Despite accelerating expenditures on health care, the United States is falling behind peer countries in population health. The mismatch between dollars spent on health care and health achieved raises the question of the value of health services. How should we value these? The Affordable Care act expands access to care but does not question expert valuation of health states and health services. Rather than beginning with health insurance, a more productive path for our thinking proceeds from the nature of health to the nature of health care to the nature of health insurance. If we are to keep health care costs from rising no faster than GDP, we must make the patient the true customer for health care. Health policy should not aim to minimize objective disease or maximize subjective well-being, but to foster health capability. This encompasses the ability to enjoy health and to pursue it.