In late June, the U.S. Supreme Court is expected to rule on the constitutionality of a health care law that would require all Americans to buy health insurance, and for most companies to provide it to their employees. Americans have been debating the health insurance issue for years, and in the meantime, the costs of medical treatment, as well as the cost of health insurance premiums, have been rising steadily. At least one expert says part of the debate should be how to reduce costs without reducing the quality of care.

Americans expressed their views on health care in late March as the Supreme Court heard arguments on a law many call "Obamacare." Health care is so expensive that without insurance, many people could not afford it. But health insurance is also expensive. Close to 50 million Americans do not have insurance for health care.

Dr. Donald Berwick is an expert on health care issues who recently retired as the head of US government health programs for the elderly and the poor (Medicare and Medicaid). He's currently a senior fellow at the Center for American Progress, a policy research organization.

"I know that the best way to reduce costs is to improve quality, not to cut back on care," he said.

Dr. Berwick co-authored an article on that topic in the Journal of the American Medical Association. He says following proper procedures can reduce expensive mistakes, mistakes resulting from post-operative complications or dangerous reactions when a patient is given the wrong medicine. Costs mount, too, when health care is not coordinated, for instance, when a patient sees both a primary care doctor and a specialist and neither knows what medicines or tests the other is prescribing.

Dr. Berwick says unnecessary treatment also drives up costs. “For example, getting antibiotics for a viral infection. That doesn’t do any good at all, and yet we do it. We do it all the time," he said.

And then there's the bane of every doctor or nurse's job - filling out forms. “Lots of different players in health care add costs by requiring you to jump through hoops if you are a doctor or nurse filling out forms and things like that that don’t add any value," said Dr. Berwick.

Dr. Berwick also points to the high cost of diagnostic procedures. In the United States, MRIs and CT scans cost many times what they cost in other countries.

Researchers says the U.S. spends 17 per cent of its gross domestic product on health care. That number is expected to reach 20 per cent in the next 8 years. “If we don’t work on waste and improvement of care as the fundamental agenda for reduction of cost we’re headed over a cliff, bad things are going to happen," he said.

However, Dr. Berwick says if costs can be contained, money will available for procedures and medicines that work.