A group of 23 high-profile health policy experts on Wednesday (Aug. 1) floated far-reaching proposals to cut back health care spending that include moving to a system that would allow states to promote payment rates within a global spending target, requiring exchanges to be active purchasers and to offer at least one “tiered” product, using competitive bidding for all commodities in the federal health system and the insurance exchange, expanding the ban of self-referrals to cover private insurers, requiring full price transparency and encouraging less restrictive state scope of practice laws.