The daily press is a potent reminder that for a number of years the United States has been engaged in fruitless discussions about how to reform its health care system, discussions that are likely to preempt any action for some time to come. One facet of this talk effort is increasingly frequent references to the health care systems of Western Europe, Canada, and even of Japan as potential models for the United States to follow to put in place a system of universal coverage at a cost that does not risk national bankruptcy. I would be the last to argue against learning what we can from foreign countries but a more promising alternative can be extracted from our own experiences in related areas of societal reforms, particularly employment, housing, and education, which can give a deeper understanding of the dilemmas that we face in seeking to improve our health care financing and delivery system.