At every level, Americans spend a lot for health care. It is 18% of the gross domestic product (see NHE Fact Sheet). It is 27% of the federal budget (see What Does The Federal Government Spend On Health Care?). Employers spend $9,325 per employee on health care annually (see 2025 Employer Health Benefits Survey). American consumers spend an average of $1,514 in out-of-pocket costs per year (see Health Care Costs & Affordability).

The question is, what do we get for that spend? A recent study commissioned by Kaiser Permanente—Using Mortality & Years-Of-Life-Lost Metrics To Evaluate Health System Performance & Inform Health Care Policy—made me think of that big policy question—and the current state of value-based…