The shortcomings of the American medical system are well known, at least by conventional wisdom: the United States spends the most on health care among all the industrialized nations, yet, our disease burden higher and our outcomes are worse. Donald Rebhun, MD, MSPH, is the national medical director of HealthCare Partners, a DaVita Medical Group, argues here that the solution to organize care in integrated coordinated care organizations, especially where the providers are at “full risk” for the outcomes. Dr. Rebhun astutely emphasizes the importance of culture in successful organizations - in the cases he admires, “a culture where patients are at the center of the clinical model.” However, the reality is more complex. Research has not shown care coordination to be a significant game changer when it comes to controlling costs, as the work of Dr. J. Michael McWilliam reveals. Care coordination is a case of advocating for spending more and doing more now in order to save more later. It almost never works. And full-risk contracts in the 1990’s promoted health system and provider behaviors that triggered a major public backlash against managed care. But maybe the key lesson is than no one size fits all. Instead we should foster full innovation in care and financial models and not assume any one method is the only best way.