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The U.S. health care system faces unprecedented challenges. Overall life expectancy has improved, but racial and socioeconomic disparities in mortality and health status have recently been widening. Many Americans fail to receive treatments of proven benefit—a burden that falls more heavily on racial minorities and low-income populations. The safety and reliability of care in hospitals, surgical centers, nursing homes and physician offices is far from assured. Patients often receive care from multiple different physicians with little coordination or assurance that their recommendations are understood by patients and their families. Health care costs—already the highest in the world—are growing at a rate that is unaffordable to an increasing share of patients and employers. The current systems of public funding for care are unsustainable at the same time that almost 50 million Americans lack health insurance.