The flaws of the U.S. health care system have been exposed and exacerbated by the coronavirus pandemic. This paper posits three underlying causes of our persistent poor performance: flawed assumptions; inadequate information; and fragmented delivery, payment, and insurance systems that make it easier to profit by shifting risk or costs to others than by improving value.

To address these, Americans should adopt a single system approach to delivery, payment, and coverage where comprehensive, real-time information empowers providers and policy makers to deliver better care and protect the public’s health, and where better performance measures and payment models enable competitive markets at every level to reward only those suppliers, providers, and insurers that help deliver better, less expensive care. This approach can satisfy current stakeholders, aligns with key interests of those on the political right and left, and offers a path toward an inclusive, resilient, and high-performing delivery system.