Medicine in the United States is riding a surge of innovation and creativity, but the ability of the nation's health care system to deliver those improvements fairly and consistently is not only inadequate--it is deteriorating. Americans, in short, now live with first-class medicine and a third-rate delivery system that, increasingly, puts people dependent on public programs at risk. That is the central conclusion of a year-long initiative to diagnose government-funded health care in the 50 states. The report by the Government Performance Project and published in Governing magazine, shows that while some states are making improvements in certain health care areas, others are facing severe financial problems that are increasing.