Health care costs continue to increase in some part, perhaps a large one, due to new medical technology. Control of health care costs risks impairment of new technology development, an undesirable outcome. Our present health care system results in substantial community variation in utilization of technologies, often overuse, because we lack an established sound decision-making process. This paper seeks to review our present use of health care technology, to indicate changes that may result from health care reform proposals, and to suggest that a market based system of managed competition can successfully control costs and preserve medical innovation.