Health care in the United States is at a critical point. Excessive costs are no longer tenable and mediocre outcomes are no longer tolerable. For 32 of the past 40 years, health care costs have grown faster than the rest of the U.S. economy. Federal health care costs expected to reach $950 billion in 2012—will become the largest contributor to the national debt. States, too, are being crippled by health care costs. Medicaid now consumes almost a quarter of state budgets, crowding out investments in education and infrastructure. In the private sector, escalating costs have eroded the bottom line for employers who purchase health care for their employees and have eliminated any appreciable gains in income for American families during the past decade. Purchasers simply cannot afford the status quo.