In his first month in office, President Barack Obama signed the reauthorization of the Children's Health Insurance Program, indicating the central role health care will play in his agenda. Enacting comprehensive reform for all, however, will require a plan that combines expanding coverage, improving care, and slowing spending growth. In a Perspectives article in the New England Journal of Medicine, Commonwealth Fund President Karen Davis outlines policy recommendations for achieving those goals, drawing from a new report released by the Commonwealth Fund Commission on a High Performance Health System. A key proposal is the creation of a national health insurance exchange that features a choice of private plans and a new public plan, which would be open to businesses and individuals. It is expected that this new public plan will encourage more competition in the insurance market—leading private plans to add value in health care delivery and become more administratively efficient. Other components include investing in health information technology and evidence-based care; increasing payment for primary care services, encouraging adoption of the medical home model, and implementing "bundled" hospital case rates including 30-day care following discharge; eliminating excess payments to Medicare Advantage plans; negotiating pharmaceutical prices; and employing strategies to improve public health. According to the Commission report, The Path to a High Performance U.S. Health System, such comprehensive reform would lead to near-universal coverage, with only 4 million of the U.S. population remaining uninsured in 2020, compared with a projected increase to 61 million under current policies. National health spending through 2020 would slow, too, resulting in cumulative savings of $3 trillion over 11 years. Two-thirds of the federal budget cost could be offset by payment and system reforms. "It is time to change 'business as usual," Davis concludes, "and to invest in the health care reforms that will benefit the public and patients and put our nation on a sounder economic footing."