Given its cumulative wealth, technologic elegance, and investing, the United States oughtto lead, not lag, the world in its healthcare efficiency. But based on 70 efficiency steps throughout 5 domains — gainaccessto to care, health results, administrative performance, care procedure, and equity — the United States came in last general and last or next to last in 4 of these 5 broad locations of efficiency when compared to 9 other high-income nations. Significant, however workable, modifications — consistingof closing staying spaces in insurancecoverage protection, restricting debilitating out-
