The new healthcare law holds out hope of meaningful reductions in costs, but everything depends on the zeal with which the opportunities are pursued. I'll be surprised if, in the end, the good ideas are not overwhelmed by continuing pressures in the other direction. So the question of how to pay for universal coverage--not to mention the government's other fiscal commitments--will remain. In this new column for National Journal I argue that policy will need to change in at least one of two fundamental ways: employers must be taken out of the healthcare business, and the US will need a big, new, broadly based tax.