Health about why Medicare reforms are so hard to implement. But compare and contrast to this, another KH article about how some innovative corporate wellness reforms are improving employee health and holding down health care costs. I see a lesson here. Teaching moment!

The first piece catalogs the myriad sidelined attempts to reform Medicare through innovative experiments. Health care experts agree that significant reductions in health care spending won't occur unless we change the way we pay for and deliver heath care, but changing even the smallest Medicare rules requires dealing with an unruly swarm of hospitals, doctors and other providers. Dig up the past on Medicare experiments, and all you get is dirty.

But we are making headway in the battle to control costs at a smaller, company-by-company level. As the interview with Johnson & Johnson's Dr. Fikry Isaac demonstrates, there are some simple commonsense approaches to "corporate wellness" (Ed: an awkward, inorganic term) that really can hold down costs and improve health. These programs might include full health risk assessments and gym membership credits. Isaac suggests the government offer tax credits to companies that offer similar programs.

The government will try to tinker with health care incentives in an attempt to hold down costs and improve care. But as a nation dependent on employer-provided care, the most important decisions about our health aren't made at the federal level. They're made at the employer level, and the employee level. The government should do its best to squeeze the health cost curve , but as long as we're living in an employer-provided health care world, it's going to take millions of smaller hands to bend the curve down.