Life expectancy is lower and disease morbidity is higher in the United States than in other high-income countries.1 This situation, decades old, is not for lack of skilled medical care; the United States has among the world’s best hospitals and technology. Nor is spending on health care inadequate; per capita health expenditures in the United States far exceed spending elsewhere. The poorer health of racial and ethnic minorities does not explain the nation’s low rankings; the US non-Hispanic white population and other advantaged groups also have worse health outcomes than their peers in other countries.1,2 The US health care system certainly has deficiencies, notably the lack of universal coverage, but this alone does not explain the pervasive health disadvantage.