Over the last 40 years, spending on both hospital and physician services in the United States has inexorably increased, often faster than gross domestic product (GDP) or any other aggregate measure. In contrast to industries such as computer software, hospitality, sports and recreation – where spending has also grown faster than the economy – health care spending growth is not thought to be matched by increased customer or patient satisfaction or improved outcomes. For some groups, especially those that are socially disadvantaged or lower income, measures of health have remained stubbornly lower relative to the rest of the population. Despite continuous criticism of the status quo and calls for transformation, little has changed. Why has this sector of the economy uniquely resisted changes in products, productivity, and services aimed at improving consumer satisfaction or reducing spending growth?