AMERICA'S health-care system is the costliest in the world, gobbling up about 16% of the country's economic output. Comparisons with other rich countries and within the United States show that its system is not only growing at an unsustainable pace, but also provides questionable value for money and dubious medical care. Economists at the OECD found that America does indeed do well on some measures, such as breast-cancer survival rates and cervical-cancer screening, but does worse in others. Infant mortality was 6.7 per 1,000 births in 2007, against an OECD average (excluding Mexico and Turkey) of 4.0. Reforms are being considered to extend coverage for the 49m people with no health insurance, possibly by obliging individuals to buy insurance.