The quality of medical care available in the United States is the best in the world. However, today's American healthcare delivery system is unacceptable. It is too expensive, disjointed, and wasteful. The amount spent on healthcare in the United States is sufficient to meet everyone's needs; the reason it does not is that the money is misspent. Healthcare makes up 16 percent of the gross domestic product, or $2.3 trillion, yet 46 million people are uninsured, the majority of people are underinsured, and even those with insurance suffer significant hassles in receiving healthcare. Medical errors occur at alarming rates. The lack of quality measures to define best practices leads to a wide variation of practices and costs. Fragmented healthcare leads to errors. The goal of this paper is to explore a set of 20 comprehensive steps to begin reform of healthcare in this country.