Given its collective wealth, technologic sophistication, and spending, the United States should lead, not lag, the world in its healthcare performance. But based on 70 performance measures across five domains — access to care, health outcomes, administrative efficiency, care process, and equity — the United States came in last overall and last or next to last in four of these five broad areas of performance when compared to nine other high-income countries. Significant, but doable, changes — including closing remaining gaps in insurance coverage, limiting crippling out-of-pocket-expenditures, and reviving its failing primary care capabilities — would help close the gap.