Fundamental changes are needed in the organization and delivery of health care in the United States. The experiences of patients, their families, and health care clinicians, as well as a large body of evidence on the quality of care, have convinced the Committee on the Quality of Health Care in America that the time for major change has come. This chapter sets forth the evidence; the reasons underlying the inability of the health care system to meet patient needs; and the committee\'s framework for a new health system, which serves to structure the remaining chapters of this report.