In this issue of JAMA, Papanicolas and colleagues1 provide a fresh perspective on an old US health policy narrative. Based on a comparison of health care spending (with data primarily from 2013-2016) in the United States compared with 10 selected high-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark), the authors report that the United States spends twice as much per capita on health care but performs less well on many health outcomes. In short, the claim from many scholars, think tanks, and policy makers is that the US citizen is not getting good care for the money spent on health care.2-5 The authors approach this claim with a much more focused analysis than in the past that seeks to identify more tangible root causes and provide insights for strategic and perhaps even tactical policy options for the United States to maximize its health dollar. While Papanicolas et al have taken care and scholarship in addressing this complex topic, they have not fully mapped out all the important factors that drive this issue.