Evidence from the past 12 years suggests some progress is occurring, with, for instance, accountable care organizations (ACOs) beginning to reduce spending and achieve savings in Medicare. Further, research shows that in California — which has a high penetration of medical groups using integrated care delivery models — physician organizations operating under capitated budgets have lower costs and higher quality of care than those primarily using fee-for-service. Yet, nationally we continue to waste resources, with health care costs exceeding GDP and affordability a concern for many Americans. In short, the required changes appear to be too slow in coming and the incentives and capabilities for change too weak.