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Dartmouth researchers have demonstrated that there is tremendous geographic variation in the efficiency of health care delivery systems, fostered by perverse incentives that penalize integration, reward fragmentation, and encourage the use of technologies in the "gray areas" of medicine. This research suggests that it is possible to deliver higher-quality care at lower cost. We argue that integrated delivery systems, bundled payments, and more sophisticated comparative effectiveness analysis, rather than crude across-the-board cuts in payments, are the keys to stemming cost growth, improving value, and raising the trillion dollars needed to cover the uninsured.