This chapter clarifies the difference between changes in levels of cost versus growth of cost and focuses on the latter. This is because increases in spending may be good if we are getting something for that growth; it all depends whether it is going toward “waste” or if we are obtaining value for that spending in the form of health outcomes – a return on investment. Four targets of cost containment are outlined: administrative costs, competition, state-based spending targets, and value-based payment. It is acknowledged that administrative costs are high in the US in part because consumers have choice over plans, benefits, providers, and networks (as opposed to once centralized system); with this choice comes coordination, information, and standardization costs. Excessive market power due to consolidation may also lead to the extraction of high prices from consumers beyond what would be possible with improved market-level competition. The chapter concludes by addressing the recent flattening in medical spending growth and what might happen in the future.