We recently joined Matthew Holt on The Health Care Blog for a thoughtful, candid conversation about Ten Ten Ten and the case for a clearer North Star in U.S. healthcare.

The discussion explored a core premise behind the initiative: the United States cannot incrementalize its way out of a system that delivers mid-tier outcomes at world-leading costs. Despite decades of innovation and reform efforts, the cost-outcome curve has not meaningfully shifted. Incremental change alone is unlikely to close that gap.

Instead, the conversation focused on the importance of setting clear, measurable goals that can align action across purchasers, providers, policymakers, and builders. Ten Ten Ten is grounded in a simple but ambitious target: Top Ten global health outcomes while reducing healthcare spending to roughly Ten Percent of GDP within ten years.

Matthew engaged the idea with both curiosity and skepticism, helping surface the central question facing the field: if the current trajectory is not delivering acceptable results, what would it take to coordinate around a shared destination?

Big problems require clarity, coordination, and measurable ambition. This conversation was an opportunity to advance that dialogue and invite more voices into the work ahead.