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The United States has mediocre health outcomes, and its health-care system performs abysmally when cost is factored in. In the 2000 World Health Organization (WHO) global ranking on health care, the United States nestled among Costa Rica, Slovenia, and Cuba at 37th (1). The United States ranked first in one category: expenditure per capita. Its “system attainment and performance” was 72nd, down with Argentina, Bhutan, and Nicaragua. WHO's metrics have been heavily criticized and are at best rough indicators, but it is no secret that U.S. health care is expensive, unfairly distributed, and highly inefficient compared with that of other developed economies. The key question is how to address this problem without gutting the parts of the U.S. health-research infrastructure that are working well. How much of such research should get done and how should it be funded? What agency should do the health services and other kinds of research needed to improve the health-care system? And how should priorities among competing lines of research be decided?