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The Supreme Court may have backed President Obama on some key health care reforms, but the work to fix America's ailing $2.6 trillion healthcare spending system is far from over. MIT Professor Jon Gruber: SOUNDBITE: JON GRUBER, PROFESSOR OF ECONOMICS, MASSACHUSETTS INSTITUTE OF TECHNOLOGY (ENGLISH) SAYING: "Now, in terms of cost control, other countries do better. For example, the Netherlands and Sweden have a system very similar to what we have done here in Massachusetts but they cost about two-thirds as much. So those are models which we can look to when we move to the next step, which is cost control." Cost control looks different from Mount Sinai's point of view. The New York City Hospital says it spends a hefty part of its operating budget on caring for those who don't pay medical bills. Fixing that would bring costs down, says hospital President and Chief Operation Officer Wayne Keathley. SOUNDBITE: WAYNE KEATHLEY, PRESIDENT AND CHIEF OPERATING OFFICER, THE MOUNT SINAI HOSPITAL (ENGLISH) SAYING: "So universal coverage, providing coverage to everyone, giving them access to primary care and encouraging them to gain access to it, having it align with social policy around the things that make the most sense for prevention, that will reduce cost over time because those patients won't wind up in the emergency room. They won't wind up having the tertiary and quaternary services required because they would be better cared for earlier in the process. That's both good medicine and good business." But good business for who? Some citizens don't want to be forced to pay for health care and the market place needs enough healthy customers to cover the sick ones. Competition may solve both problems. SOUNDBITE: WAYNE KEATHLEY, PRESIDENT AND CHIEF OPERATING OFFICER, THE MOUNT SINAI HOSPITAL (ENGLISH) SAYING: "I think that if we made insurance products truly competitive, so that companies nationally that have figured out ways to provide better service that really maximized the dollar value of what's provided in care to patients instead of administrative costs - if they are allowed to compete, you know I believe that form of competition in this segment of the industry is really healthy." But that, experts admit, won't happen without a nudge from the government. SOUNDBITE: JON GRUBER, PROFESSOR OF ECONOMICS, MASSACHUSETTS INSTITUTE OF TECHNOLOGY (ENGLISH) SAYING: "The best market-based solution is to recognize that this is a market that doesn't function well on its own. It's subject to, what economist call, market failures. We have imperfect information. We have imperfect competition. So they are built by the private system, but they are supported by government, which addresses those market failures and allows the system to succeed." And a this point success is still far off. The U.S. is top in health spending around the world, but nowhere near the top when it comes to results. Conway Gittens, Reuters