The chief executives of America's preeminent healthcare institutions say when it comes to medical care, the United States isn't getting its money's worth. "We're not getting what we pay for," says Denis Cortese, president and chief executive of the Mayo Clinic. Not only is American healthcare inefficient and wasteful, adds Kaiser Permanente chief executive George Halvorson, much of it is dangerous. The harsh assessments illustrate the enormousness of the challenge that awaits President-elect Barack Obama as he tries to overhauld the nation's healthcare system.