Health care is on a collision course with patient needs and economic reality. Without significant changes, the scale of the problem will only get worse. Rising costs, mounting evidence of quality problems, and increasing numbers of Americans without insurance are unacceptable and unsustainable, but the future of health care is not predetermined. It is a mistake to extrapolate and attempt to respond to trends within the current structure. Instead, the most pressing task for leaders in the health sector is to create a new and better structure. Effective leaders have the insight to revisit the fundamental purpose of an organization and imagine a different and more effective way to attain it. America can move now to a system based on the right kind of competition that will serve patients far better than either a government-run model or the current U.S. system.