Simultaneously improve access, quality, and efficiency. These elements are interrelated, and strategies focused on improving only one aspect of care are unlikely to achieve the central goal of long, healthy, productive lives for all Americans. All federal and state health policy proposals and private sector actions should be assessed to determine their likely impact on moving us forward as a nation on these core goals.

Ensure universal participation in health care and reduce disparities. The percentage of working-age adults without insurance is up sharply since 2000 despite a growing economy. Loss of comprehensive health insurance coverage puts families and the nation at risk of losing ground on past gains in improved health and workforce productivity.

Reduce costs. There is ample evidence that savings can be generated from improved efficiency in the health care system. Waste and duplication from our fragmented system of coverage and care abound. Widely varying hospital readmission rates from one hospital to another, one city or state to another, suggest that better transitional and follow-up care—and better support for self-care—after hospital discharge can improve quality and lower costs. The challenge is not just identifying and implementing best practices, but redirecting those savings into investments in improved coverage and system capacity to improve performance in the future.

Coordinate and integrate care. Failure to coordinate care for patients over the course of treatment as they see multiple physicians, are hospitalized and rehospitalized, cared for at home by home health aides, or in nursing homes, takes an enormous toll on all fronts. Tests are repeated as records are lost or unavailable when needed. Patients with serious health problems receive conflicting advice and become increasingly frustrated and disaffected as their time and energy are expended finding their way through a complex and seemingly impersonal health system.