The American health care system "fails too many people too often and costs to much," RAND's Dr. Art Kellermann told an audience of scholars at the University of Pennsylvania. In this excerpt, he details a study of the quality of health care delivered by primary care physicians in twelve communities across the country. The bottom line of those chart audits was that Americans "are only getting what they should getting 55% of the time." Kellermann, a leading authority of health care delivery, noted "You're not safe anywhere; whether you're in Boston or Seattle or Miami or Little Rock. It didn't matter. Everybody did about a D+ in care."