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Expanding insurance coverage is a critical step in health reform, but we argue that to be successful, reforms must also address the underlying problems of quality and cost. We identify five fundamental building blocks for a high-performance health system and urge action to create a national center for effectiveness research, develop models of accountable health care entities capable of providing integrated and coordinated care, develop payment models to reward high-value care, develop a national strategy for performance measurement, and pursue a multistakeholder approach to improving population health.

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Retrogradc axonal transport of horseradish peroxidasc (HPR) was first utilized for the tracing of central and peripheral neural pathways by KRTSFNSSEN (Acta Neuropath 19:1, 1971). Recent studics by FURSTMAN (Brain Res 81: 320. 1975) and ARVILSSON (Brain Res 99:135, 1975) have uttilized HIRP as a retrograde tracer from cat and rat teeth respectively. Their efforts confirmed a somatotopic organization of the trigeminal ganglion nerve cells from specific tecth.Based on these previous reports, we sturveyed the primary nectrons representing sensory and autonomic innervation of primate tooth pulps.Three rhesus and two squirrel monkeys were used. Buccal class V cavity preparations were cut from the cuspid to second molars of maxillary and mandibular teeth of the right side. Each pulp was entered withouit hemorrhage and then injected with a 1 yl of 30% HRP and then coxvered with zinc oxide and engenol followed by amalgam to prevent leakagc into surrounding tissues. Allowing for a retrograde axonal transport flow of 70 mm/24 hour, the animals were perfused and the followinIn tissues were dissected and removed: the right and left trigeminal, right and left geniculate, right and left pterygopalatine, right and left otic, right and left superior cervical ganglia, and portions of the brainstem and the thalamus. These tissues were then prepared for both light and electron microscopy. LTocalization of HRP was found using both light and electron niicroscopy in both ipsi-and contralateral tri-eminal ganglia (Fig 1). A groIup of 4 to 10 cells in the ipsilateral pons were also found to be HRP positive at the level of entry of the root of the trigeminal nerVe in both species (Fig 2).The former suggests a bilateral sensory innervation of the dental pulps. This type of transmedian innervation has been physiologically demonstrated for both the upper and lower cUspid teeth of the cat by ANDERSON (Exp Neurol 44:35, 1974). The clinical manifestation of cross innervation of anterior teeth has been considered by JloxFn (Local Anaesthesia in Dentistry, Wright, Bristol, 1972). It is possible that in primate dentitions there is a sensory