In this Viewpoint, David Naylor reviews the many differences between the United States and Canada that preclude the Canadian single-payer system from being a useful exemplar for US health reform.

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Among the much-repeated words woven into the US debate on national health policy are “affordability” and “sustainability.” Indeed, this debate is not confined to the United States. Remarkably, no one knows what these words actually mean at the practical level. Is there any economist or other expert, for example, who could be sure what percentage of the gross domestic product (GDP) the United States can “afford” to spend on health care, or what level of spending on Medicare is “sustainable”?

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This Viewpoint discusses the Centers for Medicare & Medicaid Services’ Accountable Health Communities project to test the role of community integrators—organizations within a community that can represent its needs and engage stakeholders to work toward improvements in health—as a possible mechanism to decrease life expectancy disparities across the United States.

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This Viewpoint calls for truthful, timely, and transparent public reports on quality measures and suggests that such reports be linked to those developed by the Centers for Medicare & Medicaid Services or the LeapFrog Group.

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