Health care costs are skyrocketing. Health insurance premiums have doubled in the last 8 years, rising 3.7 times faster than wages in the past 8 years, and increasing co-pays and deductibles threaten access to care. Many insurance plans cover only a limited number of doctors’ visits or hospital days, exposing families to unlimited financial liability. Over half of all personal bankruptcies today are caused by medical bills. Lack of affordable health care is compounded by serious flaws in our health care delivery system. About 100,000 Americans die from medical errors in hospitals every year. One-quarter of all medical spending goes to administrative and overhead costs, and reliance on antiquated paper-based record and information systems needlessly increases these costs. Tens of millions of Americans are uninsured because of rising costs. Over 45 million Americans— including over 8 million children6—lack health insurance. Eighty percent of the uninsured are in working families. Even those with health coverage are struggling to cope with soaring medical costs. Skyrocketing health care costs are making it increasingly difficult for employers, particularly small businesses, to provide health insurance to their employees. Underinvestment in prevention and public health. Too many Americans go without high-value preventive services, such as cancer screening and immunizations to protect against flu or pneumonia. The nation faces epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism. Yet despite all of this less than 4 cents of every health care dollar is spent on prevention and public health. Our health care system has become a disease care system, and the time for change is well overdue.