The United States has the worst-performing health system among all high-income countries. Even the best-performing U.S. states lag international comparators like France, Germany, the United Kingdom, and Australia. To move the United States from laggard to leader will require significant — but doable — changes in its healthcare system, including closing remaining gaps in insurance coverage, limiting debilitating out-of-pocket-expenditures, and reviving its failing primary care capabilities.