Towards Value-Based Health

The United States healthcare system is in a state of crisis. Despite spending nearly 18% of its GDP on healthcare - far more than any other developed nation, with spending growing from $1.4 trillion in 2000 to $4.5 trillion in 2023 - the U.S. consistently ranks near the bottom among OECD countries on key health outcomes like life expectancy, infant mortality, and preventable deaths. This poor return on investment points to fundamental market failures and misaligned incentives that drive up costs, reduce access, and deliver suboptimal care.

At the heart of the dysfunction is a severe disaggregation between price and value. In a well-functioning market, price serves as a signal of quality and efficiency. But in American healthcare, prices are often opaque, arbitrary, and disconnected from outcomes. Patients, insulated by third-party payers, lack the information and incentives to shop for value. Providers, paid for volume rather than results, have little reason to prioritize efficiency or prevention. And special interest groups, wielding outsized political influence, block reforms that threaten their bottom lines.

The result is a system that all too often puts profits over patients, rewarding wasteful overutilization and fragmented, uncoordinated care. Yet for all its flaws, American healthcare has also been an engine of breakthrough innovation, producing many of the life-saving drugs, devices, and procedures that the world relies on. The challenge for reformers is to realign incentives and address market failures without jeopardizing this vital progress.

This essay will examine the root causes of America's healthcare dysfunction, focusing on specific market failures like lack of price transparency, information asymmetries, and misaligned payment models. It will then outline a range of potential solutions, from value-based care initiatives to antitrust enforcement to investments in social determinants of health. Ultimately, the goal is to chart a path towards a healthcare system that delivers better outcomes at more sustainable cost - while still fostering the innovation that saves lives around the world.

I. The Dysfunction of the Current System

A. Lack of Price Transparency

One of the most glaring market failures in American healthcare is the opacity of pricing. In a typical consumer market, prices are clearly posted, allowing buyers to compare options and make informed decisions. But in healthcare, list prices are often meaningless, and the true cost to patients is buried in a morass of complex billing codes, backroom negotiations between providers and insurers, and after-the-fact "explanation of benefits" statements.

The pharmaceutical supply chain, for example, is particularly opaque, with a tangled web of list prices, rebates, and discounts that obscure the true costs. Pharmacy benefit managers (PBMs), which negotiate drug prices on behalf of insurers, have been accused of driving up costs through spread pricing, kickbacks, and other deceptive practices. This "gross-to-net bubble" means that the list prices for drugs often bear little resemblance to the actual prices paid, distorting incentives throughout the system.

This lack of transparency makes it virtually impossible for patients to shop for value, driving up costs. A 2021 RAND Corporation study found that private insurers pay hospitals on average 247% of what Medicare would pay for the same services, with prices varying widely between facilities. In one egregious example, prices for a basic MRI scan ranged from $474 to $13,259 within a single metro area.

Opaque pricing also facilitates anticompetitive practices and price discrimination. Providers can use gag clauses and other contract terms to prevent disclosure of negotiated rates, making it harder for employers and patients to compare options. And hospitals can charge vastly different prices to different payers for the same service, with little relation to underlying costs. This dynamic contributes to the growing affordability crisis, with more Americans delaying or forgoing needed care due to cost.

B. Disconnect Between Price and Value

Even when prices are known, they frequently fail to reflect quality or efficiency. The predominant fee-for-service payment model, which reimburses providers for each individual service or procedure, rewards volume over value. Providers have a financial incentive to order more tests, perform more surgeries, and schedule more visits, regardless of whether they improve patient outcomes.

This volume-driven approach leads to substantial waste and overutilization. A 2019 study in JAMA estimated that 25% of total U.S. healthcare spending (~$1 trillion) is for unnecessary services, inefficiently delivered care, excess administrative costs, and inflated prices. Another study found that U.S. patients receive recommended preventive care only 55% of the time, and recommended chronic disease care only 56% of the time. Medical errors are also disturbingly common, with recent studies suggesting that 7,000-9,000 patients die each year in the U.S. from wrong-site surgery alone.

Misaligned payment incentives also contribute to fragmentation and lack of coordination. Under fee-for-service, providers have little reason to work together to manage a patient's whole health, as they are not rewarded for preventing complications or reducing total cost of care. This siloed approach is especially problematic for patients with chronic conditions, who often require integrated care across multiple specialties and settings.

Other countries have moved more aggressively to value-based payment models that reward quality and efficiency. In the Netherlands, for example, bundled payments for chronic conditions like diabetes and COPD have been shown to improve coordination and reduce complications. And in Germany, sickness funds negotiate integrated care contracts with provider networks to manage the full continuum of care for specific patient populations.

C. Influence of Special Interest Groups

The persistence of these market failures is due in no small part to the outsized influence of special interest groups. The healthcare industry is one of the largest and most powerful lobbies in the United States, spending billions each year to shape policy in its favor. Pharmaceutical companies, medical device manufacturers, hospitals, and insurers all have a vested interest in maintaining the status quo and blocking reforms that could threaten their revenues.

This dynamic plays out in ways big and small. In 2003, the Medicare Modernization Act prohibited the federal government from negotiating drug prices, a giveaway to the pharmaceutical industry that costs taxpayers billions each year. More recently, surprise billing legislation was watered down under pressure from provider groups, leaving patients vulnerable to unexpected out-of-network charges. And entrenched interests have repeatedly blocked efforts to allow Medicare buy-in, public option plans, taking away the non-profit status of hospital conglomerates, or breaking up the pharmacy benefit manager monopoly, for example.

The revolving door between industry and government also tilts the playing field. Many key policymakers and regulators cycle in from industry jobs and then back out again, creating cozy relationships and potential conflicts of interest. This regulatory capture makes it difficult to enact and enforce rules that prioritize the public interest over private profits.

D. Information Asymmetries

Compounding these issues are stark information asymmetries between providers and patients. The specialized knowledge required to diagnose and treat illness, combined with the inherent uncertainty and stakes involved, make healthcare decisions uniquely dependent on trust and deference to expertise. Patients rely on providers not just to perform procedures, but to recommend which procedures are necessary in the first place.

This imbalance of information can lead to supplier-induced demand, where providers recommend services that may not be strictly medically necessary. The fee-for-service system exacerbates this risk by tying provider income directly to utilization. And consolidation in the provider market gives hospitals and physician groups greater leverage to drive utilization and raise prices.

Patients, meanwhile, often lack the tools and incentives to critically evaluate provider recommendations or shop for value. Most are insulated from the full cost of care by third-party insurance, and face little exposure to price variation at the point of service. Quality and outcomes data is often scarce or not easily interpretable by lay audiences. And behavioral biases, like the tendency to overvalue short-term benefits and undervalue long-term harms, can lead patients to over-consume low-value care.

While some tools like hospital quality ratings and physician-finder sites have emerged in recent years, they remain limited in scope and uptake. And initiatives to give patients more "skin in the game" through high deductible health plans have had mixed results, with some evidence of reduced utilization but also increased financial strain and delayed necessary care.

E. Lack of Competition

These information asymmetries are further exacerbated by lack of competition in many healthcare markets. Over the past few decades, the U.S. has seen significant consolidation among providers and insurers, leading to higher prices and lower quality. Mergers and acquisitions have left 90% of metropolitan areas with highly concentrated hospital markets, and 57% with highly concentrated specialist physician markets. On the insurer side, the top 4 companies now control over 80% of the commercial market in 37 states.

This market power allows dominant players to drive up prices and limit consumer choice. Large hospital systems use their clout to negotiate higher rates from insurers, who then pass costs on to employers and individuals through higher premiums. They also use anticompetitive contract terms like all-or-nothing clauses (forcing insurers to include all of a system's hospitals in their networks) and most-favored-nation clauses (guaranteeing a dominant system the highest prices in the market).

Insurers, for their part, have little incentive to drive hard bargains with providers when they can simply pass higher costs onto captive customers. And the growing trend of vertical integration, with insurers acquiring provider practices and vice versa, risks further entrenching pricing power and reducing competitive pressure.

Other countries have taken a more active approach to promoting competition and constraining prices. Japan and Germany, for example, have all-payer rate setting systems that establish uniform fee schedules across insurers. And the Netherlands requires insurers to contract with any willing provider meeting quality standards, preventing exclusive dealing arrangements that limit patient choice.

F. Unpriced Externalities

Adding to the market distortions are significant externalities that go unpriced in the current system. Foremost among these are the social determinants of health - factors like income, education, housing, and environment that drive the majority of health outcomes. Experts estimate that medical care accounts for only 10-20% of modifiable health outcomes, with social, behavioral, and environmental factors making up the rest.

Yet the vast majority of U.S. health spending goes to downstream medical interventions rather than upstream prevention and population health. This skewed allocation reflects the lack of incentives for insurers and providers to invest in long-term health, as they bear little financial responsibility for outcomes beyond short-term episodes of care. It also reflects budget siloing between health and social service programs, which makes integrated investments challenging.?

Failure to account for these social determinants leads to unpriced costs that ripple through the healthcare system. Poverty and lack of education drive higher rates of smoking, poor nutrition, and sedentary behavior, which in turn lead to chronic diseases that are expensive to treat. Lack of stable housing disrupts care continuity and leads to overuse of emergency services. And childhood traumas and toxic stress cast long shadows of poorer mental and physical health across the lifespan.

Other countries are ahead of the U.S. in developing "health-in-all-policies" approaches that integrate healthcare with housing, transportation, education, and other social services. In the UK, "social prescribing" programs connect patients with community resources like exercise classes, financial counseling, and volunteer opportunities alongside traditional medical care. And in Finland, the government has committed to considering health impacts in all policy decisions, from urban planning to tax policy.

G. Healthcare as a Public Good vs. Private Enterprise

Underlying many of these market failures is a fundamental tension between the conception of healthcare as a public good versus a private enterprise. Economic theory suggests that goods and services with certain properties - non-excludability (people can access them even without paying) and non-rivalry (one person's use doesn't diminish availability for others) - are prone to market failure and require public provision. Classic examples include national defense, infrastructure, and education.

Healthcare has elements of both public and private goods. Emergency services and vaccinations, for example, are non-excludable (ERs are legally required to stabilize patients regardless of ability to pay) and non-rivalrous (your treatment doesn't prevent me from getting treated). This creates "free-rider" problems where people know they can access care without contributing to the cost.

At the same time, much of healthcare is rival (a doctor's time with you is time not available to me) and, in the U.S. excludable (care can be withheld from those who can't pay). Treating it as a pure market commodity, however, fails to account for the significant positive externalities (a healthier, more productive population) and the fundamental importance of health to individual and societal wellbeing.

Most other developed countries resolve this tension by treating healthcare as a public good first and a private enterprise second. They guarantee universal coverage through robust public programs or tightly-regulated nonprofit insurers, and constrain medical prices either through fee schedules or global budgets. Innovation and private initiative are encouraged, but subordinate to ensuring equitable access.

The U.S. has historically tilted more towards healthcare as a private enterprise, with government as a payer of last resort. But it has never fully committed to a market approach, with a patchwork of public programs, tax subsidies, and regulations creating a maze of perverse incentives. The result is a system that captures many of the costs of treating healthcare as a public good, without fully realizing the benefits of either a well-functioning market or an equitable social contract.

II. Root Causes and Contributing Factors

While the previous section detailed the specific market failures plaguing the U.S. healthcare system, it's important to also examine some of the deeper structural and historical factors that have shaped its dysfunction:

• Resistance to government involvement: The American medical profession has a long history of opposing "socialized medicine" and government efforts to regulate the healthcare industry or expand public coverage. This resistance, combined with a cultural skepticism of government in many parts of the country, has made it politically difficult to achieve systemic reform.?
• Piecemeal policymaking: Rather than a coordinated national strategy, U.S. health policy has often been shaped by a series of ad hoc, incremental decisions and compromises. This has led to a fragmented system with perverse incentives, conflicting mandates, and lots of gaps and inefficiencies.
• Misaligned incentives: From medical school admissions to end-of-life care, payment structures and institutional priorities often work against the goals of efficiency, quality, and equity. Providers are rewarded for volume over value, specialists over primary care. Insurers are more focused on risk selection than population health.
• Lack of cost-consciousness: Extensive third-party payment, combined with a cultural belief that more care is better care, has made American patients and providers relatively insensitive to costs. High-deductible health plans have had limited impact in the face of systemic failures of price and quality transparency.
• Interest group politics: Powerful lobbies representing the medical profession, hospitals, insurers, drug companies, and device manufacturers have consistently blocked or watered down reform efforts that might threaten their revenues and autonomy. The result is a policy landscape skewed towards special interests over the public interest.

These factors, among others, help explain why the U.S. has struggled to address its market failures and achieve a more efficient, equitable healthcare system. While daunting, they are not immutable. With political will and popular demand, aligned incentives and increased accountability, strategic regulation and market-shaping policies, the U.S. can make progress towards the kind of healthcare system its people need and deserve.

III. Potential Solutions and Pathways for Reform?

Having diagnosed the key failures and root causes plaguing American healthcare, what can be done to put the system on a sounder footing? There is no one silver bullet, but rather a range of reforms that could help realign incentives, empower consumers, and improve value. Some of the most promising ideas include:

A. Price Transparency Initiatives and Mandates

Shining a light on the true costs of care is an essential first step towards a more functional market. This could take several forms:

1. Requiring providers to give binding upfront cost estimates to patients, with real penalties for exceeding them. This would allow true "comparison shopping" and make it easier to identify and avoid price gouging. While previous transparency rules have been poorly enforced, the new hospital price transparency law that took effect in 2021 has sharper teeth, with a recent analysis finding that compliance is improving.?
2. Standardizing billing practices and fee schedules across payers, so that prices are more consistent and predictable. Maryland's all-payer rate setting system, in place since the 1970s, has successfully constrained hospital cost growth and reduced price variation. More recently, Minnesota has implemented a similar model through its Integrated Health Partnership demonstration.
3. Investing in all-payer claims databases and consumer-facing price transparency tools, so that patients can easily compare costs and shop around. While early efforts like New Hampshire's HealthCost website have struggled with incomplete data and low uptake, more robust and user-friendly versions like Colorado's Center for Improving Value in Health Care show promise. Startup companies like Amino and Mango Health are also innovating with personalized out-of-pocket cost estimates for various services and procedures.

B. Realigning Incentives through New Payment Models

Shifting away from fee-for-service and towards value-based payment across the entire healthcare ecosystem is another key priority. This could take several forms:

1. Expanding bundled payments, which provide a single fee for all the services related to a given condition or episode of care. This encourages providers to coordinate care and avoid unnecessary services, since they bear financial risk for complications and readmissions. Models like Medicare's Comprehensive Care for Joint Replacement program, which achieved $1.2 billion in savings over 5 years with no reduction in quality, illustrate the potential of this approach.
2. Promoting Accountable Care Organizations (ACOs), groups of providers that take responsibility for the total cost and quality of care for a defined population. ACOs that meet quality targets and keep spending below a benchmark can share in the savings, giving them an incentive to keep patients healthy and out of the hospital. Medicare's ACO programs have grown rapidly, with over 500 organizations now participating and generating a net savings of $1.9 billion in 2020 alone.
3. Experimenting with capitation and global budgets, which give providers a fixed amount per patient or per time period, adjusted for health risk. This gives them maximum flexibility to allocate resources, but also maximum accountability for outcomes. While politically challenging, capitated payment has been used successfully by integrated delivery systems like Kaiser Permanente, which consistently ranks among the top-performing health systems in the country on measures of quality and efficiency.

There are also opportunities to align incentives for patients, such as through value-based insurance design. Safeway's "Healthy Measures" program, for example, offers lower premiums and copays to employees who meet certain biometric targets or complete preventive screenings. And several states have experimented with "wellness trusts" that use tobacco taxes or other revenue sources to fund community-based prevention programs.

C. Policies to Increase Competition and Reduce Market Power

Addressing the concentration of market power in the hands of large provider systems and insurers is another important goal. Some potential approaches include:

1. Strengthening antitrust enforcement to block anticompetitive mergers and acquisitions. While federal antitrust agencies have had a mixed record in healthcare, recent actions like the Justice Department's successful challenge of the Anthem-Cigna merger and the FTC's ongoing case against Surescripts' e-prescribing monopoly suggest a new assertiveness. Several states, like Massachusetts and California, have also beefed up their own antitrust laws and enforcement in response to rising concerns about healthcare consolidation.
2. Banning anticompetitive practices like "all-or-nothing" contracts, most-favored-nation clauses, and gag clauses on price transparency. The Trump administration issued executive orders in 2019 and 2020 targeting these practices, and Congress passed legislation in 2020 banning gag clauses in pharmacy contracts. But more could be done to challenge these practices in court and prohibit them industrywide.
3. Repealing or reforming state Certificate of Need (CON) laws, which require providers to get regulatory approval before building new facilities or offering new services. Research has shown that CON laws are associated with higher prices, lower quality, and reduced access, without achieving their stated goal of reducing overutilization. Several states, like New Hampshire and Florida, have recently reformed or repealed their CON laws, and there is growing bipartisan support for doing so nationwide.

There are also ways to encourage competition through public programs. The Affordable Care Act's health insurance marketplaces, for example, were intended to spur competition among plans, and have been shown to lower premiums in areas with more participating insurers. And the Center for Medicare and Medicaid Innovation has been testing new payment models that encourage providers to form competing "networks of care" to manage population health.

D. Expanding the Supply of Providers

Increasing the supply of primary care providers, especially in underserved areas, is critical for improving access and reducing costs. Some potential strategies include:

1. Reforming scope-of-practice laws to allow nurse practitioners, physician assistants, and other non-physician providers to practice at the top of their license. States like Arizona and Iowa that have expanded NP scope of practice have seen increases in primary care supply and reductions in prices, without any adverse effects on quality or safety.
2. Increasing funding for the National Health Service Corps and other programs that provide loan forgiveness for providers who practice in shortage areas. The American Rescue Plan passed in 2021 included a historic $800 million investment in the NHSC, supporting over 5,000 new scholarships and loan repayment awards. Building on this down payment could help attract more providers to underserved communities.
3. Expanding graduate medical education slots and reforming funding to prioritize primary care and needed specialties. The Resident Physician Shortage Reduction Act, introduced with bipartisan support in 2021, would create 14,000 new GME slots over seven years, with a focus on rural and underserved areas. It would also close loopholes that have allowed teaching hospitals to skirt caps on Medicare-funded slots.

There are also opportunities to use technology to augment the provider workforce, such as through telehealth and remote monitoring. The explosion of telehealth during the COVID-19 pandemic, aided by temporary relaxation of regulatory barriers and Medicare coverage expansions, has shown the potential of virtual care to improve access and convenience. Making these changes permanent, while addressing issues of equity and quality, could be a game-changer for provider supply and distribution.

E. Investments in Social Determinants of Health

Addressing the upstream social and economic drivers of poor health is perhaps the most challenging but also the most important frontier for reform. Some promising approaches include:

1. Encouraging hospitals and health systems to invest in housing, transportation, and other community needs through community benefit requirements and population health incentives. Innovative models like Nationwide Children's Hospital's Healthy Neighborhoods Healthy Families initiative in Columbus, Ohio, which has invested over $10 million in affordable housing and community development, show the potential of "anchor institution" strategies to address root causes of health disparities.?
2. Expanding programs like Meals on Wheels and PACE that integrate health and social services for vulnerable populations. The Biden administration's proposed American Jobs Plan includes $400 billion for expanding home and community-based care for the elderly and disabled, which could support the growth of these proven models. There are also opportunities to better coordinate existing programs through unified eligibility and enrollment systems and "no wrong door" access points.
3. Incentivizing cross-sector partnerships between healthcare, social service, and community-based organizations to address health disparities and social needs. The Accountable Health Communities model being tested by CMS, which provides funding for organizations to screen patients for unmet social needs and connect them to community resources, is showing early promise in reducing utilization and costs. And the growing field of "community information exchanges" is developing shared technology platforms to facilitate referrals and data-sharing across sectors.

There are also opportunities to use Medicaid waivers and demonstration projects to test more holistic approaches to population health. North Carolina's recently approved "Healthy Opportunities" waiver, for example, will allow the state to use Medicaid funds to pay for housing supports, food assistance, transportation, and other social services for high-need beneficiaries. If successful, it could provide a template for other states looking to leverage Medicaid as a tool for addressing social determinants.

F. Applying Information Technology and Data Analytics

Harnessing the power of data and technology is another key enabler of value-based care. Some opportunities include:

1. Accelerating the adoption and interoperability of electronic health records, so that providers can easily share data and coordinate care. The 21st Century Cures Act, passed in 2016, included several provisions to promote EHR interoperability and prohibit "information blocking" by vendors and providers. But more could be done to standardize data elements, develop open APIs, and give patients control over their own health information.
2. AI is starting to transform every aspect of the healthcare system, from drug discovery and clinical trials to diagnosis and treatment to administrative functions and population health management. Companies like Isomorphic Labs and Recursion are using generative AI and machine learning to identify promising new drug targets, while platforms like Arterys and IDx are applying AI to medical imaging to speed up and improve the accuracy of diagnosis. Other startups like Olive and Notable are using AI to automate back-office tasks like prior authorization and revenue cycle management, freeing up staff time for higher-value work. And innovative health systems like Geisinger and Kaiser Permanente are using AI-powered tools to predict which patients are most likely to be readmitted or develop complications, and proactively reaching out with personalized care plans and support services.
3. Expanding the use of patient-reported outcomes and incorporating them into quality measurement and payment. The NIH's Patient-Reported Outcomes Measurement Information System (PROMIS) provides a standardized set of measures that can be used across a wide range of conditions and settings. Integrating these measures into EHRs and using them to assess provider performance could help shift the focus from process to outcomes.

There are also opportunities to leverage technology for patient engagement and behavior change. Smartphone apps and wearables can provide real-time feedback and coaching to help patients manage chronic conditions and make healthy lifestyle choices. And online patient communities like PatientsLikeMe and Smart Patients offer a platform for peer support and knowledge-sharing.

G. Decoupling Health Insurance from Employment

Finally, reducing the linkage between health insurance and employment could increase choice, competition, and portability in the insurance market. Some potential approaches include:

1. Capping the tax exclusion for employer-sponsored insurance, which currently encourages employers to provide more generous coverage than they would otherwise. This could be done gradually and the savings used to fund subsidies for individual market coverage. The Cadillac Tax included in the ACA was an attempt at this, but it was repeatedly delayed and ultimately repealed in 2019.
2. Allowing employers to fund portable health reimbursement arrangements (HRAs) that workers can use to buy their own coverage. The Trump administration issued rules expanding the use of HRAs in 2019, but uptake has been limited so far. Making these arrangements more attractive and user-friendly for employers and workers could encourage more of them to switch to a defined-contribution model of health benefits.
3. Extending Medicare or Medicaid buy-in options to more people, such as those over 50 or those with low incomes but above the Medicaid eligibility threshold. The Biden campaign proposed a Medicare buy-in for those 60-64, which could provide a more stable and affordable alternative to employer-sponsored or individual market coverage. Several states have also explored Medicaid buy-in programs, though none have been implemented yet due to concerns about cost and disruption to existing markets.

Incremental steps like lowering the Medicare eligibility age could help pave the way for more ambitious reforms down the road.?

The U.S. healthcare system is at a crossroads. Despite spending more than any other country on health care, we have poorer health outcomes, wider disparities, and lower patient and provider satisfaction than most of our peers. The COVID-19 pandemic has only underscored the urgent need for reform, exposing deep fissures and fragilities in our public health infrastructure, healthcare delivery system, and social safety net.

At the same time, there are signs of hope and progress everywhere you look. From the rapid uptake of telehealth and portable benefits to the proliferation of value-based payment models and community-based partnerships, innovators and entrepreneurs across the country are chipping away at the structural barriers and market failures that have long plagued American healthcare. And the growing public appetite for change, fueled by rising costs and visible failures of the status quo, is creating new political opportunities for systemic reform.

To seize this moment, we need a new vision for American healthcare that is grounded in core values of equity, affordability, quality, and patient-centeredness. This vision should be guided by a set of key principles:

1. Healthcare is a human right, not a privilege. Everyone should have access to affordable, high-quality care regardless of their income, race, or zip code.
2. Healthcare should be patient-centered, not provider-centered. The system should be designed around the needs and preferences of patients, not the interests of providers or payers.
3. Healthcare should be value-based, not volume-based. Providers should be rewarded for keeping people healthy, not just for delivering more services.
4. Healthcare should be equitable, not just equal. The system should strive to eliminate disparities in access, quality, and outcomes based on social, economic, and demographic factors.
5. Healthcare should be innovative, not stagnant. The system should encourage the development and adoption of new treatments, technologies, and delivery models that can improve care and lower costs.

Realizing this vision will require a sustained effort from all stakeholders - policymakers, providers, payers, patients, and the public. It will require a willingness to challenge entrenched interests, to experiment with new approaches, and to learn from both successes and failures. It will require a commitment to measuring and reporting on progress towards clear goals and benchmarks, using reliable data and transparent methods. And it will require a spirit of collaboration and shared purpose, recognizing that none of us can solve this problem alone.

The road ahead will not be easy, but the stakes could not be higher. The health and well-being of our nation depend on our ability to rise to this challenge and build a healthcare system that works for all Americans. With creativity, persistence, and political will, we can achieve this goal and make the U.S. a categorical leader in healthcare access and healthcare outcomes, while maintaining its unprecedented leadership in healthcare innovation.